A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, Kenya. The clinical, histologic and cytogenetic features of a patient with the alveolar subtype of rhabdomyosarcoma (RMS) were investigated. The patient presented with a widely disseminated tumour including bone marrow involvement, and was a diagnostic dilemma. The presence of translocation (2;13)(q37;q14), which is strongly associated with alveolar RMS helped make the diagnosis. A review of other published cases confirms the strong association of (2;13) with alveolar RMS. The importance of considering RMS as a differential diagnosis in patients presenting with disseminated tumour as the only finding is stressed. This case also shows how cytogenetic investigation of similar patients may provide a diagnosis.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

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OBJECTIVE: To study the prevalence and clinical presentation of irritable bowel syndrome (IBS) in black Kenyans. DESIGN: A retrospective study. SETTING: Nairobi Hospital, an urban private institution. SUBJECTS: Case files of all patients presenting with abdominal pain. MAIN OUTCOME MEASURES: Prevalence of IBS using modified Manning's Symptomatic criteria in 223 consecutive adult patients presenting with abdominal pain and discomfort who had normal clinical findings and normal general and gastrointestinal investigations. RESULTS: Out of the 3472 patient files screened, there were 281 patients who fitted the diagnosis of irritable bowel syndrome giving an overall prevalence of 8%. The mean age was 40 years with range of 11 to 75 years with a peak prevalence in the 3rd decade. The male to female ratio of 1.4:1 being statistical significant at a p-value of 0.010. There was no statistical significant difference between the males and females in constipation and diarrhoea at p-value of 0.84 and 0.82 respectively. Fifteen percent of the patients were either on antidepressants or had been seen by a psychiatrist. Nine percent had undergone laparatomy for the abdominal pain. CONCLUSION: The Black African patient is equally as exposed to irritable bowel syndrome as is his counterpart in the western world and has similar morbidity patterns. The syndrome may account for over 10% of patients with abdominal pain presenting to gastroenterologists in Africa. Proper attention to symptomatology may lead to clinching the diagnosis without resorting to many unnecessary and expensive investigations.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

OBJECTIVE: To analyse the underlying aetiology, precipitating factors and certain socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

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According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

The study aimed at evaluating tolerability and efficacy of the combination enalapril 20 mg with hydrochlorothiazide 12.5 mg (co-renitec) as first line therapy in black patients with mild to moderate primary hypertension. Fifty patients completed a twelve weeks of open clinical study preceded by two weeks of washout period. They were evaluated every four weeks and haematological, biochemical urine microscopy and electrocardiographic tests were undertaken before the start and after the completion of study. Pre-treatment values of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 172.16 mm hg (+/- 20.41) and 104.38 mm hg (+/- 7.339) respectively. The usual daily dosage was one tablet which was increased to two after eight weeks in case the DBP was not normalized, i.e. less than or equal to 95 mm hg. In 44 (88%) patients, the DBP was normalised at the end of the study period; three patients (6%) were resistant to treatment and another three (6%) exhibited labile response to the treatment. Clinical tolerance was considered to be very good with only five episodes of headache, backache and anxiety, probably not related to the test drug. Biological tolerance was excellent: there was no change in the haematologic parameters; there was a decrease of 5% in mean blood urea, of 9% in the mean serum creatinine and of 4% in the mean serum uric acid and a 5% increase in plasma potassium from 3.99 to 4.28 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

hloramphenicol is a broad-spectrum antibiotic widely used in human and veterinary medicine due to its low cost and ready availability. However its use has been associated with serious adverse effects, (bone marrow suppression, hemolytic anaemia and aplastic anaemia) that may or may not be dose related. Consequently chloramphenicol is currently banned for use in food producing animals and restricted to non-food producing animals and management of life threatening infections in humans in absence of alternative therapy. Exposure to chloramphenicol can occur after regular consumption of animal foods from treated animals. Therefore the pharmacokinetic of chloramphenicol should be determined using a highly sensitive and specific assay method that can detect residue levels at the lowest concentration possible. Previous methods were limited due to low sensitivity (10 ng/m1-50Ong/mi). Therefore the aim of this study was to determine pharmacokinetics of chloramphenicol and potential residue levels in food producing animals using a published highly sensitive detection method; Chloramphenicol enzyme-linked immunosorbent assay, with a detection limit of 0.1 ng/ml. Methods: Eight male red Maasai sheep aged 9 to 12 months and weighing between 21kg to 25 kg, were weaned and allowed to acclimatize for three weeks. Pre-treatment blood samples (10m1) was collected from each animal and then 25mg/kg chloramphenicol sodium succinate administered by deep intramuscular injection. Post treatment blood samples were collected at 5, 10, 15 and 30minutes, I, 2, 4, 6 8, 12, 24 and 32 hour intervals then twice a day (week 1), once daily (week 2) thrice daily (week 3) twice daily (week 4). Phannacokinetic parameters were measured using chloramphenicol ELISA method. Data was analyzed by fitting four, parameter logistics regression curve of calibration standards and sample chloramphenicol concentration calculated from optical densities using ELISA data Eiaquik program (MC. Eisler, 1995). Samples were analyzed in duplicate. Results from these assays were compared with those from published data with respect to elimination half life, species variation, and minimum retention time. Results: Chlorarnphenicol elimination half life (36.4+3.66 h) obtained in the present study was significantly (P<0.05) longer than that of 5.75+1.25 h reported in similar species using colorimetric method. The method was able to detect the drug 7 days post administration. The area under the curve of 124,487.8 ng.h/m1 observed in sheep in the present study was significant higher than that of 31.220+3.25 rig.himl reported in literature in goats using similar treatment route and dose but different assay method. Conclusion: Chloramphenicol pharmacokinetic parameters are significantly influenced by animal species and analytical assay methods used in their determination and care must be taken when reporting the residue levels in food producing animals.

Department of Paediatrics, University of Nairobi, Kenya. Though there is still some reluctance to use human milk for low birth weight infants, we have shown that it is possible exclusively to feed these infants on milk from their own mothers. The infants have adequate weight gain and are less likely to get infections, especially gastrointestinal and respiratory. It is possible to sustain lactation through manual expression during the period that the mother is not nursing her infant directly on the breast. A cup rather than a bottle can be used to feed these small infants. The mothers are thus encouraged because the infant does not suffer nipple confusion with a bottle and they continue breastfeeding after discharge from the hospital. PMID: 1972088 [PubMed - indexed for MEDLINE]

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Cathinone, a potent psychostimulant isolated from young shoots of Catha edulis was given to four human volunteers. Examination of urine collected from the volunteers at predetermined intervals showed the presence of unchanged cathinone, d-norpseudoephedrine, and two unidentified basic substances. The observed biotransformation of cathinone to the less potent psychostimulant, d-norpseudoephedrine involves reduction of a ketone group to alcohol, a common metabolic pathway in humans.

OBJECTIVE: To determine the types and prevalence of colonic diseases in Kenyan African patients referred for colonoscopy with lower gastrointestinal tract symptoms. DESIGN: A cross sectional survey conducted over a two year period. SETTING: Major private hospitals in Nairobi. PATIENTS: Two hundred forty seven consecutive patients of both sexes and all ages referred for colonoscopy between January 1996 and December 1997. Only Kenyans of African origin were included. Patients were referred from all over the country though the majority of cases were from Nairobi and its surrounding districts. RESULTS: The major indications for colonoscopy were lower abdominal pain (35.6%), non-bloody diarrhoea (22.3%), constipation (21.4%) and rectal bleeding (19.8%). Nearly 53% of patients colonoscoped had abnormal mucosal findings, with the main abnormalities being: proctocolitis (20.2%), colorectal cancers (12.1%), haemorrhoids (7.3%), colorectal polyps (6.5%) and diverticulosis (5.3%). The main histological diagnosis among patients whose colonic biopsy were done included normal colonic mucosa (29%), non-specific colitis (28.5%), adenocarcinoma (18.2%), benign colonic polyp (9.7%) and ulcerative colitis (7.3%). There was one case of Crohn's colitis and five cases (3%) of infective colitis. CONCLUSION: The study shows that the African colon has a number of pathological lesions contrary to previous reported literature.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

No abstract available

Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi. OBJECTIVE: To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord. DESIGN: Cross-sectional survey. SUBJECTS: Mothers with infants less than three months of age attending well child clinics and health workers (HW) in the clinics, maternity and newborn units of public health, facilities serving an urban slum area in Nairobi, Kenya. RESULTS: Of the 307 mothers interviewed, 91% and 28% of mothers knew of the need for hygiene whilst cutting and tying the cord, respectively. Regarding postnatal cord care, 40% had good knowledge and 66% good practice. Fifty-one percent of mothers knew and 54% practised postnatal cord care for the appropriate duration of time. Seventy-nine percent of mothers were afraid of handling an unhealed cord. After multivariate analysis, the following variables showed significant independent association with good maternal KAP; increased level of education (OR 2.3, p < 0.001), living in middle class areas rather than slums (OR 1.5, p < 0.03), increased maternal age (OR 1.8, p < 0.001), acquisition of knowledge from a HW rather than from other sources (OR 1.5, p < 0.001), and living in stone/brick houses rather than mud houses (p = 0.01). Fifty per cent of HW had correct knowledge on type of postnatal cord care, and 79% had correct knowledge on duration required for the same. The knowledge of 50% on type of care was incorrect by international standards, but was in keeping with Nursing Council of Kenya teaching. CONCLUSION: Mothers had good knowledge on the need for hygiene when cutting the cord, had poor knowledge and practice in other aspects of cord care, and were afraid of handling the cord. Poor KAP was associated with young, poor mothers of low education, who had acquired their knowledge from sources other than HW. The knowledge of a large proportion of HW was incorrect and outdated. We recommend that health education on cord care be given at all levels of contact with mothers and that knowledge of all primary HW on cord care be updated. PIP: Using a cross-sectional survey, this study investigated the knowledge, attitudes, and practices (KAP) of mothers and the knowledge of health workers regarding care of the umbilical cord. The study interviewed a total of 307 mothers with infants less than 3 months old and 64 health workers (HWs) in an urban slum area in Nairobi, Kenya. The results showed that 91% and 28% of mothers knew of the need for hygiene while cutting and tying the cord, respectively. As to postnatal cord care, 40% had good knowledge and 66% had good practice. However, 79% of mothers were afraid of handling an unhealed cord. Results of multivariate analysis showed that the following variables had significant independent association with good maternal KAP: increased level of education, living in middle class areas, increased maternal age, and acquisition of knowledge from HWs rather than from other sources. 50% of HWs had correct knowledge on type of postnatal cord care, but the knowledge of 50% on type of care was incorrect by international standards. Based on the findings, it was recommended that good health and cord care practices be taught at all levels of contact with mothers and that knowledge of all primary HWs on cord care be updated.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

AIMS: Dihydropyrimidine dehydrogenase (DPD) reduces endogenous pyrimidines and therapeutic analogues such as the anticancer agent 5-fluorouracil (5FU). Among Caucasian populations DPD activity is highly variable and subject to polymorphic regulation. To evaluate interethnic influence, DPD activity was assessed in South-west Asian, Kenyan and Ghanaian populations. METHODS: DPD activity was determined in peripheral mononuclear cells using[14C]-5-fluorouracil and h.p.l.c. analysis. RESULTS: A high degree of variation in DPD activity was observed within each population (range CV = 34-48%). Median DPD activity also varied between these populations. South-west Asian and Kenyan subjects exhibited almost identical median values (192 and 193.5 pmol min(-1) mg(-1), respectively), which were similar to Caucasians (median 215 pmol min(-1) mg(-1). A significantly lower median DPD activity (119 pmol min(-1) mg(-1)) was observed in the Ghanaian population. CONCLUSIONS: The similarity in DPD activity between Caucasian, Kenyan and South-west Asian populations suggests that the incidence of 5FU-related toxicity may be comparable in these groups. The pharmacokinetic implications of lower activity amongst Ghanaians needs to be evaluated.

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

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According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

A 27-year old African woman with history of regular chloroquine ingestion presented with progressive deterioration of vision, easy fatiguability, dyspnoea, dizziness progressing to syncopal attacks. Ophthalmological assessment revealed features of chloroquine retinopathy, cardiac assessment revealed features of heart failure and a complete heart block with right bundle branch block pattern. The heart block was treated by pacemaker insertion and the heart failure resolved spontaneously following chloroquine discontinuation. She however remains blind.

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Two microdiffusion methods for measuring ionizable fluoride in cows’ milk have been compared. The comparison includes diffusion time, amount of fluoride in spiked and unspiked milk samples and the effect of aluminium as an interfering ion. This work uses an acid diffusion technique involving hexamethyldisiloxane at room temperature and acid diffusion at 60 °C in the oven for 20 h. A significant difference was found in diffusion time and in the effect of aluminium ions. There was no significant difference in the amount of fluoride found in the milk samples using the two microdiffusion methods.

Keywords: Fluoride; microdiffusion; milk; fluoride-selective electrode; aluminium

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Ten plant extracts commonly used by the Meru community of Kenya were evaluated for the in vitro antiplasmodial, in vivo antimalarial, cytotoxicity and animal toxicity activities. The water and methanol extracts of Ludwigia erecta and the methanol extracts of Fuerstia africana and Schkuhria pinnata exhibited high antiplasmodial activity (IC(50) < 5 microg/mL) against chloroquine sensitive (D6) and resistant (W2) Plasmodium falciparum clones. The cytotoxicity of these highly active extracts on Vero E6 cells were in the range 161.5-4650.0 microg/mL with a selectivity index (SI) of 124.2-3530.7. In vivo studies of these extracts showed less activity with chemosuppression of parasitaemia in Plasmodium berghei infected mice of 49.64-65.28%. The methanol extract of Clerodendrum eriophyllum with a lower in vitro activity (IC(50) 9.51-10.56 microg/mL) exhibited the highest chemosuppression of 90.13%. The methanol and water extracts of Pittosporum viridiflorum were toxic to mice but at a lower dose prolonged survival of P. berghei infected mice (p < 0.05) with no overt signs of toxicity. However, the extracts were cytotoxic (SI, 0.96-2.51) on Vero E6 cells. These results suggest that there is potential to isolate active non-toxic antimalarial principles from these plants.

We present two cases of neurofibromatosis type 1 (NF-1), one a 35 year old male who first recognised his problem at the age of fifteen years and at the time of assessment, satisfied the National Institute of Health (NIH) diagnostic criteria for NF-1 and had a nodular plexiform neurofibroma involving the left fifth dorsal nerve root and a diffuse plexiform neurofibroma involving the left lower limb. The second patient, a 45 year old female recognised her problem at the age of 39 years, did not quite satisfy the NIH diagnostic criteria for NF 1 and had diffuse plexiform neurofibroma involving both lower limbs and buttocks almost symmetrically, a finding which has not previously been described to the best of our knowledge. The scarcity of management options are briefly outlined.

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

OBJECTIVE: To study the prevalence and clinical presentation of irritable bowel syndrome (IBS) in black Kenyans. DESIGN: A retrospective study. SETTING: Nairobi Hospital, an urban private institution. SUBJECTS: Case files of all patients presenting with abdominal pain. MAIN OUTCOME MEASURES: Prevalence of IBS using modified Manning's Symptomatic criteria in 223 consecutive adult patients presenting with abdominal pain and discomfort who had normal clinical findings and normal general and gastrointestinal investigations. RESULTS: Out of the 3472 patient files screened, there were 281 patients who fitted the diagnosis of irritable bowel syndrome giving an overall prevalence of 8%. The mean age was 40 years with range of 11 to 75 years with a peak prevalence in the 3rd decade. The male to female ratio of 1.4:1 being statistical significant at a p-value of 0.010. There was no statistical significant difference between the males and females in constipation and diarrhoea at p-value of 0.84 and 0.82 respectively. Fifteen percent of the patients were either on antidepressants or had been seen by a psychiatrist. Nine percent had undergone laparatomy for the abdominal pain. CONCLUSION: The Black African patient is equally as exposed to irritable bowel syndrome as is his counterpart in the western world and has similar morbidity patterns. The syndrome may account for over 10% of patients with abdominal pain presenting to gastroenterologists in Africa. Proper attention to symptomatology may lead to clinching the diagnosis without resorting to many unnecessary and expensive investigations.

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

No abstract available

Forty consecutive African patients found to have duodenogastric bile reflux at endoscopy were studied. Bile reflux was found more commonly among males than females, giving a male/female ratio of 2.3:1, with a peak age at 41-60 years. ABO blood groups had no significant influence on duodenogastric bile reflux. Flatulence and borborygmi were the most consistent symptoms other than the classical dyspeptic pain pattern. Bilious vomiting was a rare finding. Duodenogastric bile reflux was more commonly associated with endoscopic gastritis (67.5%), gastric ulcer (35%) and oesophagitis (30%) than with duodenal ulcer (22.5%), deformed pyloric ring (5%) or distorted duodenal bulb (2.5%). The dysfunction in the pyloric sphincter in people with duodenogastric bile reflux appears to be more of a physiological defect than structural.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

OBJECTIVE: To investigate the main indications for, and common conditions found in bone marrow examinations (BME) of children. METHODS: This was a retrospective study from September 1, 1993 to September 3 1998. All bone marrow aspirate and trephine biopsy results were retrieved. The clinical data provided by clinicians were also noted. RESULTS: A total of 97 BME were recorded from patients aged two months to 13 years. The peak ages for BME were six to eight years (24% of patients). The more frequent indications for BME were unexplained anaemia found in 26% request forms, investigation for solid tumours (10%) and lymphoma (10%) and remission assessment after treatment for leukaemia (26%). The main findings were malignancy (27%) with leukaemia being commonest (ALL) 16% of patients and acute myeloblastic leukaemia (5%). Haematinic deficiency was seen in 12.7% of cases with iron deficiency being the commonest. There were some notable differences and similarities in the study as compared to a similar one performed at a local referral hospital. CONCLUSION: The importance of BME as a crucial investigational tool in the management of patients is underscored. Interpretation is more meaningful when the haematologist has adequate clinical data.

A cross sectional study of 115 patients admitted at the Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya was carried out to determine the prevalence and antibiotic susceptibility of Staphylococcus aureus isolated from infected wounds. The prevalence of Staphylococcus aureus was 33.0 %. The drugs tested and their corresponding sensitivity was amoxycillin (13.2 %), co-amoxyclav (39.5 %), oxacillin (55.3 %), erythromycin (44.7 %), gentamicin (60.5 %), ciprofloxacin (62.2 %), minocycline (86.8 %), cefuroxime (57.9 %), and clidamycin (84.2 %). These results show the sensitivity profile of Staphylococcus aureus and can be used to choose suitable drugs in the management of wounds for hospitalized patients.

Thirty consecutive patients with gastric ulcer diagnosed during upper gastrointestinal fibreoptic panendoscopy at both Kenya Medical Research Institute and Kenyatta National Hospital endoscopy rooms were studied. The male/female ratio was 5:1 with a peak prevalence in the 6th decade. 76.6% of the patients were from the Kikuyu ethnic group. Smoking habit was found in only 50% of patients with gastric ulcers. There were a total of 32 gastric ulcers in 30 patients. 84.4% of these were at the incisura angularis. All the incisural ulcers were benign. Two (6.25%) of the 32 ulcers were malignant (one at the cardia and the other at the antrum). Gastric ulcers whose diameter were greater than 30 mm had a higher tendency of being malignant. Five patients (16.7%) had both gastric (4 benign and 1 malignant) and duodenal ulcers while 4 (13.3%) patients had both gastric and pyloric ring ulcers. Apparent healing of a gastric ulcer while on an H2-antagonist does not totally exclude malignancy. Upper gastrointestinal bleed which was present in 53.3% of cases was the most frequent complication.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Commercial ratite farming is rapidly becoming a desirable alternative source of profitable meat production among small holder farmers. However, ratite ranching particularly ostrich production is severely constrained by a very high chick mortality rate(up to 40%). To help rural farmers including those in the developed countries such as United States gain a successful foothold in this potentially lucrative farming enterprise, the causes of chick mortality must be identified and controlled. The present collaborative study was designed to characterize and compare disease causes of mortality in chicks in small holder ratite farms in Macon and adjoining Counties of Alabama and some selected localities in Kenya between 1997 and 2000, a four-year period. The study established that, in both Alabama[USA] and Kenya, ostrich farmers incur losses of considerable magnitude from a wide range of causes, some of which could not be established. Losses are experienced right from the embryonic stages whereby embryos may develop poorly causing death before hatching. In USA, hatchability was 72% while in Kenya, hatchability was 56% on average. In Kenya, a high mortality rate in the early weeks of life (<3 weeks) [27-40%] was noted. Pathogens isolated at post-mortem from inflamed tissues and septic yolk sacs were mainly common bacteria such as Enterobacter sp; Escherichia coli, Staphyloccocus sp, Streptococcus sp, Pseudomonas sp, Corynebacterium sp. and Clostridium sp. Other causes of death were impaction, dehydration, generalized oedema, joint infection and non-specific peritonitis. Limb deformities constituted the main cause of culling among chicks. Histopathological lesions were observed in virtually all organs examined including abdominal, thoracic and even the brain tissue. Lesions associated with circulatory disturbances were common. Bacteriological analysis of feeds in Kenya showed that bacterial contamination of feed was quite possibly a cause of infections and especially fish meals.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

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According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Sixty patients with Diastolic Blood Pressure (DBP) of 100-110mmHg matched for age, sex and Bp levels were randomly assigned to propranolol 80mg daily or Hydroflumethiazide (HFM) 50mg daily. HFM causes a significant reduction in systolic blood pressure (SBP) and DBP within 4 weeks compared both with baseline and propranolol (SBP 143.7 +/- 12.3 vs 158.1 +/- 10.9mmHg, P < 0.05; DBP 92.0 +/- 4.5 vs 102.4 +/- 5.1mmHg, P < 0.05), (SBP 143.7 +/- 12.2 vs 152 +/- 11.0mmHg P < 0.05; DBP 92.0 +/- 4.5 vs 101.1 +/- 6.1mmHg, P < 0.05), respectively. Propranolol produced no significant difference from the baseline at 4 weeks (SBP 152.0 +/- H.0 vs 154.1 +/- 11.5mmHg NS; DBP 101.1 +/- 6.1 vs 102.2 +/- 5.6mmHg, NS). Reduction in BP by HFM was maintained after 8 and 12 weeks with further reduction but which did not achieve statistical significance. Increased dose of propranolol (160mg daily) after 4 weeks caused significant reduction in BP by 8 week (SBP 146.8 +/- 11.8 vs 152.0 +/- 11.0mmHg, P < 0.05; DBP 95.9 +/- 4.4 vs 101.1 +/- 6.1mmHg P < 0.05), which was maintained upto 12 weeks. The values however remained higher than in the HFM group. More patients in the HFM group achieved target BP (< 140/90), SBP 53.8% vs 29.6% P < 0.05, DBP 69.2% vs 14.8% P < 0.01. Incidence of side effects was similar and will be discussed. Thiazides are superior to B'blockers as initial monotherapy in black hypertensives.

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

The use of herbal drugs as combinations has existed for centuries in several cultural systems. However, the safety and efficacy of such combinations have not been validated. In this study, the toxicity, anti-plasmodial and antimalarial efficacy of several herbal drug combinations were investigated. Lannea schweinfurthii, Turraea robusta and Sclerocarya birrea, used by traditional health practitioners in Meru community, were tested for in vitro anti-plasmodial and in vivo anti-malarial activity singly against Plasmodium falciparum and Plasmodium berghei, respectively. Methanolic extract of Turraea robusta was the most active against Plasmodium falciparum D6 strain. Aqueous extracts of Lannea schweinfurthii had the highest anti-plamodial activity followed by Turraea robusta and Sclerocarya birrea. D6 was more sensitive to the plant extracts than W2 strain. Lannea schweinfurthii extracts had the highest anti-malarial activity in mice followed by Turraea robusta and Sclerocarya birrea with the methanol extracts being more active than aqueous ones. Combinations of aqueous extracts of the three plants and two others (Boscia salicifolia and Rhus natalensis) previously shown to exhibit anti-plasmodial and anti-malarial activity singly were tested in mice. Marked synergy and additive interactions were observed when combinations of the drugs were assayed in vitro. Different combinations of Turraea robusta and Lannea schweinfurthii exhibited good in vitro synergistic interactions. Combinations of Boscia salicifolia and Sclerocarya birrea; Rhus natalensis and Turraea robusta; Rhus natalensis and Boscia salicifolia; Turraea robusta and Sclerocarya birrea; and Lannea schweinfurthii and Boscia salicifolia exhibited high malaria parasite suppression (chemo-suppression >90%) in vivo when tested in mice. The findings are a preliminary demonstration of the usefulness of combining several plants in herbal drugs, as a normal practice of traditional health practitioners.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Cardiovascular activities of nitidine chloride from Zanthoxylunt chalybeum have been compared with those of 9-methoxychelerythrine. Whereas nitidinc chloride was found to show significant hypotensive activity in rabbits, 9-methoxychelerythrine chloride showed no hypotensive activity. The effect of nitidine chloride on isolated rabbit heart was also compared with those of adrenaline and acetylcholine. 9-Methoxychelerythrine, which has hitherto been regarded as an artefact formed by recrystallization of chelerythrine base from methanol, has been shown in this work to be a true natural constituent of Zanthoxylum chalybeum. Keywords: 9-inethoxychelerythrine; nitidine chloride; cardiovascular properties; hypotensive effect; Zanthoxylum chalybeum.

No abstract available.

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

OBJECTIVE: To determine the prevalence of HCV and HCV/HIV co-infection among medical in-patients at the Kenyatta National Hospital. DESIGN: Prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital, in-patient department SUBJECTS: HIV/AIDS and HIV negative in-patients at KNH medical wards. RESULTS: Among 458 HIV/AIDS medical in-patients, the prevalence of HCV was 3.7% while in the 518 HIV negative patients, it was 4.4%. The prevalence of co-infection with HCV and HIV was 3.7%. The incidence of risk factors in persons with HCV and/or HIV infection(s) was low. CONCLUSION: This study found the prevalence of HCV infection among medical in-patients to be similar in HIV positive and HIV negative group of patients. The co-infection rates were low, as were the risk factors for transmission of these infections.

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

No abstract available

A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).

A prospective study was carried out at Kenyatta National Hospital (KNH) between June 1987 and September 1988 to look at some aspects of obstructive jaundice in patients above 12 years of age. Screening for cases was done by use of abdominal ultrasonography. A total of 20 cases (11 females, 9 males) were diagnosed. Carcinoma of the head of pancreas accounted for 55% of cases of the obstruction, followed by gallstones (10%), hepatocellular carcinoma (10%) and gall bladder tumour (10%).

{ Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya. BACKGROUND: Infants less than 1500 grams at birth have been demonstrated to be particularly prone to development of low levels of serum sodium often leading to increased early neonatal morbidity and mortality. No local study has been done to quantify this problem among sick newborns. Studies elsewhere demonstrate a high incidence of hyponatraemia among such preterms. OBJECTIVE: To evaluate the influence of infant early neonatal morbidity on serum sodium levels and justify regular monitoring and supplementation. DESIGN: Comparative cohort study. SETTING: Newborn Unit, Kenyatta National Hospital, Nairobi. SUBJECTS: Fifty six very low birth weight (1000-1500 grams at birth) infants during their first week of life. Half of them were designated as cases in view of having various early neonatal illnesses. The remaining 28 being clinically stable were taken as controls. These two groups had comparable birthweights, sex distribution and gestational ages. Their sodium intakes were also similar during the first week of life. RESULTS: The sick infants (cases) had persistently low serum sodium (mean of 120 mmols/L) throughout the first week while among the healthy infants (controls) a sequential increase from 127 to 133 mmol/l, (mean values) was observed during the same period. The difference registered on day seven (133 versus 120) was statistically significant (p = 0.02). Using a cut off point of 130 mmol/L to define hyponatraemia the proportion of infants with hyponatraemia, which was similar at the beginning became higher among the cases for the rest of the week with the largest disparity observed on the seventh day (75% versus 23%

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

The human beta-2 adrenergic receptor (beta2AR) is responsible for the binding of endogenous catecholamines and their exogenously administered agonists and antagonists. Three functional polymorphisms in codons 16, 27 and 164 have been described which have clinical importance for several diseases, including asthma, hypertension, heart failure, cystic fibrosis and obesity, as well as response to beta-agonist therapy. These were evaluated in 726 individuals from 8 distinct ethnic populations (Chinese, Filipino, Southwest Asian, Saudi, Ghanaian, Kenyan, Sudanese, and European from Scotland). The results show that most haplotypes are shared among all populations, yet there are marked differences in their frequency distributions geographically. The genetic distance tree is different from standard human population distance trees, implying a different mode of evolution for this locus than that for human population gene-flow history. The multilocus frequency differences between the observed clusters of populations correspond to historical haplotype groupings that have been found to be functionally different with respect to multiple medically related phenotypes. Further studies are needed to see if functional relationships are the same across populations.

The study aimed at evaluating tolerability and efficacy of the combination enalapril 20 mg with hydrochlorothiazide 12.5 mg (co-renitec) as first line therapy in black patients with mild to moderate primary hypertension. Fifty patients completed a twelve weeks of open clinical study preceded by two weeks of washout period. They were evaluated every four weeks and haematological, biochemical urine microscopy and electrocardiographic tests were undertaken before the start and after the completion of study. Pre-treatment values of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 172.16 mm hg (+/- 20.41) and 104.38 mm hg (+/- 7.339) respectively. The usual daily dosage was one tablet which was increased to two after eight weeks in case the DBP was not normalized, i.e. less than or equal to 95 mm hg. In 44 (88%) patients, the DBP was normalised at the end of the study period; three patients (6%) were resistant to treatment and another three (6%) exhibited labile response to the treatment. Clinical tolerance was considered to be very good with only five episodes of headache, backache and anxiety, probably not related to the test drug. Biological tolerance was excellent: there was no change in the haematologic parameters; there was a decrease of 5% in mean blood urea, of 9% in the mean serum creatinine and of 4% in the mean serum uric acid and a 5% increase in plasma potassium from 3.99 to 4.28 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Sixty newly diagnosed adult patients with mild to moderate essential hypertension were assessed to determine their cardiovascular risk factor profiles. Detailed history and physical examinations were done. Resting 12-lead ECG was done and serum levels of uric acid, fasting cholesterol, and fasting glucose were determined. Twenty nine patients had hypertension and two or more cardiovascular risk factors. The most prevalent cardiovascular risk factors other than hypertension were electro-cardiovascular left ventricular hypertrophy (31.7%), obesity (28.3%) and hypercholesterolaemia (28.3%). About a half of these patients (48.3%) can be classified as high risk hypertensives. This calls for aggressive management of cardiovascular risk factors as a whole and not just hypertension alone if we are to reduce incidence of hypertensive complications.

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

Ethnopharmacological relevance: Traditional medicines play an important role in the management of chronically painful and debilitating joint conditions, particularly in the rural Africa. However, their potential use as sources of medicines has not been fully exploited. The present study was carried to find the medicinal plants traditionally used to manage chronic joint pains in Machakos and Makueni counties in Kenya. Materials and methods: To obtain this ethnobotanical information, 30 consenting traditional herbal med-ical practitioners were interviewed exclusively on medicinal plant use in the management of chronic joint pains, in a pre-planned workshop. Results and discussion: In this survey, a total of 37 plants belonging to 32 genera and 23 families were cited as being important for treatment of chronic joint pains. The most commonly cited plant species were Pavetta crassipes K. Schum, Strychnos henningsii Gilg., Carissa spinarum L., Fagaropsis hildebrandtii (Engl.) Milve-Redh. and Zanthoxylum chalybeum Engl. Acacia mellifera (Vahl) Benth., Amaranthus albus L., Balanites glabra Mildbr. & Schltr., Grewia fallax K. Schum., Lactuca capensis, Launaea cornuta (Oliv. & Hiern) O. Jeffrey, Lippia kituiensis Vatke, Pappea capensis Eckl. & Zeyh. and Pennisetum glaucum (L.) R. Br. are documented for the first time as being important in the management of chronic joint pains. Conclusions: The findings of this study show that a variety of medicinal plants are used in the management of chronic joint pains and the main mode of administration is oral. Keywords: Ethnobotanical survey; Medicinal plants; Chronic joint pains; Rheumatoid arthritis; Akamba; Machakos-Kenya

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Kamau RK, Osoti AO, Njuguna EM. Department of Obstetrics and Gynaecology, College of Health Sciences, University of Nairobi, P.O. Box 1%76-00202, Nairobi, Kenya. BACKGROUND: Cancer of the uterine cervix is the most common female cancer in Kenya. Despite being preventable, it is often diagnosed when it is already late. For this reason, only palliative therapy is provided. Hence, it is expected that their daily routines and that of their caregivers are severely disrupted. OBJECTIVES: To determine the extent to which diagnosis and treatment of inoperable cervical carcinoma affects quality of life (QOL). DESIGN: Cross-sectional descriptive study. Setting Radiotherapy Department at the Kenyatta National Hospital. SUBJECTS: Women undergoing radiotherapy for inoperable cervical cancer. RESULTS: There is high prevalence of profound disruptions in nearly all domains of QOL. In the social domain, between 33% and 44% had the perception that family members and friends had withdrawn social support. Reduction in various economic facets was reported by 47.4%-52.6%, with 44.7% reporting a fall in the overall living standards. There were significant changes in the sexual domain, as a result in which 28.3% reported marital discordance. In the personality domain, decreased self-esteem and self-projection in life occurred in 30.9% and 36.2% respectively. On functional outcomes (EORTC QLQ-C30), only 32%-41% reported not being affected in the various facets of emotional function. Physical functions were affected in 19%-79%, role functions in 69%-75%; symptoms in 49%-80%; cognitive functions in 46%-56%; social functions in 63%-71% and financial aspects by 63%. On global QOL, 53% and 47% respectively reported high level disruption in overall physical health and overall QOL. CONCLUSION: Severe deterioration of QOL occurs as a result of diagnosis of inoperable cervical cancer and subsequent therapies. For this reason there is need to establish severe disease and end-of-life research and management services that would ensure better coping with cancer for patients and for home-based caregivers. PMID: 17633581 [PubMed - indexed for MEDLINE]

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Chloroquine is extensively used in the management of malaria in Kenya. It is widely available for self medication. Often it is used concurrently with other drugs. In the present paper, possible drug interactions with Chloroquine have been investigated. Isolated rat phrenic nerve diaphragm preparation was used to study the effect of Chloroquine alone and in combination with several drugs on neuromuscular impulse transmission. Chloroquine in the dose range 0.025 - 0.3 vg/m1 organ bath concentration induced a dose-dependent neuromuscular junction (NMJ) transmission blockade. The drug significantly potentiated the NMJ transmissionblockade induced by commonly used agents gallamine, succinylcholine and lignocaine. It antagonised the NMJ facilitatory action of physostigmine, calcium chloride and barium chloride. Chloraquine could. be interfering with ion conductance processes. It is suggested that Chloroquine should be used with caution in conditions characterised by muscle contractile disorders or during treatment with drugs that cause decreased skeletal muscle activity. Key Words: Chloroquine, interactions, neuromuscular junction.

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

BACKGROUND: Highly active antiretroviral therapy (HAART) has dramatically reduced AIDS morbidity and mortality, however long-term metabolic consequences including dysglycaemia and dyslipidemia have raised concern regarding accelerated cardiovascular disease risk. OBJECTIVE: To determine the period prevalence of dyslipidemia and dysglycaemia in HIV-infected patients. DESIGN: Cross-sectional comparative group study. SETTING: Kenyatta National Hospital, a tertiary HIV dedicated out-patient facility. SUBJECTS: Consecutive HIV- positive adult patients. MAIN OUTCOME MEASURES: Dyslipidemia: presence of raised total or LDL cholesterol or low HDL cholesterol, or raised triglycerides. Dysglycaemia: presence of impaired fasting glucose or impaired glucose tolerance, or diabetes mellitus. Results: Between January and April 2006, out of 342 screened patients, 295 were recruited and 58% were females. One hundred and thirty four (45%) were on HAART, 82% of whom were on stavudine, lamivudine and either nevirapine or efavirenz. Overall prevalence of dyslipidemiawas 63.1% and dysglycaemia was 20.7%. High total cholesterol occurred in 39.2% of HAART and 10.0% HAART naive patients (p<0.0001, OR 5.18, CI 3.11-10.86), whereas high LDL cholesterol occurred in 40.8% and in 11.2% respectively (p<0.0001, OR 5.43, CI 2.973-9.917). HDL levels were low in 14.6% and 51.3% among HAART and HAART naive patients, respectively, (p<0.0001, OR 0.16, CI 0.091-0.29) while high triglycerides occurred in 25.6% and 22.5% respectively (p=0.541 OR 1.184 CI 0.688-2.037). Among patients on HAART compared to HAART naive patients, diabetes was found in 1.5% against 1.2% (p=0.85), impaired fasting in 2.2% against 0.6% (p=0.30) and impaired glucose tolerance in 16.4% against 21.1% (p=0.22), respectively. CONCLUSIONS: HIV- infected patients demonstrated a high prevalence of dyslipidemia. HAART use was associated with high levels of total, and LDL cholesterol and high triglyceride levels, an established athrogenic lipid profile. However, HAART was not associated with low HDL cholesterol and had no significant effect on dysglycaemia.

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

The promotion and support of urban agriculture (UA) has the potential to contribute to efforts to address pressing challenges of poverty, under nutrition and sustainability among vulnerable populations in the growing cities of sub-Saharan Africa (SSA). This may be especially relevant for HIV/AIDS-affected individuals in SSA whose agricultural livelihoods are severely disrupted by the devastating effects of the disease on physical productivity and nutritional well-being. This paper outlines the process involved in the conception, design and implementation of a project to strengthen technical, environmental, financial and social capacity for UA among HIV-affected households in Nakuru, Kenya. Key lessons learned are also discussed. The first has been the value of multi-stakeholder partnerships, representing a broad range of relevant experience, knowledge and perspectives in order to address the complex set of issues facing agriculture for social purposes in urban settings. A second is the key role of self-help group organizations, and the securing of institutional commitments to support farming by vulnerable persons affected by HIV-AIDS is also apparent. Finally, the usefulness of evaluative tools using mixed methods to monitor progress towards goals and identify supports and barriers to success are highlighted.

We studied 506 consecutive adult acute medical admissions to hospital in Nairobi; 95 (18.8%) were seropositive for HIV-1, and 43 new cases of active tuberculosis (TB) were identified. TB was clearly associated with HIV infection, occurring in 17.9% of seropositive patients compared with 6.3% of seronegatives [odds ratio (OR) 3.2; 95% confidence limits (CL) 1.6-6.5]. Extrapulmonary disease was more common in seropositive than seronegative TB patients (nine out of 17 versus five out of 26; OR 4.7; 95% CL 1.01-23.6); this accounted for most of the excess cases of TB seen in seropositive patients. Mycobacteraemia was demonstrated in two of eight seropositive TB patients but in none of 11 seronegative TB patients. No atypical mycobacteria were isolated. The World Health Organization (WHO) clinical case definition for African AIDS did not discriminate well between seropositive and seronegative TB cases. Five out of seven seropositive women with active tuberculosis had delivered children in the preceding 6 months and were lactating, compared with only one out of eight seronegative tuberculous women. An association between recent childbirth, HIV immunosuppression and the development of TB is suggested.

No abstract available.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.

Between April 1990 to January 1991, a prospective study of 97 consecutive patients admitted to the medical wards of Kenyatta National Hospital with upper gastrointestinal haemorrhage was done. All the patients studied under went upper gastrointestinal endoscopy within 24 hours of presentation and a positive endoscopic diagnosis was possible in 90 (93%) of the patients studied. The leading causes of bleeding were oesophageal varices in 34 (35%) patients, duodenal ulceration in 17 (17.5%) patients, and superficial inflammatory lesions in 17 (17.5%) patients. 17 (17.5%) patients had multiple lesions with superficial inflammation and oesophageal varices as the commonest combination. In 86 (88%) patients, bleeding settled on simple conservative measures which included intravenous fluids, blood transfusion and antacids. Further haemorrhage was observed in 11 (11.3%) patients. Tachycardia (> 100/minute), hypotension (systolic BP < 100mm Hg) and low haemoglobin (< 8 g/dl) at admission were all correlated with a poor outcome. Variceal bleeding had the worst prognosis and the overall mortality rate was 5%.

n/a

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

Ethnopharmacological relevance: Traditional medicines play an important role in the management of chronically painful and debilitating joint conditions, particularly in the rural Africa. However, their potential use as sources of medicines has not been fully exploited. The present study was carried to find the medicinal plants traditionally used to manage chronic joint pains in Machakos and Makueni counties in Kenya. Materials and methods: To obtain this ethnobotanical information, 30 consenting traditional herbal med-ical practitioners were interviewed exclusively on medicinal plant use in the management of chronic joint pains, in a pre-planned workshop. Results and discussion: In this survey, a total of 37 plants belonging to 32 genera and 23 families were cited as being important for treatment of chronic joint pains. The most commonly cited plant species were Pavetta crassipes K. Schum, Strychnos henningsii Gilg., Carissa spinarum L., Fagaropsis hildebrandtii (Engl.) Milve-Redh. and Zanthoxylum chalybeum Engl. Acacia mellifera (Vahl) Benth., Amaranthus albus L., Balanites glabra Mildbr. & Schltr., Grewia fallax K. Schum., Lactuca capensis, Launaea cornuta (Oliv. & Hiern) O. Jeffrey, Lippia kituiensis Vatke, Pappea capensis Eckl. & Zeyh. and Pennisetum glaucum (L.) R. Br. are documented for the first time as being important in the management of chronic joint pains. Conclusions: The findings of this study show that a variety of medicinal plants are used in the management of chronic joint pains and the main mode of administration is oral. Keywords: Ethnobotanical survey; Medicinal plants; Chronic joint pains; Rheumatoid arthritis; Akamba; Machakos-Kenya

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

The study aimed at evaluating tolerability and efficacy of the combination enalapril 20 mg with hydrochlorothiazide 12.5 mg (co-renitec) as first line therapy in black patients with mild to moderate primary hypertension. Fifty patients completed a twelve weeks of open clinical study preceded by two weeks of washout period. They were evaluated every four weeks and haematological, biochemical urine microscopy and electrocardiographic tests were undertaken before the start and after the completion of study. Pre-treatment values of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 172.16 mm hg (+/- 20.41) and 104.38 mm hg (+/- 7.339) respectively. The usual daily dosage was one tablet which was increased to two after eight weeks in case the DBP was not normalized, i.e. less than or equal to 95 mm hg. In 44 (88%) patients, the DBP was normalised at the end of the study period; three patients (6%) were resistant to treatment and another three (6%) exhibited labile response to the treatment. Clinical tolerance was considered to be very good with only five episodes of headache, backache and anxiety, probably not related to the test drug. Biological tolerance was excellent: there was no change in the haematologic parameters; there was a decrease of 5% in mean blood urea, of 9% in the mean serum creatinine and of 4% in the mean serum uric acid and a 5% increase in plasma potassium from 3.99 to 4.28 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Department of Paediatrics, University of Nairobi, Kenya. Multidrug-resistant organisms are increasing worldwide. Over the years we have noted increasing resistance of organisms isolated in our neonatal unit. There is a need therefore to scrutinize the problem so as to be able to plan for the future. Over a 5-month period, 716 infants were admitted of which 192 were screened for sepsis. Overall, 121 (16.7 per cent) had positive blood cultures. The predominant organisms were Gram negative (73.6 per cent of isolates) with Klebsiella species topping the list at 31 per cent. Case fatality for infants infected with Gram negative organisms was 41 per cent. Resistance to gentamicin was 20 per cent chloramphenicol 23.6 per cent, and amoxicillin/ampicillin 66.3 per cent. Of worry is the resistance to ceftazidime 19.1 per cent, and cefuroxime 21.3 per cent, with the figures rising to 27 per cent when more specialized tests are done (disc approximation and potentiation tests). If these drugs cannot be used in 20-27 per cent of cases then the situation is serious. The contributory factors to increased resistance include: non-investigation of infants put on antibiotics (50 per cent of cases); prolonged (73 per cent) and sometimes unjustified (41.7 per cent) use of antibiotics; and non-utilization of investigations when these are done (52 per cent) together with the delay in getting results back in the ward (6 days). PMID: 10822934 [PubMed - indexed for MEDLINE]

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

The in vitro antimalarial activity of the root extract in partly supports the ethnobotanical use of the plant to manage malaria. Clematis brachiata Thunberg (Ranunculaceae) is used in Kenya for the management of headaches, malaria and other febrile illnesses, abdominal disorders, yaws and for skin disorders. Old stems and leaves are chewed for the management of toothaches and sore throats. Extracts of the plant were subjected to tests for antimalarial, antibacterial and antifungal activity. The toxicity of the extracts was assessed using the brine shrimp lethality bioassay. The root extract gave the highest in vitro antimalarial activity against the inulitidrug resistant strain, Plasmodium falciparum VI/S (IC50=39.24 jig/nil). The stem and leaf extracts had insignificant antiplasmodial activity. The leaf, stein and root extracts had no bacterial or fungal inhibitory effects even at very high concentrations of 10 mg/ml. The Lll50 values of the stem and leaf methanol extracts against the brine shrimp larvae was 365.60 and 66.5 jig/ml, respectively. Key Words: Clematis brachiata, Ranuneulaceae, antimalarial, antibacterial, antifungal, brine shrimp.

No abstract available.

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Towers are typical structures that can be found in many urban and rural landscapes the world over. From their basic design, they are usually exposed to severe environmental loads. It is therefore prudent to carry out periodic maintenance that includes checking that they are correctly aligned. This paper describes a method that was used for the re-alignment of a guyed tower in Limuru, Kenya. Angular and distance observations, made from two observation points detected a vertical misalignment that was larger than the acceptable tolerance of l/400. An iterative re-alignment procedure was then applied, resulting in an acceptable final misalignment of 1 / 520.

A survey of proprietary pharmaceutical products used inslf-medication, in Kenya, has been undertaken. Out of 472 products covered in the survey, 32% were those used for gastrointestinal disorders and 18% for respiratory disorders. The significance and limitations of self-medication as they relate to management of minor health problems are discussed.

In this retrospective study carried out covering the period, 1978-1991, 62 neonates were seen, diagnosed and treated for intestinal atresia which included: duodenal atresia and stenosis, small bowel atresia and atresia of large bowel. Locations of obstruction were duodenal in 17 patients, jejunal in 25 patients, jejuno-ileal in 5 and colon in two. Duodenal atresia was noted in 9 infants and duodenal stenosis due to annular pancreas, Ladd's bands with malrotation of bowel in 8. Associated anomalies which were observed were anorectal malformations in 2 and malrotation in 2 infants. Birth weights ranged from 1450 gm to 3000 gm. Prematurity was recorded in 11 infants. Diagnosis of intestinal atresia in our patients was made clinically and radiologically. Intestinal atresia in neonates was differentiated from other causes of obstruction such as Meconium Ileus, Hirschsprung's disease, neonatal volvulus, rectal atresia in anorectal malformations. Treatment of infants with intestinal atresia was surgical. Surgical techniques used depended on pathological findings. In 36 patients, complications such as functional obstructions with vomiting and failure to thrive, malabsorption, aspiration, bronchopneumonia, sepsis were observed. Overall mortality rate in our cases was 25 (41.9%) out of 62 patients.

The range of clinical presentations of HIV-related disease in Africa has not been adequately described, despite the fact that many hospitals have to rely heavily on clinical diagnosis. Six hundred adult medical patients seen in the Casualty Department of the main Government hospital in Nairobi were enrolled in a study of the presentation and outcome of HIV-related disease: 506 of these patients were admitted, of whom 19 per cent (95) were HIV seropositive. The remaining 94 were dealt with as outpatients: 11 percent (10) of these were seropositive. A history of prior treatment for sexually transmitted disease and, if male, being uncircumcised, were associated with being seropositive. Three presentations were strongly associated with HIV infection: acute fever with no focus except the gastrointestinal tract (enteric fever-like illness), acute cough with fever (community-acquired pneumonia) and chronic diarrhoea with wasting. The WHO clinical case definition (CCD) for AIDS missed a substantial amount of HIV-related morbidity (sensitivity 39 per cent) and misidentified many seronegative patients (positive predictive value 59 per cent). In comparison with the Centers for Disease Control surveillance definition for AIDS, the CCD was specific (91 per cent) and sensitive (79 per cent) but only had a positive predictive values of 30 per cent: the CCD may therefore be a poor surveillance tool for AIDS. Seropositive patients were much more likely to die than were seronegative patients (39 per cent vs. 15 per cent mortality). Enteric fever-like illness was the presentation which most commonly proved fatal. A wider spectrum of disease is associated with underlying HIV immunosuppression than has previously been described in Africa.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

A case of cryptococcal hepatitis is described in a patient with Human Immunodeficiency Virus (HIV) infection. There has been no previous reports of this in the East African literature. A review of world literature showed that the entity of cryptococcal hepatitis is very rare.

socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Catechol O-methyltransferase (COMT) inactivates neurotransmitters, hormones and drugs such as levodopa. COMT activity is inherited in an autosomal recessive manner and individuals with low activity have thermolabile COMT protein. A low activity allele has been demonstrated at codon 108/158 of the soluble and membrane bound COMT protein, respectively, whereby a G to A transition results in a valine to methionine substitution, rendering the protein more thermolabile. As ethnic differences in erythrocyte COMT activity have been previously demonstrated, the frequency of low activity alleles were investigated in 265 British Caucasian, 99 British South-west Asian and 102 Kenyan individuals. Genotyping of COMT codon 108/158 was performed using a minisequencing method. Erythrocyte COMT activity was measured in 60 British Caucasian individuals by radiochemical assay. The frequency of low activity alleles was 0.54 in Caucasians, 0.49 in South-west Asians, and 0.32 in Kenyans. There was a much lower frequency of individuals with homozygous low activity allele in the Kenyan population (9%) than in Caucasians (31%) or South-west Asians (27%). Erythrocyte COMT activity was lower and less thermostable in individuals with homozygous low activity alleles. The data provide molecular evidence that low COMT is less common in African individuals than the Caucasian population. PMID: 9682265 [PubMed - indexed for MEDLINE]

Department of Periodontology/ Community and Preventive Dentistry, School of Dental Sciences, University of Nairobi, P.O. Box 19676 - 00202, Nairobi, Kenya. OBJECTIVE: To determine the influence of oral hygiene habits and practices on the risk of developing oral leukoplakia. DESIGN: Case control study. SETTING: Githongo sublocation in Meru District. SUBJECTS: Eighty five cases and 141 controls identified in a house-to-house screening. RESULTS: The relative risk (RR) of oral leukoplakia increased gradually across the various brushing frequencies from the reference RR of 1.0 in those who brushed three times a day, to 7.6 in the "don't brush" group. The trend of increase was statistically significant (X2 for Trend : p = 0.001). The use of chewing stick as compared to conventional tooth brush had no significant influence on RR of oral leukoplakia. Non-users of toothpastes had a significantly higher risk of oral leukoplakia than users (RR = 1.8; 95% confidence levels (CI) = 1.4-2.5). Among tobacco smokers, the RR increased from 4.6 in those who brushed to 7.3 in those who did not brush. Among non-smokers, the RR of oral leukoplakia in those who did not brush (1.8) compared to those who brushed was also statistically significant (95% CL = 1.6-3.8). CONCLUSION: Failure to brush teeth and none use of toothpastes are significantly associated with the development of oral leukoplakia, while the choice of brushing tools between conventional toothbrush and chewing stick is not. In addition, failure to brush teeth appeared to potentiate the effect of smoking tobacco in the development of oral leukoplakia. Recommendations: Oral health education, instruction and motivation for the improvement of oral hygiene habits and practices; and therefore oral hygiene status, should be among the strategies used in oral leukoplakia preventive and control programmes.

Forty one consecutive patients (24 males and 17 females) with AIDS had their blood assayed for HBsAg, anti-HBs and anti-HBc by Reversed Passive Haemagglutination (RPHA), Passive Haemagglutination (PHA) and Enzyme Linked Immunosorbent Assay (ELISA) techniques respectively. 5 (12.2%) were found positive for HBsAg. 10 (24.4%) for anti-HBs and 31 (75.6%) for anti-HBc. 32 (78%) out of 41 patients with AIDS had serological evidence of exposure to hepatitis B virus (HBV). The prevalence of HBsAg found in this study is not different from what has been found in the Kenyan community without AIDS, while that of anti-HBs is much lower than what has been reported in the general community.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

OBJECTIVE: To analyse the underlying aetiology, precipitating factors and certain socio-demographic determinants in patients admitted to Kenyatta National Hospital, Nairobi in congestive heart failure. DESIGN: Cross sectional descriptive study. SUBJECT: All patients aged thirteen years and above of either sex consecutively admitted with clinical diagnosis of congestive heart failure. SETTING: Kenyatta National Hospital (KNH), a national referral hospital. PATIENT EVALUATION: Detailed history including socio-demographic characteristics and physical examination was done. Patients underwent haematological and biochemistry tests followed by a chest x-ray, ECG and 2D Echo-doppler examination. Blood culture sensitivity was done when clinically indicated. RESULTS: Ninety one patients were studied, 44 males and 47 females. Almost 32% had rheumatic heart disease, 25.2% had cardiomyopathy, 17.6% hypertensive heart disease, 13.2% had pericardial disease while 2.2% had ischaemic heart disease. Three quarters of patients with hypertensive heart disease were above the age of 50 years, while 79% of patients with rheumatic heart disease were below the age of 30 years. Factors associated with patient deterioration leading to admission with congestive heart failure (CHF) included inadequate therapy (27.4%), arrhythmia (20.9%), respiratory infections (17.6%), anaemia (13.2%) and infective endocardiatis. Sixty two per cent of patients investigated were in New York Heart Association (NYHA) functional classification class IV, 31.9% in class III and 5.5% in class II. CONCLUSION: Congestive heart failure constitutes 3.3% of all medical admissions at KNH. Rheumatic heart disease is the commonest cause of congestive heart failure in our set-up while inadequate therapy, arrhythmias and respiratory infections are the three major causes of decompensation in our patients with cardiac disease.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

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According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

The study aimed at evaluating tolerability and efficacy of the combination enalapril 20 mg with hydrochlorothiazide 12.5 mg (co-renitec) as first line therapy in black patients with mild to moderate primary hypertension. Fifty patients completed a twelve weeks of open clinical study preceded by two weeks of washout period. They were evaluated every four weeks and haematological, biochemical urine microscopy and electrocardiographic tests were undertaken before the start and after the completion of study. Pre-treatment values of mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 172.16 mm hg (+/- 20.41) and 104.38 mm hg (+/- 7.339) respectively. The usual daily dosage was one tablet which was increased to two after eight weeks in case the DBP was not normalized, i.e. less than or equal to 95 mm hg. In 44 (88%) patients, the DBP was normalised at the end of the study period; three patients (6%) were resistant to treatment and another three (6%) exhibited labile response to the treatment. Clinical tolerance was considered to be very good with only five episodes of headache, backache and anxiety, probably not related to the test drug. Biological tolerance was excellent: there was no change in the haematologic parameters; there was a decrease of 5% in mean blood urea, of 9% in the mean serum creatinine and of 4% in the mean serum uric acid and a 5% increase in plasma potassium from 3.99 to 4.28 mmol/l.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: In November and December, 1993, a self-administered questionnaire was distributed to men in the town of Machakos and to nonmedical hospital workers of Machakos General Hospital. The purpose of the study was to assess their knowledge about and attitude towards vasectomy. The majority of men were in the age group of 30-44 years and were married; the hospital group was more educated. The town men perceived the pill to be the best contraceptive method for women in contrast to the hospital group who gave more importance to bilateral tubal ligation. The hospital group also perceived vasectomy as the best method for men. Overall, 53.2% men were aware of the correct procedure of vasectomy, but only 24% had correct knowledge of how the procedure affects masculinity. The knowledge of the procedure among hospital workers was not very different from that of the town group. Recommendations were made to increase information and education to all groups of people through various media. author's modified

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a fluke-free area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep. Keywords: Dorper, Fasciola gigantica, Red Masai, serum biochemical changes

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

According to the statements made by a number of scholars, in the 80's East African Anglophone novel, which once received a nickname of "social documentary", began to lose gradually its social commitment. Many of the writers known previously as the most active supporters of the social trend, moved their attempts to other literan areas - criminal novel ("Weapon of hunger" by Meja Mцangi, 1989), love story (Yussuf Dawood's "Off my chest", 1988), even children's literature (books for children in Gikuyu, written by Ngugi wa Thiong'o). However, in the late 80's and early 90's East African Anglophone novel stepped onto a new level of social trend, moving from "social documentary" to "social epic". The authors now are trying to sum up the historical experience of East African countries over a large time span, and to that effect appeal mostly to elaborate and spacious literary forms, such as epic novel. These authors, although chosen one and the same literary form, are showing clearly their inclinations towards different styles of writing. For example, Tanzanian author Moyez Vassanji in his novel "The gunny sack" (1989) makes a rather convincing attempt to replant on East African soil the method of "mythological writing", previously used by such author as Gabriel Garcia Marquez. The novel definitely appeals not only to local reader, but to a wider international audience; on its pages the author manages to restore not only the fate of several generations of Indian family, but even the slightest details of their mentality, using myth as one of the basic means for changing the dimensions of time and space, according to the logic of the narration. The development of Kenyan novel in the early 90's confirms also one of the main tendencies in modem literature - bridging between "elite" and popular fiction. The first attempt of an epic novel in Kenyan Anglophone literature was, oddly enough, made by the veteran of Kenyan popular fiction David Maillu in his "Broken drum" H991). The novel hardly aims the widest reading public - nevertheless, stylistically it bears distinct features of popular fiction, such as crime story, romance, etc. Popular novel in East Africa also shows certain inclination towards urgent social themes, but the authors inevitably uses the artistic means they feel most happy with - that is, the style of popular fiction. For example, the "clash of cultures" - the experience of young Africans studying abroad - is presented in the form of a picaresque ("Times beyond" by Omondi Makoloo, 1992) or love story ("The girl from Uganda" by Tengio Urrio, 1993); feministic problems are spiced with sentimentalism ("Judy the nun" by P .Waweru, 1990); the thoughts on the hardships of younger generation are guised in Bildungs roman ("The plight of succession" by a Tanzanian Prosper Rwegoshora, 1990). At the same time, some authors, who have been ploughing successfully the field of pop fiction for a few decades, show their interest in more elaborate literary forms ("Dedan Kimathi: the real story" by Samuel Kaluga, 1990). All the mentioned facts do not allow us to state that the division into popular and elite novel will disappear within the foreseeable future. However, the most interesting developments seem to take place precisely in the field of bridging between these two branches of East African fiction.

The anti-inflammatory and antidiarrhoeal activities of 3(1-Hydroxy-16. 17-seco-16- nor-5-androsten-15-(2-indoxyliden)-17-oic acid (I) are reported. After intraperitoneal administration, compound (I) gave an ED50 of 9.5 mg/kg using the carrageenan induced rat paw oedema anti-inflammatory assay method. Indomethacin had an ED50 of 5.8 mg/kg in this assay. Compound (I) and indomethacin caused comparable and dose-dependent varying degrees of delay in diarrhoea and also significantly reduced net colonic water flux into the colon of rats induced by castor oil. Key words: Steroidal Indoxyl, Anti-Inflammatory, Antidiarrhoeal.

The weight of 64 preterm appropriate for gestational age infants were followed closely during the period of stay in the newborn unit. They were subdivided into three groups: A (1001-1250 g), B (1250-1500 g), and C (1501-1750 g). The mean gestation for these groups were 28.7, 30.5, and 31 weeks, respectively, while mean birth weights were 1132 +/- 81.7 g, 1377 +/- 85.6 g, and 1641 +/- 88.6 g. All were fed their own mothers breast milk during the period of study with no supplements. During the first week, there was significant weight loss in all groups as follows: A (12.0 per cent), B (7.7 per cent), and C (4.4 per cent). Thereafter, only group A lost weight in the second week, but the loss was not significant. Birth weights were regained at 23, 16, and 15 days, respectively. The weight gain after the initial loss was A (20.0 g), B (20.4 g), and C (20.2 g) per day. Group A had the fastest growth rate. PMID: 2585581 [PubMed - indexed for MEDLINE]

Isolated mouse interstitial cells were incubated with different concentrations of khat (Catha edulis) extract (0.06 mg/ml, 0.6 mg/ml. 6 mg/ml. 30 mg/ml and 60 mg/ml) and cell viability as well as testosterone concentration measured at 30 min intervals over a 3 h incubation period. High concentrations of khat extract (30 mg/ml and 60 mg/ml) significantly inhibited testosterone production while low concentrations (0.06 mg/ml. 0.6 mg/ml and 6 mg/ml) significantly stimulated (P < 0.05) testosterone production by mouse interstitial cells. Similarly, at concentrations of 30 mg/ml and 60 mg/ml, there was a significant decrease in interstitial cell viability, whereas at 0.06 mg/ml, 0.6 mg/ml and 6 mg/ml there was no significant decrease. There was only a weak correlation (r= 0.39) between testosterone production and viable interstitial cells. We postulate that khat extract at high concentrations may cause reproductive function impairment in the user but at low concentrations. may enhance testosterone production with accompanying effects on reproductive functions in male mice. @2006 Publishedby Elsevier Ireland Ltd. Kel'lVords: In dtro; Khat; Testosterone; Interstitial cells; Mouse

Eimeria christenseni and Eimeria arloingi were used separately to infect one month-old goat kids which were then killed 34 days post-infection. Their small intestines contained small nodular lesions made of several endogenous stages mainly macrogametocytes and macrogametes. Electron microscope studies of macrogametocytes revealed a prominent central nucleus and nucleolus. Other cellular components were mitochondria, wall forming bodies(WFB) type 1( homogenous) and type 2(reticular). Polysaccharide granules of E.christenseni had a chain like arrangement in the young cells, and increased dramatically with maturation of the macrogemetes to become the main cytoplasmic component along with the WFB. Type 1 WFB were peripheral while type 2 were more central but in E.christeseni macrogametes, some type 2 WFB appeared to give rise to membranous vesicles at the areas of wall formation.. The macrogamete nucleus was small and usually indented with polysaccharide granules and reticular bodies, named nuclear derived bodies(NBD), arising from the perinuclear regions. Within the periparasitic areas of both species, membranous/dark bodies were seen. E. arloingi had a large and well defined parasitophorous vacuole(PV), within which an inner lighter, and outer layer with dark granules were found. Both species had some poorly developed intravacuolar tubes(IVT), which occurred at certain points in the case of E.arloingi, while in E.christenseni, they had a diffuse distribution

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Towers are typical structures that can be found in many urban and rural landscapes the world over. From their basic design, they are usually exposed to severe environmental loads. It is therefore prudent to carry out periodic maintenance that includes checking that they are correctly aligned. This paper describes a method that was used for the re-alignment of a guyed tower in Limuru, Kenya. Angular and distance observations, made from two observation points detected a vertical misalignment that was larger than the acceptable tolerance of l/400. An iterative re-alignment procedure was then applied, resulting in an acceptable final misalignment of 1 / 520.