Students intellectual, social and human development is enhanced if lecturers are equipped with appropriate pedagogical and people-skills. Insights gained from lecturers capacity-building in-service training programs in a public university in Kenya are presented in this paper. Twenty thematic areas were covered aimed at improving competences of lecturers in facilitating students' learning. In-service lecturers' responses were analyzed qualitatively. In-service lecturers have training expectations and challenges in teaching university students when preparing them to become responsible citizens. They are generally satisfied with focused professional development seminars they attend, and are likely to provide effective lecturing and improved classroom practices in their faculties.

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Universities continue to develop new methods of teaching in order to reach many people who cannot access education through the conventional methods; and to attain equity and increase access in higher education for development. Education is a key pillar in development. As Kenya works towards the attainment of Vision 2030 a lot has to be done in education to increase equity and access to allow many people to participate in the development. A lot of resources have been committed to development and implementation of DE materials and facilities but adoption of DE continues to be minimal at the Kenyan Public universities. This paper explores the role DE support facilities plays in the participation of university managers in DE activities in Kenya’s Public Universities. To study this role, the following indicators were analysed: computer availability to the managers and staff; access to personal computer; internet availability; number of internet connection points; and availability of ICT help desk. The study sort to establish the extent to which availability of personal computers availability of internet, number of internet connection points, availability of computers for teaching influence managers’ participation in DE; and to assess the availability of ICT help desks. The research employed cross-sectional descriptive survey design; and multi-stage stratified sampling design. The findings indicated that availing necessary support facilities is crucial if adoption of DE is to be increased in the public universities in Kenya.
KEY WORDS: Participation, distance education, university managers.

University managers have tried to attain improved access and equity in higher education for development. In recent years, there has been a major shift towards Distance Education as universities strive to attain this goal and to strengthen the social pillar of Kenya Vision 2030 development agenda. Use of ICT in teaching and learning in conventional mode of education was thought to be the means to increase access and equity in higher education but this has not been sufficient. More innovations are being explored as the universities struggle with the challenge of access and equity in higher education. Distance education has slowly been adopted in public universities in Kenya. This provides access to higher education by persons who are geographically distant from the institutions of higher learning and those whose responsibilities cannot allow them to attend classes among other challenges. The study sought to establish the extent to which managers’ level of knowledge in Distance Education has influenced their participation in Distance Education activities at the public universities in Kenya. The sample consisted of 196 managers drawn from seven public universities in Kenya. Spearman’s rank correlation coefficient was used in analysis. The results indicated a significant positive correlation between level of knowledge in Distance Education and managers’ participation in Distance Education activities. Based on these findings, it is important to ensure that the managers are trained in Distance Education and its practice, and how to apply it in order to improve access and equity in higher education in order to support the national and international development agenda.
KEY WORDS: Participation, distance education, level of knowledge, university managers, study support, access and equity.

There are two medical schools training doctors in Kenya: the Moi University established in 1984 and the University of Nairobi established in 1967. The University of Nairobi has so far produced the majority of Kenyan doctors. Both are public universities with the Government being the main financier. The increased demand for university education and the inability to meet these demands has led to the introduction of a system of training self-sponsored medical students alongside Government-subsidised students. One other public university has started a medical school. The pressure to increase the number of schools and students in the absence of increased resources poses a particular challenge to the country.

There are two medical schools training doctors in Kenya: the Moi University established in 1984 and the University of Nairobi established in 1967. The University of Nairobi has so far produced the majority of Kenyan doctors. Both are public universities with the Government being the main financier. The increased demand for university education and the inability to meet these demands has led to the introduction of a system of training self-sponsored medical students alongside Government-subsidised students. One other public university has started a medical school. The pressure to increase the number of schools and students in the absence of increased resources poses a particular challenge to the country.

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Strategic planning is the cornerstone of every organization without which the organization will
never know where it is going or whether it will ever get there. While strategic planning is
important, what is o f more importance is how it is practiced in the different institutions or
organizations Different scholars and author have advanced that strategic planning can be formed
implicit as well as formulated explicitly (Mintzerberg 1991 and Johnson and Scoles, 1993).
While several studies have been done in Kenya on the strategic planning practices, most of them
have been to general to elicit a comprehensive view on strategic planning practices adopted by
institutions.

  

Online learning has increasingly been adopted by most institutions of higher learning to facilitate teaching and learning as a continuum to the traditional face-to-face approach. Most of these institutions utilize Learning Management Systems which contain features that are intended to make students active participants not only by delivering learning resources to learners but also providing the environment for effective interaction in the learning process. Our examination of the literature reveals that there is limited empirical evidence that addresses how these features are being utilized by students in promoting Self-Regulated learning. To realize the usefulness of the features of Learning Management Systems in promoting Self-Regulated Learning, a structured survey was carried out among University students in Kenya. The findings reveal that the features of Learning Management Systems are underutilized by students. The qualitative results of the study illustrate that students face several challenges that obstruct them from being actively involved in online learning. There is lack of individualized feedback on students' learning habits, lack of instructor guidance, lack of interaction with course instructors, lack of peer interaction and lack of automation tools. This study provides insights for educators and researchers on the areas of focus that can be prioritized towards offering support to students in improving their Self-Regulated learning in online learning environments.

Kenya's capital city, Nairobi, like many rapidly growing cities in the global South is confronting massive inter-related problems of slum expansion, violence, ethnic segregation, poor service delivery, public health hazards and environmental degradation. These problems, in turn, are deep reflections of a long history of inequitable power relations at both local and global levels, repression, democratic institutional failure and skewed, exclusive urban policy and planning processes. How can a foreign university like Columbia University play a constructive role in this exceptionally challenging context? We argue that part of the answer involves fostering a research and teaching agenda that directly addresses the complexity inherent in the problems of simultaneous urbanization and democratization in places like Nairobi. However, this is not enough. All too often research by external universities fails to circulate or have any impact on urgently needed policy change. We argue that a key role for Columbia University is not just providing research, technical advice or “technology transfer,” rather it is also most critically about nurturing a sustained authentic partnership with local universities to enhance their role in urban transformation. By an authentic partnership we mean a collaboration that produces relationships of trust, honesty, transparency, respect and equity and results in the genuine co-production or facilitation of knowledge for positive local change.1 Fowler succinctly characterizes “authentic partners” versus relations involving “clients” or “counterparts” as involving“equality in ways of working and mutuality in respect for identity, position and role.”2 This paper explores the dynamics and importance of one such a partnership in the field of urban planning. This partnership, which started in April 2005, involves the Centre for Sustainable Urban Development (CSUD)3 at Columbia University and the Department of Urban and Regional Planning (DURP) at the University of Nairobi.

This report concerns an outbreak that occurred during July/August 1997. Ten pigs from a herd of 181 pigs in a medium-scale, semi-closed piggery in Kiambu District, Kenya, contracted the clinical disease. The main clinical findings in affected pigs included: fever (40.5-41.8 degrees C), prostration, inappetence, dog-sitting posture, abortion, erythema and raised, firm to the touch and easily palpated light pink to dark purple diamond-shaped to square/rectangular spots on the skin around the belly and the back. Based on the pathognomonic skin lesions, a clinical diagnosis of swine erysipelas was made. The diagnosis was confirmed by the isolation of Erysipelothrix rhusiopathiae organisms from the blood and skin biopsies taken from the affected pigs. Response to treatment with a combination of procaine penicillin and dihydrostreptomycin at the dosage rate of 20,000 IU/kg body weight (based on procaine penicillin) for 3 days was good and all the affected pigs recovered fully. The farm was placed under quarantine to prevent spread of the disease

Induction of labor is being increasingly used to prevent adverse outcomes in the mother and the newborn.This study assessed the prevalence of induction of labor and determinants of its use in Africa. Methods We performed secondary analysis of the WHO Global Survey of Maternal and Newborn Health of 2004 and 2005. The African database was analyzed to determine the use of induction of labor at the country level and indications for induction of labor. The un-met needs for specific obstetric indications and at country level were assessed. Determinants of use of induction of labor were explored with multivariate regression analysis. Results A total of 83,437 deliveries were recorded in the 7 participating countries. Average rate of induction was 4.4% with a range of 1.4 – 6.8%. Pre-labor rupture of membranes was the commonest indication for induction of labor. Two groups of women were identified: 2,776 women with indications had induction of labor while 7,996 women although had indications but labor was not induced. Induction of labor was associated with reduction of stillbirths and perinatal deaths [OR – 0.34; 95% CI (0.27 – 0.43)]. Unmet need for induction of labor ranged between 66.0% and 80.2% across countries. Determinants of having an induction of labor were place of residence, duration of schooling, type of health facility and level of antenatal care. Conclusion Utilization of induction of labor in health facilities in Africa is very low. Improvements in social and health infrastructure are required to reverse the high unmet need for induction of labor.

This textbook does not aim at helpig teachers to acquire Kenyan Sign Language(KSL). It is meant for teachers who already have a good mastery of KSL and whose primary objective is to learn how to teach it. It thus introduces teachers to teaching of KSL as a language focusing on theory and skillsof langauge teaching in general and teaching of sign Language in particular using KSl as base language.

In this paper, we shall use clearly identified random variables required to study the Dorfman-Sterrett procedure first introduced by Sterrett. Based on the identified random variables, we shall derive probability distributions, conditional probability distributions and the expected number of runs (tests) in the Dorfman-Sterrett designs. Using combinatorial theory, we shall derive results obtained by earlier authors in a much simplified version.

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45 Kenyan traditional healers were interviewed with respect to the diagnosis and treatment of eye diseases. Traditional management of eye diseases is based on the healers' concept of the disease causation as well as their knowledge of the herbal, animal and chemical substances that possess (or are reported to possess) remedial effect on the disease. While many of the healers interviewed failed to give a clear distinction between the various eye conditions, diseases such as cataract, foreign bodies and injuries were recognized easily. In almost all cases the medicinal substances were first diluted in water before they were applied to the eyes. Human milk, blood and the white of the egg were the animal substances listed as medicinal to various eye conditions. A solution of sugar was one of the chemical substances used in the treatment of specific eye conditions. Given correct information, some of these healers could f

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The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical-legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts.

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical-legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze. The case illustrates the fallibility of the men and women in the operating theatres and the vital role of correct instrument and sponge counts.

We report a case of a 44 year old man who presented with right gluteal pain following trivial trauma, associated with unusual bones, with all the characteristics of clavicles articulating with the pelvic girdle. The pain on that side was completely relieved by excision of the bone.

Ninety seven patients were examined for dental caries using two standard methods: (a) clinical examination based on WHO Basic Methods Oral Health surveys and (b) radiographic examination. Clinical examination method under records caries by upto 40%. Such under recording may give an impression of a decreasing caries prevalence in epidemiological studies.

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A 72 year old African male presented with a 2 weeks history of haematurla with clots, dysuria, nocturia, frequency and subsequently 2 day history of acute urinary retention (AUR). There were no colonic symptoms of mucus discharge, blood per rectum or malaena stools. Imaging studies demonstrated a tumour mass invading the roof of the urinary bladder whilst cyctoscopic finding were inconclusive. Following surgical intervention, the mass was subjected to histopathological evaluation which confirmed colonic adenocarcinoma matastasis in the urinary bladder. It is now 4 ½ years since surgery was carried out and follow up shows good prognosis.

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30 year old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30 year old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30-year-old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side, the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30-year-old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side, the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome.

Abstract
BACKGROUND: The anatomy of the radial artery draws great interests among anatomists for its frequent involvement in variations. Equally, these variations have gained significant attention from clinicians because of the preference to use the radial artery for catheterization. The commonest of radial artery variations involve its site of origin. In published literature, data on this variations exist, but the prevalence of such variations in a Kenyan population has hitherto been unknown.
METHODS: Sixty-two upper limbs from 50 formalin-fixed cadavers were studied during dissection in the Department of Human Anatomy, University of Nairobi.
RESULTS: Fifty-four (87.1%) radial arteries arose within the cubital fossa, while eight (12.9%) had a high origin. Out of the eight high arteries, two (3.2%) branched off from the axillary artery, another two (3.2%) were branches of the proximal third of the brachial artery and four (6.5%) arose from the middle third of the brachial artery. The high origin radial arteries were more common on the right upper limbs (5 out of the 8 cases). Both axillary and brachial origins were seen bilaterally.
CONCLUSION: The present study details important variations in the anatomy of the radial artery in a Kenyan population. With the radial artery being utilized during clinical, surgical and radiological interventions so frequently, an increased understanding and anticipation of such topographic variances is paramount.

It has been the view of the Association of Surgeons of East Africa (ASEA) that, like primary health care, there is primary surgery. The unit of provision of primary surgery is the district hospital. The training of surgeons for district hospitals starts at the undergraduate level, leading to the attainment of Bachelor of Medicine and Bachelor of Surgery (M.B. Ch.B.) degree. After internship the doctor works in a district or provincial hospital for 2-3 years, then trains for the degree of Master of Medicine (M. Med. (Surg.)) for a period of 3 years. The training involves rotation through all branches of surgery, so that the surgeon should be able to handle all aspects of routine surgery in a district hospital. To equip the surgeon further, a period in an outside setting is considered advisable. There are arrangements for regional surgical colleges to standardise the form of surgical training in the ASEA region. To keep surgeons in touch with the outside world, specialist training is done outside the region, but arrangements are being made for localised specialised units to offer this training.

Appendicitis is the most common surgical emergency, but its diagnosis in children can be a challenge to the treating surgeon. PMID: 19829951

To obtain an update of the treatment of advanced prostate cancer. DATA SOURCE: Review of all published literature on advanced prostate cancer was carried out through medline and index medicus search. DATA SELECTION: Published data on advanced prostate cancer from June 2005 to June 2007 was included in the review. DATA EXTRACTION: Abstracts of articles identified were assessed, read and analysed to determine relevance to the title under review. DATA SYNTHESIS: After establishing relevance from the abstract, the entire paper was read, and significant points included in the review. CONCLUSION: The mainstay of treatment of advanced prostate cancer remains hormone withdrawal. The introduction of docetaxel based chemotherapy has caused a paradigm shift.

Background: Postpartum haemorrhage (PPH) affects 6% of births and accounts for almost 30% of maternal deaths. The use of clinical protocols for preventing and treating PPH is recommended by WHO. Protocols should be evidence-based, regularly updated, widely available and routinely adhered to.
Broad Objective: To update the Kenyatta National Hospital (KNH) PPH prevention and management protocol based on latest recommendations, and ensure its dissemination and use by providers.
Materials and Methods: A literature search identified selected PPH-related guidelines which were assessed using the AGREE-II tool for guideline quality. A matrix was created to compare recommendations across guidelines. Recommendations included in the KNH protocol were based on agreement across guidelines, guideline quality, publication year, and contextual factors in our setting. To aid implementation, an updated KNH protocol document, a clinical algorithm and a PPH management checklist were developed. These were reviewed and accepted as best practice by KNH and University of Nairobi.
Results: Six PPH-related guidelines were used (WHO, FIGO, RCOG, ACOG, FOGSI, and the Kenya National Guidelines for Quality Obstetrics and Perinatal care). The KNH protocol covers PPH prevention, including: active management of third stage, oxytocin after vaginal or caesarean delivery, other drugs for prevention (when oxytocin is not available), controlled cord traction and delayed cord clamping. It also covers PPH management (supportive and definitive measures).
Conclusion: An updated PPH prevention and management protocol for KNH was developed. Implementation and adherence will help standardize PPH-related care and improve health outcomes for women.

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1. Singh C. B.  .  August . .

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

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Background: Easy availability, accessibility and affordability make ultra-sonography an invaluable diagnostic tool in clinical investigation of infectious and non-infectious complications of human immunodeficiency virus (HIV).
Objective: To determine the pattern of upper abdominal abnormalities in HIV infected patients at ultra-sonography and correlate with clinical presentations.
Design: A descriptive cross-sectional study.
Setting: Kenyatta National Hospital and the Defence Forces Memorial Hospital, Nairobi, Kenya.
Subjects: HIV infected patients referred for upper abdominal sonography within the study duration of eight months.
Results: Two hundred and seventy three (273) patients were included in the study. Overall, upper abdominal pain accounted for 31.9%, pyrexia of unknown origin 30.40% and general abdominal pains 27.68% of clinical indications for sonography. The main clinical indication for liver sonography was hepatitis (45.80%) and the kidney was renal failure (66.67%). The most common liver pathology was diffuse fat infiltration at 35.71%. The most common renal pathology was renal parenchymal disease (93%). Para-aortic lymphadenopathy was present in 42.90% and ascites 25.60% of patients. Conclusion: Renal parenchymal changes (type I and II), fatty liver, intra-abdominal lymphadenopathy and gallbladder sludge are common findings in HIV infected individuals despite paucity of clinical suspicion.

No abstract available.

OBJECTIVE: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya. SUBJECTS: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic. RESULTS: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H.pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. CONCLUSION: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

OBJECTIVE: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia.
DESIGN: Cross-sectional study.
SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya.
SUBJECTS: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic. RESULTS: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H.pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. CONCLUSION: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

This study seeks to document recent trends in early childhood mortality in the country and to offer some plausible explanations for the upsurge in the trends. Data and information from various sources are used in this paper to achieve this purpose. The results obtained show that infant, child and under-five mortality rates had declined in the 1960s and 1970s but were taking un upward trend since early 1990s. This situation is attributable to a combination of factors, including increased poverty, adverse effects of economic hardships and cost recovery programs associated with structural adjustment programs, increased childhood malnutrition, decreased use of certain maternity care services, decline in the coverage of child immunisations, inability of the public health system to provide services, and the HIV/ AIDS epidemic and the recent ethnic clashes that rocked some parts of the Rift Valley, Coast, Nyanza and Western province. In order to reverse the upward trend in mortality, there is an urgent need to intensify efforts to reduce poverty, to enable most people to have adequate food supply, improve the public health sector so that it can deliver health care to all people; to make greater efforts to raise the living standards of rural populations and improve the quality of housing, sanitary and sewerage conditions in urban slums. In addition, concerted efforts must continue to be made to contain the spread of HIV/AIDS, to assist AIDs orphans and to eliminate completely and to avoid recurrence of ethnic clashes and cattle rustling.

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%.

Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised.

Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program.

Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%.

Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable.

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The growing rate of HIV infection particularly among women in 'subSaharan African region suggests the need tor a. broader framework for prevention and care efforts. In particular, the socio-economic context that draws women into commercial sex is a key factor to be addressed. In this context, the Strengthening STDjAIDS Control in Kenya Project, in collaboration with Improve Your Business-Kenya, a small enterprise development organisation, initiated an operational research in February 1999, to assess the eftecnvecess of alternative economic activities support for women engaged in commerdal sex work in the slums of Nairobi as an HIV prevention strategy. The rnajoritv of the women had been in commercial sex work for more than 3 years and reported having an average of 4 different commercial sex clients per day with whom close to a. quarter used condoms only sometimes. Corroborative data from previous studies have shown female sex workers in Nairobi to be 50-80% HIV infected. In view of their risk of HIV infection, the women expressed the need for support for alternative income sources to enable them exercise more control over their sexual behaviour or exit sex work altogether. The financial support for the study was provided by the Canadian International Development Agency (CIDA).

The need for improving practice in low-income settings has been demonstrated in recent research assessing the quality of hospital care. Consequently, the Ministry of Health developed clinical practice guidelines and an evidenced-based programme for their dissemination. This thesis explored what factors influence the uptake of the best-practice recommendations in a university teaching hospital. This thesis used a mixed methods research approach that utilized a before and after design and participatory action research. This approach recognizes that health recommendations are compiled for universal use, but that their successful implementation requires particular attention to the individual and complex socio-political contexts of each setting, both at the micro and -macro level, which in this case was the Kenyatta National Hospital (KNH). This thesis is supported by eighteen months of participant observation, based on ethnographic research methodology and action research. Patients' care was largely inconsistent with best-practice recommendations, with nine of the 17 key indicators having performance of below 10% in the pre-intervention period. The intervention had an absolute effect size of over 20% in eight of the 17 key indicators; three of which had an effect size of over 50%. The indicators that required collective efficacy achieved performance of less than 10% in the post-intervention period. The activities during the action research component failed to predict the trend in practitioners' performance, illustrating the difficulty of gaining a holistic understanding of the quantitative results using component parts of the qualitative results as the lens. The notion of professionalism provided an overarching understanding of the implementation process. There were clear gaps between the stated values espoused in the ideal of professionalism and the observed actions of professionals in KNH. Gaps spanned knowledge management, expertise and skills, teamwork, conscientiousness and patient centeredness. I attributed the gaps in professionalism to complexity of professional development.

This study conducted in western Kenya demonstrates how a gendered intersectionality lens can be used to explore how and the extent to which farming communities are coping with climate change. Results from a quantitative survey undertaken with 51 farmers and from 4 focused group discussions held with 33 farmers (19 males and 14 females) indicate that 85% of the respondents are willing to adopt climate-smart agriculture (CSA) interventions if constraining factors are resolved.This study reveals that farmers, regardless of whether they are male or female, are willing to adopt climate smart technologies and practices. However, factors such as ethnicity, education, age and marital status determine the levels of uptake of CSA technologies and practices. Looking at crops for instance, we find a high uptake (62.7%) of improved high yielding varieties (HYVs) amongst farmers with primary level education, meaning literacy levels influence adoption of practices. Analysis using age as a lens reveals that there is a high uptake among the youth and adults. Interestingly, the study site comprises of both the Luo and Kalenjin ethnic communities and even though they neighbor each other, we find a high rate of uptake among the Luo community due to existing social and cultural norms and practices related to farming. In conclusion, using a gendered intersectionality lens strengthens the argument for targeted interventions which focus on local needs and priorities while recognizing local contexts as informed by social, cultural and economic factors.

Keywords
Climate-smart agriculture Uptake Gender Intersectionality Kenya

This study conducted in western Kenya demonstrates how a gendered intersectionality lens can be used to explore how and the extent to which farming communities are coping with climate change. Results from a quantitative survey undertaken with 51 farmers and from 4 focused group discussions held with 33 farmers (19 males and 14 females) indicate that 85% of the respondents are willing to adopt climate-smart agriculture (CSA) interventions if constraining factors are resolved. This study reveals that farmers, regardless of whether they are male or female, are willing to adopt climate-smart technologies and practices. However, factors such as ethnicity, education, age, and marital status determine the levels of uptake of CSA technologies and practices. Looking at crops, for instance, we find a high uptake (62.7%) of improved high yielding varieties (HYVs) amongst farmers with primary level education, meaning literacy levels influence the adoption of practices. Analysis using age as a lens reveals that there is a high uptake among youth and adults. Interestingly, the study site comprises both the Luo and Kalenjin ethnic communities and even though they neighbor each other, we find a high rate of uptake among the Luo community due to existing social and cultural norms and practices related to farming. In conclusion, using a gendered intersectionality lens strengthens the argument for targeted interventions that focus on local needs and priorities while recognizing local contexts as informed by social, cultural, and economic factors.

Keywords
Climate-smart agriculture Uptake Gender Intersectionality Kenya

Abstract
Background: We set out to determine the relative roles of stigma versus health systems in non-uptake of
prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional
assessment of all consenting mothers accompanying infants for six-week immunizations.
Methods: Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya’s
Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy.
Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status
determined by HIV-1 polymerase chain reaction.
Results: Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely
to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001)
and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant
antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was
associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by
between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection
rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors
contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed
opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1-
exposed infants were HIV-1 infected.
Conclusions: Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1
infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and
antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.
Keywords: mother-to-child HIV transmission, HIV/AIDS, Health system, testing, antiretrovirals, facility delivery

We set out to determine the relative roles of stigma versus health systems in non-uptake of
prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional
assessment of all consenting mothers accompanying infants for six-week immunizations.

Background: We set out to determine the relative roles of stigma versus health systems in non-uptake of
prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional
assessment of all consenting mothers accompanying infants for six-week immunizations.
Methods: Between September 2008 and March 2009, mothers at six maternal and child health clinics in Kenya’s Nairobi and Nyanza provinces were interviewed regarding PMTCT intervention uptake during recent pregnancy.
Stigma was ascertained using a previously published standardized questionnaire and infant HIV-1 status
determined by HIV-1 polymerase chain reaction.
Results: Among 2663 mothers, 2453 (92.1%) reported antenatal HIV-1 testing. Untested mothers were more likely to have less than secondary education (85.2% vs. 74.9%, p = 0.001), be from Nyanza (47.1% vs. 32.2%, p < 0.001)and have lower socio-economic status. Among 318 HIV-1-infected mothers, 90% reported use of maternal or infant antiretrovirals. Facility delivery was less common among HIV-1-infected mothers (69% vs. 76%, p = 0.009) and was associated with antiretroviral use (p < 0.001). Although internal or external stigma indicators were reported by between 12% and 59% of women, stigma was not associated with lower HIV-1 testing or infant HIV-1 infection rates; internal stigma was associated with modestly decreased antiretroviral uptake. Health system factors contributed to about 60% of non-testing among mothers who attended antenatal clinics and to missed opportunities in offering antiretrovirals and utilization of facility delivery. Eight percent of six-week-old HIV-1- exposed infants were HIV-1 infected.
Conclusions: Antenatal HIV-1 testing and antiretroviral uptake was high (both more than 90%) and infant HIV-1infection risk was low, reflecting high PMTCT coverage. Investment in health systems to deliver HIV-1 testing and antiretrovirals can effectively prevent infant HIV-1 infection despite substantial HIV-1 stigma.

We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations.

We set out to determine the relative roles of stigma versus health systems in non-uptake of prevention of mother to child transmission (PMTCT) of HIV-1 interventions: we conducted cross-sectional assessment of all consenting mothers accompanying infants for six-week immunizations.

This article considers the extent to which farming activities undertaken by low-income dwellers in Nairobi, Kenya, play a role in the food security and nutritional status of the households involved. It compares three low-income groups - two in Korogocho, viz. those who practise urban agriculture and those who do not, and one in the Kitui-Kanuku-Kinyago area, viz. households involved in the Undugu Society Urban Agriculture Project (USUAP). The questionnaire results indicate that those who farmed produced mainly for home consumption. The major problem urban farmers faced was theft. The food situation of the USUAP farming group was generally better than that of the two Korogocho groups. In all three groups, purchased food formed by far the most important food source. On average, all three groups had inadequate energy intake. However, the energy and protein intakes in the USUAP group were higher than in the other two groups. The USUAP group purchased more food, a fact related to their higher level of welfare as a result of benefits derived from income-generating activities and a shelter improvement project that came along with the urban agriculture project. Measures of nutritional health for young children showed a similar pattern in favor of the farming groups, albeit to a lesser extent. The long-term beneficial effect on nutritional status, however, was negligible. Bibliogr., notes, ref., sum. in English and French

No abstract available.

The effect of acqueous extract of the tuber of Adenia globosa on the isolated preparation of the rat uterus was determined. The crude drug caused a dose-dependent contraction of the tissue preparation. This action was enhanced by a small dose of oxytocin. The results are discussed in relation to the traditional uses of this plant.

No abstract available.

OBJECTIVE: To assess the relationship between maternal factors and child nutritional status among children aged 6-36 months. DESIGN: Cross sectional descriptive survey. SETTING: Urban slum settlement in Nairobi, Kenya. SUBJECTS: This study included a random sample of 369 households of mothers with children aged 6-36 months at the time of the study. RESULTS: Maternal factors which showed a positive significant association with at least one of the three child nutritional status indicators (height for age, weight for age and weight for height) were birth spacing, parity, maternal education level and mothers marital status. Child spacing and parity emerged as the most important predictors of stunting among study children. Maternal nutritional status was also shown to be positively associated with child nutritional status. Maternal ill health had a negative effect on child nutritional status. CONCLUSION: Maternal factors are an underlying cause of childhood malnutrition.

New Directions in water legislation in Kenya?. A Paper presented as the National Workshop on environmental Governance in kenya, held at the UNEP Headquarters Gigiri, Nairobi, March 29-30. 2000

A retrospective study of the hospital records revealed that 39 cases of mandibular fractures presented at Kisii District Hospital during a two-year period. 27 cases were due to interpersonal violence while road traffic accidents and accidental falls accounted for 9 and 3 of the cases respectively. The male ratio was 2.9:1. Majority (26 cases) of the patients were aged between 20 and 39 years. The commonly involved fracture site was the left body of the mandible accounting for 20 of the fractures.

Nairobi River originates from a swamp near Kikuyu town, about 24 kilometres west of Nairobi city centre and meanders across the city covering a stretch of about 30 kilometres. Within the city area, the river is contaminated by runoff waters; untreated effluent from …

Nairobi River originates from a swamp near Kikuyu town, about 24 kilometres west of Nairobi city centre and meanders across the city covering a stretch of about 30 kilometres. Within the city area, the river is contaminated by runoff waters; untreated effluent from residential areas and small-scale industries; and a significant volume of treated wastewaters from Kariobangi Sewerage Treatment Works. Its waters are used for various purposes, in particular agricultural, both within and outside the city environs. Most often the food crops grown along this river appear healthy and are attractive to customers. However, it is suspected that the waters used for irrigation purposes may contain high levels of heavy metals and these may end up being assimilated by these food crops and thereafter enter the food chain.

Nairobi River originates from a swamp near Kikuyu town, about 24 kilometres west of Nairobi city centre and meanders across the city covering a stretch of about 30 kilometres. Within the city area, the river is contaminated by runoff waters; untreated effluent from residential areas and small-scale industries; and a significant volume of treated wastewaters from Kariobangi Sewerage Treatment Works. Its waters are used for various purposes, in particular agricultural, both within and outside the city environs. Most often the food crops grown along this river appear healthy and are attractive to customers. However, it is suspected that the waters used for irrigation purposes may contain high levels of heavy metals and these may end up being assimilated by these food crops and thereafter enter the food chain.

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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.