Psychiatric morbidity among 200 medical in-patients at Kenyatta National Hospital was determined by a two-stage screening procedure, using the Self Reporting Questionnaire (SRQ) and standardized psychiatric interview (SPI). 44 (22%) of the total sample of 200 patients who were interviewed met the pre-established criteria for psychiatric morbidity; of these 59% comprised affective disorders. 4 (9%) of the psychiatric morbidity cases were referred for psychiatric evaluation. Referral seemed to be related to severity of illness and a previous history of psychiatric illness. There was no evidence in the notes that the psychiatric problems had been detected, treated or dealt with in any other way by the medical team in 34 patients out of 44 with psychiatric morbidity. Increase in the mental health input in the training of all health workers with emphasis on recognition and management of some of the commoner psychological problems is recommended.

Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. BACKGROUND: Strategies to circumvent or lessen the myelotoxicity associated with combination chemotherapy may improve the overall outcome of the management of patients particularly in resource poor settings. OBJECTIVES: To develop effective non-myelotoxic therapies for Burkitt's Lymphoma (BL) and AIDS-related non-Hodgkin's lymphoma. DATA SOURCES: Publications, original and review articles, conference abstracts searched mainly on Pubmed indexed for medline. DATA EXTRACTION: A systematic review of the clinical problem of combination chemotherapy. Identification of clinical strategies that circumvent or lessen the myelotoxicity of combination cytotoxic chemotherapy. Length of survival, lack of clinically significant (> grade 3) myelosuppression and weight loss were used as markers of myelotoxicity. DATA SYNTHESIS: Review of published experience with some of these strategies including dose-modification of multi-agent chemotherapy; rationale for targeted therapies, and the preclinical development of a mouse model exploring the role of metronomic scheduling substantiate pragmatism and feasibility of these approaches. CONCLUSION: Myelotoxic death rates using multi-agent induction chemotherapy approach 25% for endemic Burkitt's lymphoma and range between 20% to 60% for AIDS-related malignancy. This is mostly explained by the paucity of supportive care compounded by wasting and inanition attributable to advanced cancer and HIV infection making patients more susceptible to myelosuppressive side effects of cytotoxic chemotherapy. Investigations and alternative approaches that lessen or circumvent myelotoxicity of traditional cytotoxic chemotherapy for the management of Burkitt's lymphoma and AIDS-related non-Hodgkin's lymphoma in the resource-constrained setting are warranted. Pertinent pre-clinical and clinical data are emerging to support the need for abrograting the myelosuppressive effects of traditional cytotoxic chemotherapy. This can be achieved by developing targeted anti-viral and other strategies, such as the use of bryostatin 1 and vincristine, and by developing a preclinical mouse model to frame the clinical rationale for a pilot trial of metronomic therapy for the treatment of Burkitt's and AIDS-related lymphoma. Implementation of these investigational approaches must be encouraged as viable anti-cancer therapeutic strategies particularly in the resource-constrained settings.

Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. BACKGROUND: Strategies to circumvent or lessen the myelotoxicity associated with combination chemotherapy may improve the overall outcome of the management of patients particularly in resource poor settings. OBJECTIVES: To develop effective non-myelotoxic therapies for Burkitt's Lymphoma (BL) and AIDS-related non-Hodgkin's lymphoma. DATA SOURCES: Publications, original and review articles, conference abstracts searched mainly on Pubmed indexed for medline. DATA EXTRACTION: A systematic review of the clinical problem of combination chemotherapy. Identification of clinical strategies that circumvent or lessen the myelotoxicity of combination cytotoxic chemotherapy. Length of survival, lack of clinically significant (> grade 3) myelosuppression and weight loss were used as markers of myelotoxicity. DATA SYNTHESIS: Review of published experience with some of these strategies including dose-modification of multi-agent chemotherapy; rationale for targeted therapies, and the preclinical development of a mouse model exploring the role of metronomic scheduling substantiate pragmatism and feasibility of these approaches. CONCLUSION: Myelotoxic death rates using multi-agent induction chemotherapy approach 25% for endemic Burkitt's lymphoma and range between 20% to 60% for AIDS-related malignancy. This is mostly explained by the paucity of supportive care compounded by wasting and inanition attributable to advanced cancer and HIV infection making patients more susceptible to myelosuppressive side effects of cytotoxic chemotherapy. Investigations and alternative approaches that lessen or circumvent myelotoxicity of traditional cytotoxic chemotherapy for the management of Burkitt's lymphoma and AIDS-related non-Hodgkin's lymphoma in the resource-constrained setting are warranted. Pertinent pre-clinical and clinical data are emerging to support the need for abrograting the myelosuppressive effects of traditional cytotoxic chemotherapy. This can be achieved by developing targeted anti-viral and other strategies, such as the use of bryostatin 1 and vincristine, and by developing a preclinical mouse model to frame the clinical rationale for a pilot trial of metronomic therapy for the treatment of Burkitt's and AIDS-related lymphoma. Implementation of these investigational approaches must be encouraged as viable anti-cancer therapeutic strategies particularly in the resource-constrained settings.

We conducted a prospective study among women in Mombasa, Kenya, to determine whether Trichomonas vaginalis infection was associated with an increased risk of human immunodeficiency virus type 1 (HIV-1) infection. At monthly follow-up visits, laboratory screening for HIV-1 and genital tract infections was conducted. Among 1335 HIV-1-seronegative women monitored for a median of 566 days, there were 806 incident T. vaginalis infections (23.6/100 person-years), and 265 women seroconverted to HIV-1 (7.7/100 person-years). Trichomoniasis was associated with a 1.52-fold (95% confidence interval, 1.04-2.24-fold) increased risk of HIV-1 acquisition after adjustment for potential confounding factors. Treatment and prevention of T. vaginalis infection could reduce HIV-1 risk in women.

We conducted a prospective study among women in Mombasa, Kenya, to determine whether Trichomonas vaginalis infection was associated with an increased risk of human immunodeficiency virus type 1 (HIV-1) infection. At monthly follow-up visits, laboratory screening for HIV-1 and genital tract infections was conducted. Among 1335 HIV-1-seronegative women monitored for a median of 566 days, there were 806 incident T. vaginalis infections (23.6/100 person-years), and 265 women seroconverted to HIV-1 (7.7/100 person-years). Trichomoniasis was associated with a 1.52-fold (95% confidence interval, 1.04-2.24-fold) increased risk of HIV-1 acquisition after adjustment for potential confounding factors. Treatment and prevention of T. vaginalis infection could reduce HIV-1 risk in women.

Thirty-one chronic idiopathic demyelinating polyradiculoneuropathy (CIDP) patients have been typed for HLA-A, -B and -C antigens serologically and for HLA-DR, -DQ and -DP class II genes by RFLP analysis. Our results confirm a previously reported slight association with HLA-B8 and identify a stronger association with HLA-Cw7.

PIP: The effects of the triphasic oral contraceptive (OC) ethinyl estradiol (EE) and levonorgestrel (LNG) on lipid and lipoprotein metabolism were evaluated in 97 black Kenyan women. Subjects were recruited from the Family Planning Clinic and were followed for 12 months. There was an increase in fasting levels of total cholesterol. These changes were not statistically significant. However, the triglyceride increase was statistically significant at 9 months and 12 months (p0.05). The high density cholesterol remained unchanged. Thus, this triphasic OC was found to have minimal effect on lipid and lipoprotein metabolism. author's modified

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

Department of Psychiatry and Psychology, Neuropsychiatric Institute, University of California, Los Angeles, CA, USA. swhaley@mednet.ucla.edu

Previous observational studies in developing countries have suggested that diet quality, particularly increased animal source food (ASF) consumption, is positively associated with child cognitive development. This report presents findings from a study in rural Kenya, designed to test the impact of three different diets on the cognitive development of school children. Twelve schools with a total of 555 Standard 1 children (equivalent to U.S. Grade 1) were randomized to one of four feeding interventions: Meat, Milk, Energy or Control (no feeding). Feeding continued for seven school terms (21 mo), and cognitive tests were administered before the commencement of feeding and during every other term of feeding. Hierarchical linear random effects models and associated methods were used to examine the effects of treatment group on changes in cognitive performance over time. Analyses revealed that children receiving supplemental food with meat significantly outperformed all other children on the Raven's Progressive Matrices. Children supplemented with meat, and children supplemented with energy, outperformed children in the Control group on tests of arithmetic ability. There were no group differences on tests of verbal comprehension. Results suggest that supplementation with animal source food has positive effects on Kenyan children's cognitive performance. However, these effects are not equivalent across all domains of cognitive functioning, nor did different forms of animal source foods produce the same beneficial effects. Implications of these findings for supplementation programs in developing countries are discussed.

PMID: 14672297 [PubMed - indexed for MEDLINE]

Objective: To determine the prevalence and pattern of eye diseases and visual impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. Design: Community based survey conducted from October 15th to 31st 2007 Setting: Kibera and Dagoreti divisions of Nairobi City Subjects: 4200 people of all ages were randomly selected; 4056 were examined (96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined to be examined. Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only 241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti divisions are conjunctival disorders including allergic conjunctivitis and conjunctival growths. This was found to affect 7.6% of the subjects. This was followed by refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects (0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the subjects and corneal disorders in 0.5%. The prevalence of visual impairment was 0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates that most of the ocular disorders encountered were not visually threatening. The main cause of visual impairment is refractive errors and the causes of severe visual impairment and blindness are cataract, corneal opacity and glaucoma. Conclusion: The population of the NCES is relatively young and the prevalence of blindness and visual impairment is low. The main cause of visual impairment was refractive errors and the causes of severe visual impairment and blindness were cataract, corneal opacity and glaucoma. Recommendations: The level of blindness in NCES is low and the project should focus more on rendering eye care and not treatment of blindness. There is need to address the issue of refractive errors as this was one of the main ocular problems encountered. In this survey, it was not possible to perform detailed refraction and hence it was recommend that a refractive error survey be conducted; especially in school going children.

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The root of Solanum incanum is used by some Kenyan communities as a folklore remedy for fever, wounds, toothache, and stomach ache. However studies have not been done to validate these claims. The aim of this study was to investigate antinociceptive and antipyretic effects of Solanum incanum root extract using animal models. The antinociceptive assays were carried out using tail flick and hot plate tests on CBA mice. The 100 and 200 mg doses of Solanum incanum root extract showed significant antinociceptive activity (p < 0.05) in both hot plate and tail flick tests. In the antipyretic, assay fever was induced in Sprague Dawley rats using lipopolysacharide (LPS). The 50 mg dose of Solanum incanum extract exhibited significant antipyretic effect (p < 0.05) at 180 minutes while the 100 mg dose of S. incanum exhibited significant antipyretic effect (p < 0.05) at 120 and 180 minutes after the lipopolysaccharide pyrogen injection. The results obtained renders support to folklore use of Solanum incanum root extract for pain and fever. Keywords: Solanum incanum, Antinociceptive, Analgesic, Antipyretic, Fever.

Psychiatric morbidity among 200 medical in-patients at Kenyatta National Hospital was determined by a two-stage screening procedure, using the Self Reporting Questionnaire (SRQ) and standardized psychiatric interview (SPI). 44 (22%) of the total sample of 200 patients who were interviewed met the pre-established criteria for psychiatric morbidity; of these 59% comprised affective disorders. 4 (9%) of the psychiatric morbidity cases were referred for psychiatric evaluation. Referral seemed to be related to severity of illness and a previous history of psychiatric illness. There was no evidence in the notes that the psychiatric problems had been detected, treated or dealt with in any other way by the medical team in 34 patients out of 44 with psychiatric morbidity. Increase in the mental health input in the training of all health workers with emphasis on recognition and management of some of the commoner psychological problems is recommended.

Psychiatric morbidity among 200 medical in-patients at Kenyatta National Hospital was determined by a two-stage screening procedure, using the Self Reporting Questionnaire (SRQ) and standardized psychiatric interview (SPI). 44 (22%) of the total sample of 200 patients who were interviewed met the pre-established criteria for psychiatric morbidity; of these 59% comprised affective disorders. 4 (9%) of the psychiatric morbidity cases were referred for psychiatric evaluation. Referral seemed to be related to severity of illness and a previous history of psychiatric illness. There was no evidence in the notes that the psychiatric problems had been detected, treated or dealt with in any other way by the medical team in 34 patients out of 44 with psychiatric morbidity. Increase in the mental health input in the training of all health workers with emphasis on recognition and management of some of the commoner psychological problems is recommended.

The response to anti-allotype (anti-Ab4), Nocardia Water Soluble Mitogen (NWSM), pneumococcal polysaccharide type III (SSS III), and human Fc fragments of various purified and unfractionated rabbit spleen cell populations was determined in terms of 3H-thymidine up-take. B cells were isolated either from untreated suspensions of spleen cells or from suspensions from which adherent and phagocytic cells were removed. The purification factor was greater than the enhancement of 3H-thymidine uptake by anti-Ab4, NWSM, and SSS III as compared with the response of unfractionated spleen cells. It thus appears that a helper cell was involved: the mitogen response of purified B cells was enhanced by the addition of T cells. B subpopulations were separated by sedimentation or by rosetting, which allowed us to separate Fcgamma receptor-bearing cells from cells that did not possess this receptor. There were differences between cells responding to B mitogens not only in sedimentation velocity but also in the absolute number of cells. B cells bearing the Fcgamma receptor were less responsive to anti-Ab4 and more responsive to SSS III, NWSM, and human Fc than were B cells lacking the Fcgamma receptor.

The superfused retinal slice preparation was used to examine the morphology and glutamate-activated whole-cell currents of rabbit bipolar cells. There were six morphologically distinct types of cone bipolar cells and a rod bipolar cell that had axon terminals stratifying in stratum 3 to 5 of sublamina-b. All of these bipolar cell types exhibited an outward current in response to the application of the metabotropic glutamate receptor, mGluR6, agonist AP-4 (APB), and had I/V curves indicative of membrane channel closure. Conversely, there were no currents activated during the application of kainate, the AMPA/kainate receptor agonist. These data demonstrate they were on-bipolar cells. In addition, there were six morphologically distinct cone bipolar cells that stratified in sublamina-a. Every cell with axonal arborizations in stratum 1 and 2 exhibited an inward current when the ionotropic glutamate receptor agonist kainate was applied. This current was blocked by application of the AMPA/kainate receptor antagonist CNQX. These cells also decreased their membrane resistance in response to kainate, a characteristic of the opening of channels within the plasma membrane. Without exception, no cells stratifying in sublamina-a responded to the mGluR6 agonist AP-4, further identifying them as off-bipolar cells.

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Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

Exserohilum turcicum the causal agent of northern corn leaf blight is a threat to corn production in many areas of the world. The pathogen has a high genetic variability in terms of virulence, genetic structure and several races have been reported. Diseased corn plants from Kenya, Germany and Austria were used to isolate the pathogen following the standard isolation procedures. Detached leaf technique using leaves of maize plants with (Ht0) genes for resistance were used to evaluate aggressiveness and the parameters assessed included incubation period, size of chlorotic and necrotic lesions, lesion density, area under disease progress curve (AUDPC) and rate of lesion expansion. Differential cultivars bearing Ht1, Ht2, Ht3, HtN and Ht0 resistance genes were used to perform race typing on 87 isolates under greenhouse conditions. Isolates from the three countries showed a great variation in aggressiveness with incubation periods ranging from 2 to 6 days, lesion size ranging from 1.81 mm2 to 57.04 mm2, rate of lesion expansion ranging from 0.29 mm2/day to 21.67 mm2/day and AUDPC ranging from 31.3 mm2 to 133.9 mm2. Twelve races namely 0,1,2,3,N,12,13,13N,3N,123,23,23N were identified from the three countries. Race 2 was the most common and had 27% frequency of occurrence followed by race 0 and 1 which had frequency occurrence of 22% and 12% respectively. There was no distinct correlation between the type of the race and its origin and different races scattered within the various countries. The high level of genetic variability may explain the occurrence of the disease in the different geographical localities and the ability of the pathogen to infect most of the germplasm including the resistant varieties

Background

Diarrhoea is the second most common cause of death in children under 5 years of age in Kenya. It is usually treated with oral rehydration, zinc and continued feeding. Racecadotril has been in use for over 2 decades; however, there is a paucity of data regarding its efficacy from Africa.
Objectives

The objectives of this study were: to compare the number of stools in the first 48 hours in children with severe gastroenteritis requiring admission and treated with either racecadotril or placebo, to study the impact of racecadotril on duration of inpatient stay as well as duration of diarrhoea and to describe the side effect profile of racecadotril.
Methods

This was a randomised, double-blinded, placebo-controlled trial. It enrolled children between the age of 3 and 60 months who were admitted with severe acute gastroenteritis. They received either racecadotril or placebo in addition to oral rehydration solution (ORS) and zinc and were followed up daily.
Results

120 children were enrolled into the study. There were no differences in the demographics or outcomes between the 2 groups. Stools at 48 hours: median (IQR) of 5 (3–7) and 5 (2.5–7.5), respectively; p=0.63. The duration of inpatient stay: median (IQR): 4 days (1.5–6.5) and 4.5 (1.8–6.3); p=0.71. The duration of illness: 3 days (2–4) and 2 days (1–3); p=0.77. The relative risk of a severe adverse event was 3-fold higher in the drug group but was not statistically significant (95% CI 0.63 to 14.7); p=0.16.
Conclusions

Racecadotril has no impact on the number of stools at 48 hours, the duration of hospital stay or the duration of diarrhoea in children admitted with severe gastroenteritis and managed with ORS and zinc

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.

BACKGROUND: The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to compare surgical results in developed countries. Its ability to stratify postoperative mortality risk has been validated in several developed countries, however, this has not been examined in a developing country. OBJECTIVES: To assess the ability of the RACHS-1 system to stratify postoperative mortality risk in a developing country. DESIGN: Retrospective study over a five year period between 1st January 2002 and 31st December 2006. SETTING: Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya. SUBJECTS: Three hundred and seventeen consecutive operations were performed on 313 patients aged between 0.25 and 204 months. RESULTS: Operations were performed in RACHS-1 categories 1, 2, 3 and 4 with hospital mortalities of 2.5%, 16.9%, 29.4% and 50% respectively. The difference in mortality between categories 1 and 2 was significant (p-value of 0.0003), however, the difference in mortality between categories 2 and 3 and categories 3 and 4 was not significant (p-values 0.193 and 0.67 respectively). CONCLUSIONS: The RACHS-1 system did not adequately stratify risk in a low case load setting. The use of the RACHS-1 method as a benchmark to compare surgical results of paediatric cardiac surgery services in developing countries may be limited.

Activity concentrations of 226Ra, 232Th and 40K of limestone samples collected from Kitui South have been measured using Hyper Pure Germanium (HPGe) detector gamma ray spectrometry.  A total of 48 samples were collected from the limestone rock outcrops in the region.  The average activity concentrations varied from 28.3 to 47.4 with a mean value of 35.9 Bq/kg and 87.4 to 142.6 with an average of 108.5 Bq/Kg for 226Ra and 40K respectively.  232Th was below detection limits in all the samples.  The value of the absorbed dose rates, annual effective dose rates, external hazard index, gamma activity index and alpha index were all below the maximum recommended values for radiological safety and showed good comparison within other studies in the world.    

Radiation doses received by patients during dental x-ray examinations were measured in 95 patients referred to the X-ray Department of the Teaching Dental Hospital, University of Nairobi. The mean skin dose for single periapical films was 5.96 milligray (596 millirads) with the bitewing view recording a mean dose of 5.57 milligray (mGy). During a 14-film full-mouth periapical survey, mean doses ranged from 10.3-16.2 mGy for the upper jaw and 10.1-13.5 mGy for the lower jaw, respectively, depending on the region of dentition. In these full-mouth examinations, the distribution of skin dose over different parts of the dentition showed a characteristic pattern which may be explained by the overlap of radiation fields in the aggregated series of exposure. Orthopantomography recorded lower mean skin doses of 3.26 mGy in the molar region and 2.67 mGy at the posterior midline at the level of the 2nd cervical vertebra. The relative merits of intra-oral radiography versus orthopantomography are discussed, with radiation dosage as one of the factors to be considered. Some observations are made on measures to reduce patient dose

Radiation doses received by patients undergoing radiological examinations of the gastrointestinal tract have been measured in 405 patients at two major hospitals in Nairobi using thermoluminescent LiF dosimeters. Skin-entry doses were found to be high at one of the facilities (A) and very high at the other (B). Barium meal delivered mean doses of 77 mGy (7.7 rad) and 558 mGy (55.8 rad) at facilities A and B respectively, while the corresponding mean values for barium enema were 93 mGy (9.3 rad) and 712 mGy (71.2 rad). Differences between the two hospital mean doses were highly significant (p < 0.001). Doses to the thyroid gland and the gonads were also generally higher than those reported in other similar studies. Poor performance of old and ill-maintained radiological equipment, among other possible factors, is suggested to be the main cause of excessive patient exposure. Radiation risks to patients are considered in the context of such high doses being received by a generally young patient population. The authors suggest that there ought to be limits on the extent to which social and economic considerations in the provision of radiological services should be allowed to compromise sound principles in the radiation protection of the patient. It is recommended that increased efforts be directed at establishing and supporting quality assurance programmes for the performance testing of radiological equipment in Africa.

Abstract

The aim of this study was to estimate radiation doses patients and staff are exposed to during interventional procedures (IPs), compare them with the international diagnostic reference levels and to develop initial National Diagnostic Reference Levels. The IP survey was undertaken as the initial task of which, retrospective data were collected from the only four Kenyan hospitals carrying out interventional radiology and cardiology procedures at the time of the study. Real-time measurement of radiation dose to patients and staff during these procedures was done. To the patients, kerma-area product (KAP) and fluoroscopy time measurements were done using an in-built KAP meter, while peak skin dose (PSD) was measured using slow Extended Dose Range (EDR2®) radiographic films. The staff occupational doses were measured using individual thermoluminescence dosemeters. The maximum and minimum KAP values were found to be 137.1 and 4.2 Gy cm2, while the measured PSD values were 740 and 52 mGy, respectively. The fluoroscopic time range was between 3.3 and 70 min. The staff doses per procedure ranged between 0.05 and 1.41 mSv for medical doctors, 0.03 and 1.16 mSv for nurses, 0.04 and 0.78 mSv for radiographers and 0.04 and 0.88 mSv for clinical staff. The measured patient PSDs were within the threshold limit for skin injuries. However, with the current few IP specialists, an annual increase in workload as determined in the study will result in the International Commission on Radiation Protection annual eye lens dose limit being exceeded by 10 %. A concerted effort is required to contain these dose levels through use of protective gear, optimisation of practice and justification.

Radiation doses received by patients during chest X-ray examinations have been measured at six X-ray centres in Kenya. Absorbed doses from full-size radiography were found to be within acceptable limits at mean values of 29 millirad (0.29 milligray) per exposure for the postero-anterior view in adults and 20 millirad (0.20 milligray) for the antero-posterior view in children. The lateral view in full- ize examinations in children delivered a mean dose of 36 millirad (0.36 mGy). Photofluorography without image intensification delivered much higher doses, amounting to skin-entry doses of several hundred mrad per exposure, and showing large inter-hospital dose variations. Some observations are made on dose reduction measures.

Skin and gonad doses have been measured in 144 adult patients undergoing barium meal and barium enema examina-tions at a University Teaching Hospital. Intrahospital variations are discussed and their implications for national dose surveys considered, It is suggested that, due to differences in leakage and scattered radiation levels, overcouch tube machines may deliver higher doses to organs outside the useful beam than undercouch units, The study also points towards increased film consumption in GIT studies, National surveys of radiation doses to patients in diagnostic radiology are restricted to selected institutions over short periods of time. Consequently, although the dose data from such exercises may provide a broad picture of a national situation, detailed studies of intrahospital and interhospital variations for anyone type of examination are made difficult by the small numbers of examinations carried out at anyone institution during national surveys. Detailed surveys of doses received in selected examinations at single institutions, or within limited regions, enable better analysis of such variations to be made. Matthews and Miller (1969) have reported the results of a regional survey in Great Britain. A large hospital with staff of varying levels of skill provides a suitable environment for studying within-hospital dose variations. When a particular type of examination is performed by several radiologists in rotation, the "personal factor" in dose variation tends to be evened out in the mean values obtained. Furthermore, the use of uniform film¬processing conditions removes another of the , traditional causes of variations. The present survey was undertaken at the University Hospital of South Manchester in Great Britain. Studies of the radiation exposure to patients in diagnostic examinations of the gastro-intestinal tract (GIT) are important because this group of investigations gives large doses to the active bone marrow as well as the gonads of the irradiated individuals. Following a sharp decline in the frequency of mass miniature chest radiography, GIT studies now probably make the largest contribution to the annual ner canut mean bone marrow dose in Great Britain. despit~ their low frequency compared to othe; diagnostic examinations. The relatively low con¬tribution of GIT studies to the genetically-significant dose (Wall et ai, 1980) is due to a combination of their low frequency and the age distribution of the patients examined (Kendall et ai, 1980). It may be possible that the somatic stochastic risks associated with this group of examinations are more important than the genetic risks. However, the computation of mean bone marrow doses, which requires a model combining data on the distribution of active bone marrow in different segments of the body with estimated radiation doses to the bone marrow in those segments, is beyond the objectives of this paper. In the present work, gonad doses in male patients, and abdominal skin doses in female patients, have been measured for larger numbers of patients than are normally achieved at individual institutions during national surveys. In female patients, ovary doses have been calculated from the skin doses. In the case of barium enema examinations the skin doses may be found useful in estimating mean bone marrow doses.

The development of radiation protection guidelines as contained in the 'Ten Day Rule' are reviewed. Facts for and against the rule and the changing altitudes in radiation protection leading to the 'death' of the 'Ten Day Rule' (I) are discussed. The current recommendation by the International Commission on Radiation Protection (ICRP) and the adaptation of the recommendation by the National Radiation Protection Board (NRPB) UK, and the Royal College of Radiologists (RCR) UK, are given. Some policy statements by the American College of Radiology (ACR) are also discussed. A few recommendations are put forward for the professional bodies and teaching institutions, in order to make them aware of the new radiation protection measures.

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%).

Ablation of the synovium with radiopharmaceuticals, referred to as radiation synovectomy, (RS),has emerged as a simple affordable and safe procedure that is highly effective in preventing chronic disabling end stage arthritis in haemophilia patients. Objective: To provide a review of the principles and role of radiation synovectomy, (RS), in the management ofhaemophiliacpatients with chronichaemarthrosis, and to consider the possibility of this treatment option in Kenyan patients with haemophilia. Data sources: A literature search through the internet using Boolean commands, PubMed interface to MEDLINE, Evidence, the Cochrane library. Papers from reputable haematology and radiation medicine journals, as well as conference presentations of the World Federation of Hemophilia were also included. Data selection: The searches for papers, abstracts and reviews were limited to English language, haemophilia, haemarthrosis, synovectomy, RS, radiopharmaceuticals for RS and safety of RS. Data extraction: All abstracts, and most of the papers were reviewed. Only those abstracts, papers and conference materials from reputable sources were used for this paper. Data synthesis: All available papers and abstracts were reviewed for the most up to date information. The indications, requirements, procedure and safety aspects of RS were examined. The merits of alternative forms of synovectomy were considered. In the light of this information, the feasibility ofRS as a treatment option for haemophilia patients in Kenya was considered. Conclusion: Radiation synovectomy has been carried out on thousands of haemophilia patients with chronic haemathrosis over the last 20 years. Experience accumulated in numerous centres in America, Europe, Asia, North and South Africa indicates that majorityofhaemophilia patients undergoing RS are spared life long crippling arthritis and deformity. The principle safety concern of the potential for late radiation- related malignancy has been mitigated by appropriate choice of radiopharmaceuticals, and carefully executed procedure. The effectiveness, simplicity and affordability of RS make it particularly suitable for treatment of haemophilia patients in developing countries like Kenya.

A preliminary study of microbiological quality of honey was carried out using 26 samples obtained from the National Bee Keeping Research Station. Total viable counts (TVC) of aerobic bacteria, yeasts and moulds, and Clostridium species were done. Of the 26 samples, 24 (92.3%) had a TVC ranging from 3 x10 -87 x 10 colony forming units (cfu) per gram of honey. Two samples did not yield any microorganisms. Of the 24 positive samples, 9 (37.5%) were found to contain Clostridium species per gram while eight (33.3%) were positive for moulds with counts ranging from 10-100 c.f.u / g. No yeasts were detected. In addition, three samples yielded the three types of microorganisms.

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Radioactivity measurements were carried out around Maumba and Nguluku villages, two of the proposed sites for titanium mining in the coastal area of Kenya. Samples of surface soils were analyzed using a HPGe gamma spectrometer. The average activity concentrations for …

Normal anatomical values regarding size and patterns of maxillary sinuses often refer to standards obtained in population groups in western countries, This study aims to deduce normal radiographic values of maxillary sinus size and patterns of frontal and maxillary sizes in Kenyan adults. Standard occipitomental radiographs of patients referred to the University of Nairobi Dental Hospital formed the material of study and analysis included mean height and width of maxillary sinuses. Data for mean population sizes were computed accordingly There was no statistically significant differences between the results obtained in this study and those quoted in standard textbooks. The study concludes that size measurements for the maxillary sinus can be 'accurately derived from standard occipitomental radiography,

OBJECTIVE: To record the costs of hospital care for HIV-positive and -negative patients in Nairobi, and identify costs paid by patients per admission. DESIGN: Cost data were collected on inpatients enrolled in a linked clinical study using standardized costing methods. SETTING: Kenyatta National Hospital, Nairobi's main district hospital. PATIENTS: Consecutive adult medical admissions to one ward over 14 weeks who consented to enrollment; tertiary referrals were excluded. MAIN OUTCOME MEASURE: Average length of stay and cost per patient admission. RESULTS: The hospital costs of 398 patients (163 HIV positive; 33 with clinical AIDS) were analysed. The mean length of stay was 9.3 days and the mean cost per patient admission was US$163. There was no significant difference in costs or mean lengths of stay between HIV-positive and -negative groups, nor were the costs and lengths of stay for clinical AIDS patients significantly different to those for HIV-positive patients without AIDS. The patient charges paid to the hospital per admission, recorded for 344 patients, were on average US$61; and did not differ by HIV status. CONCLUSION: The similar cost patterns for inpatient care irrespective of HIV status or clinical AIDS probably reflects the limited provision of care beyond basic clinical services. Length of stay rather than differing treatment regimes thus appears to be the main cost driver. Private costs of medical care were high and were likely to pressurize households. When resources are limited, the introduction of new, more costly therapies needs careful planning. The study provides cost information for planning care services in resource-poor settings.

Dental anomalies were observed in 43 of 1,226 barren-ground caribou (Rangifer tarandus groenlandicus) taken between 1966 and 1968. In five of these 43 animals, the mandibles had deformities which radiography showed to be the result of dental abscesses in four cases and probably of a trauma in the other. The absence of actinomycotic lesions of the jaw bones of these 1,226 animals, and of more than 500 examined previously, indicates that "lumpy jaw" is rare in barren-ground caribou. The authors suggest the use of radiography to determine the nature of bone growth on skeletal remains, in the absence of soft tissues for examination for Actinomyces, either microscopically or by cultural methods.

The objective of the study was to determine the common radiographic features in laminitic claws from dairy cows using abattoir samples. A total of 192 claws were collected from Wangige slaughter slab and 126 claws from Kiserian abattoir. The claws were examined for gross lesions. Dorso-palmar/ dorso-plantar and lateral radiographic exposures of each clawwere taken and evaluated for radiographic changes. Subclinical and chronic laminitis was respectively present in 35% and 21% of the claws examined and 44% of the claws showed extreme deformities. Concurrent appearance of lesions was in 27% of the claws.Radiographic changes were observed in the pedal bones but not in the adjacent joints. Dilated vascular channels (61%) and prominently visible non-dilated vascular channels (24%) in the pedal bones were observed in subclinical and chronic laminitis. The most frequently observed radiographic changes in pedal bones were: irregular (serrated) margins (14%), exostoses (8%), and narrowing (6%), complete absence (3%) or partial absence (1%) of its apex.Other changes on the pedal bones were: rotation (4%), "dropping (sinking)" (3%), fissure fractures (2%), periostitis (1%) and osteolysis (1%). Most of these radiographic changes were seen in claws that had chronic laminitis with extreme deformities. It is concluded that radiographic changes in laminitis occur during the chronic phase and are most severe when concurrent extreme deformities of the claws are present.

The objective of the study was to determine the common radiographic features in laminitic claws from dairy cows using abattoir samples. A total of 192 claws were collected from Wangige slaughter slab and 126 claws from Kiserian abattoir. The claws were examined for gross lesions. Dorso-palmar/ dorso-plantar and lateral radiographic exposures of each clawwere taken and evaluated for radiographic changes. Subclinical and chronic laminitis was respectively present in 35% and 21% of the claws examined and 44% of the claws showed extreme deformities. Concurrent appearance of lesions was in 27% of the claws.Radiographic changes were observed in the pedal bones but not in the adjacent joints. Dilated vascular channels (61%) and prominently visible non-dilated vascular channels (24%) in the pedal bones were observed in subclinical and chronic laminitis. The most frequently observed radiographic changes in pedal bones were: irregular (serrated) margins (14%), exostoses (8%), and narrowing (6%), complete absence (3%) or partial absence (1%) of its apex.Other changes on the pedal bones were: rotation (4%), "dropping (sinking)" (3%), fissure fractures (2%), periostitis (1%) and osteolysis (1%). Most of these radiographic changes were seen in claws that had chronic laminitis with extreme deformities. It is concluded that radiographic changes in laminitis occur during the chronic phase and are most severe when concurrent extreme deformities of the claws are present.

The objective of the study was to determine the common radiographic features in laminitic claws
from dairy cows using abattoir samples. A total of 192 claws were collected from Wangige slaughter
slab and 126 claws from Kiserian abattoir. The claws were examined for gross lesions. Dorso-palmar/
dorso-plantar and lateral radiographic exposures of each clawwere taken and evaluated for radiographic
changes. Subclinical and chronic laminitis was respectively present in 35% and 21% of the claws
examined and 44% of the claws showed extreme deformities. Concurrent appearance oflesions was in
2~Al ofthe claws.Radiographic changes were observed in the pedal bones but not in the adjacent joints.
Dilated vascular channels (61%) and prominently visible non-dilated vascular channels (24%) in the
pedal bones were observed in subclinical and chronic laminitis. The most frequently observed radiographic
changes in pedal bones were: irregular (serrated) margins (14%), exostoses (8%), and narrowing (6%),
complete absence (3%) or partial absence (1%) of its apex.Other changes on the pedal bones were: rotation
(4%), "dropping (sinking)" (3%), fissure fractures (2%), periostitis (1%) and osteolysis (1%). Most of
these radiographic changes were seen in claws that had chronic laminitis with extreme deformities. It
is concluded that radiographic changes in laminitis occur during the chronic phase and are most severe
when concurrent extreme deformities of the claws are present.

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Department of Orthopaedic Surgery, College of Health Sciences, University of Nairobi, Kenya. A case report is presented of a 53 year old man who presented with posterior dislocation of the hip after a road traffic accident. Initial management by closed reduction failed due to presence of an occult free intra-articular fragment. This fragment was not visualised on plain A-P and lateral X-ray views. The cause of the failed closed reduction was eventually detected by CT scan. Open reduction and removal of the bone fragment was done and the hip remained stable thereafter. It is concluded that plain X-rays are not adequate in the diagnosis of free intra-articular bone fragments within the hip joint and CT scanning is advised for accurate detection of such occult bine fragments.

Five plaster of Paris casting bandages including Nairobi Enterprises, salvagyps, helm, Plasrunpgyps and Veronese, available on the Kenyan market were evaluated based on their resistance to abrasion. The mean loss in mass per square area for Nairobi enterprises and Salvagyps was significantly lower (P<0.05) indicating that these two products were more resistance to abrasion. A new method of evaluation of resistance to abrasion is also described

ABSTRACT The literature and research on domestic violence against women have

received increased attention in the 1980's and 1990's, but research on wife beating/battering

is still sparse. This paper reports from a research project in Nairobi that focused on the legal

experiences of battered women and their perceptions of the violence. Findings reveal that the

problem of battering is rampant and most battered women do not seek legal intervention. It

was also found that a majority of the women remained in intimate relationships with their

batterers due to economic dependence on the batterers and lack of alternatives outside the

relationship.

Key Words: Domestic violence; Legal Experiences; Nairobi; Kenya.

The radiological features of Burkitt's Lymphoma were
assessed in 49 children with a histological diagnosis of
Burkitt's lymphoma admitted to the Kenyatta National Hospital
Paediatric wards. The commonest radiological findings were
associated with abdominal lymphomas seen in 65.2% of the
cases. The least findings were associated with cervical
adenopathy seen in 3.3% and a similar number had pleural
effusion. Disease extent on radiological evaluation was
greater than as assessed clinically alone. For instance,
while 20 cases were clinically found to have disease confined
to the facial bones, on radiological evaluation 5 of the 20
cases were found to have Burkitt's Lymphoma deposits in the
abdominal viscera besides the facial lesions. The age
range was 2-14 years with the incidence falling rapidly after
10 years. The male female ratio was 2.3 : 1. Peak
incidence was at 5 - 7 years. The highest incidence was found
among tribes residing in endemic malarial areas. The Luo had
the highest incidence with 19 cases (38.8%) followed by the
Luhya with 11 cases (22.4%).

Carbonatites and alkaline intrusive complexes are rich in a variety of mineral deposits such as rare earth elements (REEs), including Nb, Zr and Mn. These are often associated with U and Th bearing minerals, including monazite, samarskite and pyrochlore. Mining waste resulting from mineral processing activities can be highly radioactive and therefore poses a risk to human health and environment. The Jombo complex located in Kenya's south coastal region is potentially one of the richest sources of Nb and REEs in the world. It consists of the main intrusion at Jombo hill, three associated satellite intrusions at Mrima, Kiruku and Nguluku hills, and several dykes. The complex is highly heterogeneous with regard to its geological formation as it is characterized by alkaline igneous rocks and carbonatites which also influence its radio-ecological dynamics. In-situ gamma spectrometry offers a low-cost, rapid and spatially representative radioactivity estimate across a range of landscapes compared to conventional radiometric techniques. In this work, a wide ranging radiological survey was conducted in the Jombo complex as follow up on previous studies[1,2], to determine radiation exposure levels and source distributions, and perform radiological risk assessments. The in-situ measurements were carried out using a 2.0 l NaI(Tl) PGIS-2 portable detector from Pico Envirotec Inc integrated with GPS, deployed for ground (back-pack) and vehicular gamma-ray spectrometry. Preliminary results of radiological distribution and mapping will be presented. [1] Patel, J. P. (1991). Discovery and Innovation, 3(3): 31-35. [2] Kebwaro, J. M. et. al. (2011). J. Phys. Sci., 6(13): 3105-3110.

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The use of products containing naturally occurring radioactive materials (NORM) such as minerals, quarry, sand, clays, etc is widespread in Rwanda, but they are not subject to radiological quality control.  This paper presents the results of studies on the occupational radiation exposure due NORM in the extraction and processing of the Columbite-Tantalite (Coltan) mineral in the Muhanga, Ruli and Ngoma areas of Rwanda, by artisanal miners.  Activity concentration of primordial radionuclides, 40K, 238U and 232Th series in coltan ore (extracted, processed), soil, and mine tailing sediment were determined by HPGe-based gamma-ray spectrometry.  The average activity             concentrations of 238U were 50.2-972.9 Bq kg-1, 64.3-2011.8 Bq kg-1 and 70.7-853.3 Bq kg-1 in Muhanga, Ruli and Ngoma respectively.  These values are far higher than the world average of 35 Bq kg-1.  In all samples from the three regions, the activity concentrations of 40K were below average of 500 Bq kg-1 with the processed ore being   the lowest (< 30 Bq kg-1).  This implies that 40K is primarily in soil and not the ore.  The  average activity of 232Th (44.78-75.5 Bq kg-1) for processed coltan was greater than the world average, while the average activity for 232Th (26.7 Bq kg-1) in the extracted coltan was below the world wide average.  This indicates that 232Th is enhanced when processing coltan.  Based on these values and the working scenarios in artisanal coltan        mining, the occupational doses that may accrue from a variety of exposure pathways were determined by model calculation.  The working scenarios considered included digging to exposure the coltan ore, drying the coltan in open air, grinding, and sieving the dried coltan.  The exposure pathways considered in the dose calculation included external exposure due to gamma-rays from bulk materials containing gamma emitting  radionuclides, external exposure due to sumersions in air containing radioactive dust and the internal exposure due to ingestion and inhalation of radionuclides.  Among the exposure pathways considered, inhalation of coltan bearing dust resulted in the highest does while crushing and sieving coltan in the mill; 0.27, 0.52, 0.25 mSv per annum on  average in Muhanga, Ruli and Ngoma respectively.  These values are below 1 mSv y-1 which are the values recommended by ICRP for the public and occupational exposure respectively.  These results are however important in establishing radiological regulatory  protocol for occupational exposure in artisanal coltan mining since the area is a HBRA (X 11 the world average).  Key words:  Coltan; Processed coltan; Extracted coltan; Background radiation, Naturally Occurring Radioactive Materials (NORM); High Background Radiation Areas (HBRA).    

An enzyme-linked immunosorbent assay (ELISA) has been developed to detect amebic antigen in polyethylene-glycol-precipitable circulating immune complexes. Seventy-nine percent of 191 patients with amebic liver abscesses and 46% of 26 Entamoeba histolytica cyst passers had positive tests. None of the samples from 43 apparently healthy controls, 8 patients with past amebic liver abscesses or 31 patients with Giardia lamblia infections were positive. One patient out of 32 with viral hepatitis and 1 patient out of 27 with intestinal tuberculosis had positive tests.

Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.

Full report on the derivation of rain characteristics and consequential application to microwave linkk designs.

The paper shows that in the analysis of a queuing system with fixed-size batch arrivals, there emerges a set of polynomials which are a generalization of Chebyshev polynomialsof the second kind. The paper uses these polynomials in assessing the transient behaviour of the overflow (equivalently call blocking) probability in the system. A key figure to noteis the proportion of the overflow (or blocking) probability resident in the transient component,which is shown in the results to be more significant at the beginning of the transient and naturally decays to zero in the limit of large t. The results also show that the significanceof transients is more pronounced in cases of lighter loads, but lasts longer for heavier loads.

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Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.

In semi arid Kenya, the occurrence of flush floods and soil erosion on agricultural watersheds is attributed to intense rainstorm events of short duration. Thus when agricultural watersheds have no erosion control structures in place, the generation of direct runoff would increase with cultivation. Of the two components of runoff namely, runoff volume and peak runoff discharge, the consideration of peak runoff discharge rate is critical to the design of effective hydraulic structures for controlling floods and soil erosion. In order to accurately predict a watershed's peak runoff discharge, it is important to select a model that is deterministic and yet simple to use. The model should be able to consider the time distribution of runoff response as influenced by Watershed characteristics. The time to peak runoff discharge is largely influenced by the time of concentration. The time of concentration depends on the shape, size and relief of the watershed. In Iiuni Watershed, the Nash model, a parsimonious deterministic model, was selected to predict peak runoff discharges. This model uses the instantaneous unit hydrograph principle to simulate the direct runoff hydrographs and estimate peak runoff discharge. The Nash model was applied using input parameters derived from the watershed's rainfall-runoff characteristics. The results obtained showed that the Nash model was good in predicting peak runoff discharges. This statistic of comparison, R2 (coefficient of efficiency) for the model was above 70% for the model which is indicative of good model prediction of peak runoff discharge (Nash and Sutcliffe, 1970). From this analysis, the Nash model is recommended for the estimation of peak runoff discharge from un-gauged agricultural watersheds in Kenya.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

Ethiopia is one of the countries on the eastern side of Africa which has high spatial and temporal variability of rainfall. The trade winds are the major source of moisture in this region. The chatacteristics of the trade winds are controlled by the location, intensity and orientation of the majorbquasi-permanent anticyclones of Africa together with other general circulation parameters such as sea surface temperatures, jet streams, easterly waves and extratropical weather systems. The study showed that years of strong El-Nino are characterized by severe droughts over Ethiopia.

A double antibody enzyme linked immunosorbent assay for identification of thermostable muscle antigens of autoclaved meat samples is described. The assay differentiates heterologous thermostable muscle antigens from homologous at P 0.001. In model meat mixtures, the assay detects adulterants at the level of 1% at p0.001 even in phylogenetically related species such as buffalo and cattle.

When rainfall is received on a watershed, depending on the ini al soil moisture content some of the water seeps underground while the excess forms surface water response. The nature of the runoff and its effects in the watershed can be represented by the applica on of hydrologic models to predict streamfl ow. In this study, the Geological Streamfl ow Model (GeoSFM) and the Muskingum Cunge (M-C) model were used to model the hydrologic processes of the Yala river network. The objec ve of the study was to develop a flood early warning system to mi gate poten al fl ood hazard risk exposed to the downstream inhabitants. Historical hydro-metric datasets of 1975-2005 were used for calibra on, verifi ca on and streamfl ow rou ng based on a split record analysis. For the runoff genera on, rainfall and evapora on datasets were provided by the Kenya Meteorological Department (KMD) while for model calibra on and verifi ca on, streamfl ow was obtained from Water Resources Management Authority (WRMA). To determine the hydrologic connec vity, the 30 meters by 30 meters Digital Eleva on Model was obtained from the Interna onal Centre for Research in Agro-Forestry (ICRAF). The Digital Soil Map of the World developed by Food and Agricultural Organiza on (FAO) and the Global Land Cover data of the United States Geological Survey (USGS) were used for model pa- rameteriza on. The soil moisture accoun ng and rou ng method transferred water through the subsurface, overland and river phases. The percentage of the square of the correla on coeffi cient (R2% value) was used to determine model performance. The GeoSFM modeled streamfl ow at the Bondo streamflow gauging sta on, coded 1FG02 where during the calibra on and verifi ca on phases, streamfl ow was modeled at R2 value of 80.6% and 87.3% respec vely. The M-C model routed streamfl ow from 1FG02 to the Kadenge streamflow gauging sta on, coded 1FG03 at R2 value of 90.8%, Muskingum K value of 2.76 hours and Muskingum X value of 0.4609. The error in predicted peak streamfl ow was 2.3% with a posi ve 1.5% error in predicted speed. This ensured a forecast of the me of peak streamfl ow on the safe side before the actual fl ood peak arrival at 1FG03 sta on. It was concluded that the GeoSFM and M-C models were hence useful tools for flood mi ga- on by issuing fl ood early warning messages defi ned by peak streamfl ow and fl ood wave travel me.

This article is about the programmes aimed at improving food production for greater self sufficiency at the household level based on clear identification of existing qualities of soil and water resources. Baringo district has varied soil types, ranging from high potential soils to low potential soils (60-70% land area) which require a bit of reinforcement, irrigation and improvement before any crops can be grown. Lack of rainfall in a good part of the district confines rain-fed agriculture to only a few parts. For most parts of the district only irrigation can facilitate production of any food and cash crops.

Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

There are multiple subtypes of HIV-1 circulating worldwide, but recently, subtype C has become highly prevalent, particularly in certain geographic regions. It is unclear whether the dominance of subtype C or other subtypes is due to increased fitness of certain subtypes for transmission, or a founder effect in new, rapidly growing epidemics. To examine whether the prevalence of one subtype increases over the course of an expanding epidemic that includes several circulating subtypes, we examined the distribution of HIV-1 subtypes in Kenya from 1986 to 2000. We found no evidence for an increase in the prevalence of subtype C, which remained low throughout this approximately 15-year period. Interestingly, the percentage of subtype D present in the population decreased significantly over that period, with a slight increase in subtype A. Throughout that period, intersubtype recombinant viruses were detected, including at the early stages of the epidemic. This latter finding suggests that reinfection may have occurred in high-risk groups early in the epidemic, leading to intersubtype recombinant viruses that underwent secondary spread.

OBJECTIVES: To determine the status of blood donor haematology in two regional sites in Kenya and to assess the potential role of automated haematology in National blood bank process control. DESIGN: A cross sectional descriptive study. SETTING: Two regional blood banks–Nairobi and its environs (Blood Transfusion Services, Nairobi) and Western Region (National Blood Transfusion Services, Kisumu). MAIN OUTCOME MEASURES: Distribution, mean, median, and 95% percentile ranges of haemoglobin (Hb), red cell parameters (red cell count, haematocrit, MCV, MCH and MCHC), total and differential white blood cell (WBC) counts, and platelet counts in the two donor populations. RESULTS: A significant number of donations (16.5% in Kisumu and 3.4% in Nairobi) showed haemoglobin levels below the recommended National Blood Transfusion Service (NBTS) guideline of 42g/unit. Compared to Kisumu, Nairobi donors had significantly (p < 0.001) higher Hb, MCV and MCH values while the red blood cell counts and MCHC values were similar (p > 0.05). A low MCV (< 78 fl) was observed in 12.4% and 3.4% of Kisumu and Nairobi donors respectively. Both populations showed similar but significant frequencies (Kisumu, 21.3%; Nairobi, 18.7%) of mild neutropenia (< 1.5 x 10(9)/1), while eosinophilia (> 0.5 x 10(9)/1 in the tropics the cut off is > 0.6 x 109) was more prominent in Kisumu donors (18.8% versus 8.5%). Platelet counts were also significantly lower in Kisumu donors, with the prevalence of thrombocytopenia (< 150 x 10(9)/1) being considerably higher (15.9% versus 3.7%). CONCLUSIONS: A significant number of Kenyan donors showed abnormal haematology profiles that may indicate underlying pathology. Such abnormalities are not detected by current blood transfusion services screening practices and there may be a need to strengthen donor selection criteria to protect both donors and recipients.

Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, P. O. Box 19676, Nairobi, Kenya. OBJECTIVES: To determine the status of blood donor haematology in two regional sites in Kenya and to assess the potential role of automated haematology in National blood bank process control. DESIGN: A cross sectional descriptive study. SETTING: Two regional blood banks–Nairobi and its environs (Blood Transfusion Services, Nairobi) and Western Region (National Blood Transfusion Services, Kisumu). MAIN OUTCOME MEASURES: Distribution, mean, median, and 95% percentile ranges of haemoglobin (Hb), red cell parameters (red cell count, haematocrit, MCV, MCH and MCHC), total and differential white blood cell (WBC) counts, and platelet counts in the two donor populations. RESULTS: A significant number of donations (16.5% in Kisumu and 3.4% in Nairobi) showed haemoglobin levels below the recommended National Blood Transfusion Service (NBTS) guideline of 42g/unit. Compared to Kisumu, Nairobi donors had significantly (p < 0.001) higher Hb, MCV and MCH values while the red blood cell counts and MCHC values were similar (p > 0.05). A low MCV (< 78 fl) was observed in 12.4% and 3.4% of Kisumu and Nairobi donors respectively. Both populations showed similar but significant frequencies (Kisumu, 21.3%; Nairobi, 18.7%) of mild neutropenia (< 1.5 x 10(9)/1), while eosinophilia (> 0.5 x 10(9)/1 in the tropics the cut off is > 0.6 x 109) was more prominent in Kisumu donors (18.8% versus 8.5%). Platelet counts were also significantly lower in Kisumu donors, with the prevalence of thrombocytopenia (< 150 x 10(9)/1) being considerably higher (15.9% versus 3.7%). CONCLUSIONS: A significant number of Kenyan donors showed abnormal haematology profiles that may indicate underlying pathology. Such abnormalities are not detected by current blood transfusion services screening practices and there may be a need to strengthen donor selection criteria to protect both donors and recipients.

OBJECTIVES: To determine the status of blood donor haematology in two regional sites in Kenya and to assess the potential role of automated haematology in National blood bank process control. DESIGN: A cross sectional descriptive study. SETTING: Two regional blood banks–Nairobi and its environs (Blood Transfusion Services, Nairobi) and Western Region (National Blood Transfusion Services, Kisumu). MAIN OUTCOME MEASURES: Distribution, mean, median, and 95% percentile ranges of haemoglobin (Hb), red cell parameters (red cell count, haematocrit, MCV, MCH and MCHC), total and differential white blood cell (WBC) counts, and platelet counts in the two donor populations. RESULTS: A significant number of donations (16.5% in Kisumu and 3.4% in Nairobi) showed haemoglobin levels below the recommended National Blood Transfusion Service (NBTS) guideline of 42g/unit. Compared to Kisumu, Nairobi donors had significantly (p < 0.001) higher Hb, MCV and MCH values while the red blood cell counts and MCHC values were similar (p > 0.05). A low MCV (< 78 fl) was observed in 12.4% and 3.4% of Kisumu and Nairobi donors respectively. Both populations showed similar but significant frequencies (Kisumu, 21.3%; Nairobi, 18.7%) of mild neutropenia (< 1.5 x 10(9)/1), while eosinophilia (> 0.5 x 10(9)/1 in the tropics the cut off is > 0.6 x 109) was more prominent in Kisumu donors (18.8% versus 8.5%). Platelet counts were also significantly lower in Kisumu donors, with the prevalence of thrombocytopenia (< 150 x 10(9)/1) being considerably higher (15.9% versus 3.7%). CONCLUSIONS: A significant number of Kenyan donors showed abnormal haematology profiles that may indicate underlying pathology. Such abnormalities are not detected by current blood transfusion services screening practices and there may be a need to strengthen donor selection criteria to protect both donors and recipients.

OBJECTIVES: To determine the prevalence of malaria in donor units in a low and a high endemic region in Kenya and evaluate the cost effectiveness of recipient anti-malarial prophylaxis and pre-transfusion screening (using an automated method) as options to prevent post transfusion malaria. DESIGN: A descriptive cross-sectional study. SETTING: Two regional blood banks, Nairobi and its environs (National Blood Transfusion Services, Nairobi) a low malaria endemic region and western region (National Blood Transfusion Services, Kisumu) high malaria endemic region. SUBJECTS: All the donated units were included in the study for analysis, during the duration of study, from the two study sites. MAIN OUTCOME MEASURES: Prevalence of malaria in donor units in low endemic area (Nairobi) and high endemic area (Kisumu). Cost per case prevented for the two options, Option I Prophylactic administration of anti-malarial (sulfadoxine pyrimethamine SP) drugs to recipients, and Option II pre-transfusion screening using an automated technique. RESULTS: A malaria prevalence of 0.67% was found in Nairobi and its environments (low endemic) and 8.63% for Kisumu and its environments (high endemic area). The cost analysis showed a cost per case prevented of Ksh.105 (US$1.4) adult, Ksh.52.5 (US$0. 69) and paediatric for the option of recipient prophylaxis using an SP based drug. The cost escalated to Ksh.592 (US$7.79) adult Ksh.444 (US$5.84) paediatric if the prophylaxis was upgraded to the recommended artemisinin derivative (ACT-artemisinin based combination) and for the option of pre-transfusion screening using an automated technique the cost was Ksh.2.08 (US$0.03). CONCLUSION: The prevalence of malaria in donors showed the expected regional variation in the low and high endemic areas and was comparable to data obtained elsewhere. If malaria positive donor units were to be excluded from the national blood supply, an estimated 5% (compared to 1.3% for human Immunodeficiency virus, 3.6% for hepatitis B virus and 1.3% for hepatitis C virus) would be wasted. The cost per case prevented of transfusion-associated malaria is considerably higher for recipient antimalarial prophylaxis than pre-transfusion screening using an automated technique. The cost escalates by five to seven times if the newer artemesinin based combination antimalarial drugs are adopted.

OBJECTIVES: To determine the prevalence of malaria in donor units in a low and a high endemic region in Kenya and evaluate the cost effectiveness of recipient anti-malarial prophylaxis and pre-transfusion screening (using an automated method) as options to prevent post transfusion malaria. DESIGN: A descriptive cross-sectional study. SETTING: Two regional blood banks, Nairobi and its environs (National Blood Transfusion Services, Nairobi) a low malaria endemic region and western region (National Blood Transfusion Services, Kisumu) high malaria endemic region. SUBJECTS: All the donated units were included in the study for analysis, during the duration of study, from the two study sites. MAIN OUTCOME MEASURES: Prevalence of malaria in donor units in low endemic area (Nairobi) and high endemic area (Kisumu). Cost per case prevented for the two options, Option I Prophylactic administration of anti-malarial (sulfadoxine pyrimethamine SP) drugs to recipients, and Option II pre-transfusion screening using an automated technique. RESULTS: A malaria prevalence of 0.67% was found in Nairobi and its environments (low endemic) and 8.63% for Kisumu and its environments (high endemic area). The cost analysis showed a cost per case prevented of Ksh.105 (US$1.4) adult, Ksh.52.5 (US$0. 69) and paediatric for the option of recipient prophylaxis using an SP based drug. The cost escalated to Ksh.592 (US$7.79) adult Ksh.444 (US$5.84) paediatric if the prophylaxis was upgraded to the recommended artemisinin derivative (ACT-artemisinin based combination) and for the option of pre-transfusion screening using an automated technique the cost was Ksh.2.08 (US$0.03). CONCLUSION: The prevalence of malaria in donors showed the expected regional variation in the low and high endemic areas and was comparable to data obtained elsewhere. If malaria positive donor units were to be excluded from the national blood supply, an estimated 5% (compared to 1.3% for human Immunodeficiency virus, 3.6% for hepatitis B virus and 1.3% for hepatitis C virus) would be wasted. The cost per case prevented of transfusion-associated malaria is considerably higher for recipient antimalarial prophylaxis than pre-transfusion screening using an automated technique. The cost escalates by five to seven times if the newer artemesinin based combination antimalarial drugs are adopted.

OBJECTIVES: To determine the prevalence of malaria in donor units in a low and a high endemic region in Kenya and evaluate the cost effectiveness of recipient anti-malarial prophylaxis and pre-transfusion screening (using an automated method) as options to prevent post transfusion malaria. DESIGN: A descriptive cross-sectional study. SETTING: Two regional blood banks, Nairobi and its environs (National Blood Transfusion Services, Nairobi) a low malaria endemic region and western region (National Blood Transfusion Services, Kisumu) high malaria endemic region. SUBJECTS: All the donated units were included in the study for analysis, during the duration of study, from the two study sites. MAIN OUTCOME MEASURES: Prevalence of malaria in donor units in low endemic area (Nairobi) and high endemic area (Kisumu). Cost per case prevented for the two options, Option I Prophylactic administration of anti-malarial (sulfadoxine pyrimethamine SP) drugs to recipients, and Option II pre-transfusion screening using an automated technique. RESULTS: A malaria prevalence of 0.67% was found in Nairobi and its environments (low endemic) and 8.63% for Kisumu and its environments (high endemic area). The cost analysis showed a cost per case prevented of Ksh.105 (US$1.4) adult, Ksh.52.5 (US$0. 69) and paediatric for the option of recipient prophylaxis using an SP based drug. The cost escalated to Ksh.592 (US$7.79) adult Ksh.444 (US$5.84) paediatric if the prophylaxis was upgraded to the recommended artemisinin derivative (ACT-artemisinin based combination) and for the option of pre-transfusion screening using an automated technique the cost was Ksh.2.08 (US$0.03). CONCLUSION: The prevalence of malaria in donors showed the expected regional variation in the low and high endemic areas and was comparable to data obtained elsewhere. If malaria positive donor units were to be excluded from the national blood supply, an estimated 5% (compared to 1.3% for human Immunodeficiency virus, 3.6% for hepatitis B virus and 1.3% for hepatitis C virus) would be wasted. The cost per case prevented of transfusion-associated malaria is considerably higher for recipient antimalarial prophylaxis than pre-transfusion screening using an automated technique. The cost escalates by five to seven times if the newer artemesinin based combination antimalarial drugs are adopted.

BACKGROUND AND OBJECTIVES: To determine the prevalence, correlates, and incidence of Haemophilus ducreyi antibodies, a cohort of East African trucking company employees was evaluated. STUDY DESIGN: Human immunodeficiency virus (HIV)-1-seronegative men working in six trucking companies in Mombasa, Kenya, were evaluated with a questionnaire and serologic testing for antibodies to H. ducreyi and other sexually transmitted pathogens. Men who were initially H. ducreyi seronegative were retested at 1 year of follow-up. RESULTS: The H. ducreyi seroprevalence among 501 men at enrollment was 26.5%. Seropositivity was significantly associated with older age, married status, years of active sex life, number of sex partners in the past year, history of unprotected sex with a prostitute in the past year, and history of alcohol intake (all P values < 0.01). Occupational travel for more than 14 days per month was also significantly associated with H. ducreyi seropositivity (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.3-3.2). Using multivariate analysis, H. ducreyi seropositivity was independently associated with age, married status, history of sex with a prostitute, and history of alcohol intake. Presence of H. ducreyi antibodies was significantly associated with seropositivity to the other major genital ulcerative pathogens, Treponema pallidum (OR 4.3, 95% CI 2.2-8.3), herpes simplex virus type 2 (OR 4.9, 95% CI 2.0-11.5), and Chlamydia trachomatis (OR 3.2, 95% CI 1.5-6.9). These associations remained significant after adjusting for demographic and exposure variables. The incidence of seroconversion to H. ducreyi antibodies was 3.6 per 100 person years. CONCLUSIONS: Serologic evidence of H. ducreyi infection was common among male trucking company employees. H. ducreyi seropositivity is an objective marker of high-risk behavior and is associated with serologic evidence of other ulcerative sexually transmitted diseases. PIP: A prospective cohort study of 501 human immunodeficiency virus (HIV)-negative male trucking company employees from Kenya revealed high rates of infection with Haemophilus ducreyi, the causative agent of chancroid. At enrollment in March 1993, the seroprevalence of H ducreyi antibodies was 26.5%. Also detected were high rates of herpes simplex virus-2 (49%), Chlamydia trachomatis (41%), and syphilis (8%). Of the 368 men who were seronegative at enrollment, 241 were re-evaluated after 12 months of follow-up. There were 9 seroconversions (3.6/100 person years). Sexual contact with a prostitute in the preceding year was reported by 33% of truckers and only a third of these encounters involved condom use. Ever-use of condoms was reported by only 51%. H ducreyi seropositivity was significantly and positively associated with older age, occupational travel for more than 2 weeks per month, history of sex with a prostitute, high number of sex partners in the past year, unprotected sex with a prostitute in the past year, alcohol drinking, and infection with other sexually transmitted diseases. The significant association of H ducreyi and seropositivity to syphilis, herpes simplex virus-2, and C trachomatis (odds ratios: 4.3, 4.9, and 3.2, respectively) raises the possibility that a genital ulcer increases the likelihood of infection with a second ulcerative pathogen. Overall, these findings suggest that the seroprevalence of H ducreyi may be used as an indicator of the extent of high-risk sexual risk behavior in a population, as well as an objective end point for measuring the efficacy of behavioral interventions in communities where the HIV seroincidence is too low to serve this purpose.

We aimed to determine the knowledge and attitudes towards HIV/STDs among women attending an STD clinic by interviewing 520 randomly selected women. Nearly all had heard of HIV/AIDS/STDs, with posters, pamphlets and the radio being the main source of their information. The years of schooling was the only predictive factor of knowing a preventive measure of HIV. Two-thirds thought they were at risk of contracting HIV from their regular partner. Knowledge of the sexual habits of their male partners was low with 260 (50%) of the women distrusting their partner. Only 52 (10%) of respondents admitted to sex in exchange for gifts or money. In the event of a positive HIV test result, the perceived partner response would be to blame the woman for introducing the infection into the relationship. After a positive HIV test result, only 3.5% would resort to using condoms while another 3.7% would try to pass on the disease to other people. The quality of their knowledge of the transmission of HIV was low in spite of the fact that most respondents have heard of HIV/AIDS/STDs. Violence against women was expected in relation to a positive test result. There is a need for better educative effort on the modes of transmission and prevention of HIV, also in 'low risk' populations.

OBJECTIVE: To determine the prevalence, incidence, and correlates of HIV-1 infection in a cohort of east African trucking company employees. METHODS: HIV-1-seronegative trucking company employees were enrolled in a prospective cohort study and evaluated at 3 monthly intervals for HIV-1 seroconversion, sexually transmitted diseases, and sexual behavior. RESULTS: The baseline seroprevalence of HIV-1 among 1500 trucking company employees was 17.8%. Among 752 HIV-1-seronegative men who were followed, the HIV-1 annual seroincidence was 3.1%. In univariate analysis, HIV-1 acquisition was associated with age under 25 years, 10 years or less of sexual activity, occupation as a driver/driver's assistant, occupational travel for more than 14 days per month, religion other than Christian or Muslim, uncircumcised status, sex with a prostitute, sex with a girlfriend/casual partner, extramarital sex, and enrollment seropositivity to Treponema pallidum, Haemophilus ducreyi, and Herpes simplex virus type 2 (all P values < or = 0.05). Using multivariate analysis, HIV-1 acquisition was independently associated with 10 years or less of sexual activity (hazard rate ratio (HRR) 2.0, 95% confidence interval (CI) 1.0-4.3), occupation as a driver/driver's assistant (HRR 3.9, 95% CI 1.7-9.0), religion other than Christian or Muslim (HRR 6.1, 95% CI 1.4-25.7), uncircumcised status (HRR 2.3, 95% CI 1.0-5.0), and unprotected sex with a prostitute (HRR 2.8, 95% CI 1.1-7.0). CONCLUSIONS: Trucking company employees had a high HIV-1 seroprevalence rate at enrollment and a high HIV-1 seroincidence during follow-up. Risk factors for HIV-1 seroconversion included years of sexual activity, occupation, religion, uncircumcised status, and unprotected sex with a prostitute. This population is an appropriate target for HIV-1 prevention trials and behavioral interventions.

Abstract
Aluminium induced crystallization (AIC) was used to crystallize sputtered amorphous silicon thin films on aluminium-coated glass at annealing temperatures ranging from 250-520°C in vacuum. Crystalline volume fractions were measured by Raman spectrometry as a function of annealing temperature. It was shown that the crystallized films had large grains as the Raman peaks were centred at about 520 cm-1 at and over annealing temperatures of 420°C. The three-layer sample crystallization resulted in crystallization of the films at lower temperatures compared to the two-layer sample crystallizations which implied a reduction in the
cost of production of the seedlayer and resulting products. Hall mobilities and hole densities ranging from 17.0-22.8 cm2V-1s-1and (4.7-9.2) x 1018 cm-3 respectively were measured. Low hole charge densities for films of the same thickness were achieved at high annealing temperatures which was an indication of less aluminium in seed layers prepared at those temperatures. Having seed layers with sufficiently low hole
charge densities is desirable for application of the seed layer in photovoltaic applications.

Key Words: microcrystalline, silicon, annealed, raman, crystallinity, hall-effect

Aluminium induced crystallization (AIC) was used to crystallize sputtered amorphous silicon
thin films on aluminium-coated glass at annealing temperatures ranging from 250-520° C in
vacuum. Crystalline volume fractions were measured by Raman spectrometry as a function
of annealing temperature. It was shown that the crystallized films had large grains as the
Raman peaks were centred at about 520 cm-1 at and over annealing temperatures of 420°
C. The three-layer sample crystallization resulted in crystallization of the films at lower
temperatures compared to the two-layer sample crystallizations which implied a reduction in
the cost of production of the seedlayer and resulting products. Hall mobilities and hole
densities ranging from 17.0-22.8 cm2V-1s-1and (4.7-9.2)× 1018 cm-3 respectively were
measured. Low hole charge densities for films of the same thickness were achieved at high annealing temperatures which was an indication of less aluminium in seed layers prepared at those temperatures. Having seed layers with sufficiently low hole charge densities is desirable for application of the seed layer in photovoltaic applications.
Key words: microcrystalline, silicon, annealed, raman, crystallinity, hall-effect

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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.

Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who has become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in the identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even is such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.

To test the suitability of a simple once daily (OD) gentamicin regimen for use in young infants where routine therapeutic drug monitoring is not possible. METHODS: In an open, randomised, controlled trial, infants with suspected severe sepsis admitted to a Kenyan, rural district hospital received a novel, OD gentamicin regimen or routine multi-dose (MD) regimens. RESULTS: A total of 297 infants (over 40% < or =7 days) were randomised per protocol; 292 contributed at least some data for analysis of pharmacological endpoints. One hour after the first dose, 5% (7/136) and 28% (35/123) of infants in OD and MD arms respectively had plasma gentamicin concentrations <4 microg/ml (a surrogate of treatment inadequacy). Geometric mean gentamicin concentrations at this time were 9.0 microg/ml (95% CI 8.3 to 9.9) and 4.7 microg/ml (95% CI 4.2 to 5.3) respectively. By the fourth day, pre-dose concentrations > or =2 microg/ml (a surrogate of potential treatment toxicity) were found in 6% (5/89) and 24% (21/86) of infants respectively. Mortality was similar in both groups and clinically insignificant, although potential gentamicin induced renal toxicity was observed in <2% infants. CONCLUSIONS: A "two, four, six, eight" OD gentamicin regime, appropriate for premature infants and those in the first days and weeks of life, seems a suitable, safe prescribing guide in resource poor settings.

Behavioral interventions that promote adherence to antiretroviral medications may decrease HIV treatment failure. Antiretroviral treatment programs in sub-Saharan Africa confront increasing financial constraints to provide comprehensive HIV care, which include adherence interventions. This study compared the impact of counseling and use of an alarm device on adherence and biological outcomes in a resource-limited setting. Methods and Findings A randomized controlled, factorial designed trial was conducted in Nairobi, Kenya. Antiretroviral-naïve individuals initiating free highly active antiretroviral therapy (HAART) in the form of fixed-dose combination pills (d4T, 3TC, and nevirapine) were randomized to one of four arms: counseling (three counseling sessions around HAART initiation), alarm (pocket electronic pill reminder carried for 6 months), counseling plus alarm, and neither counseling nor alarm. Participants were followed for 18 months after HAART initiation. Primary study endpoints included plasma HIV-1 RNA and CD4 count every 6 months, mortality, and adherence measured by monthly pill count. Between May 2006 and September 2008, 400 individuals were enrolled, 362 initiated HAART, and 310 completed follow-up. Participants who received counseling were 29% less likely to have monthly adherence <80% (hazard ratio [HR]=0.71; 95% confidence interval [CI] 0.49–1.01; p=0.055) and 59% less likely to experience viral failure (HIV-1 RNA ≥5,000 copies/ml) (HR 0.41; 95% CI 0.21–0.81; p=0.01) compared to those who received no counseling. There was no significant impact of using an alarm on poor adherence (HR 0.93; 95% CI 0.65–1.32; p=0.7) or viral failure (HR 0.99; 95% CI 0.53–1.84; p=1.0) compared to those who did not use an alarm. Neither counseling nor alarm was significantly associated with mortality or rate of immune reconstitution. Conclusions Intensive early adherence counseling at HAART initiation resulted in sustained, significant impact on adherence and virologic treatment failure during 18-month follow-up, while use of an alarm device had no effect. As antiretroviral treatment clinics expand to meet an increasing demand for HIV care in sub-Saharan Africa, adherence counseling should be implemented to decrease the development of treatment failure and spread of resistant HIV.

Behavioral interventions that promote adherence to antiretroviral medications may decrease HIV treatment failure. Antiretroviral treatment programs in sub-Saharan Africa confront increasing financial constraints to provide comprehensive HIV care, which include adherence interventions. This study compared the impact of counseling and use of an alarm device on adherence and biological outcomes in a resource-limited setting.

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The use of phosphate therapy in the management of diabetic ketoacidosis (DKA) has been controversial, particularly with respect to the effect of phosphate intermediates on tissue oxygenation. In a prospective randomized study we evaluated the effect of phosphate (8.5 mmol/h or approximately 6 g phosphate/24 h) (experimental group) vs. no phosphate therapy (control group) in 30 DKA patients, 15 in each group. Various determinations including erythrocyte 2,3-diphosphoglycerate (2,3-DPG), oxyhemoglobin dissociation (p50), serum phosphate, calcium, lactate, pyruvate, electrolytes, and response time to reach predetermined values for glucose, bicarbonate, and pH were measured at frequent intervals during the first 24 h of therapy and daily for 5 days after metabolic control. Initial electrolytes, glucose, pH, erythrocyte 2,3-DPG, lactate, and p50 were not different in either group. Whereas the experimental group had a greater level of 2,3-DPG than the control group by 48 h, the difference was not statistically significant. Recovery indices, including hours to reach glucose of 250 mg/dl, bicarbonate greater than 15 meq/liter, pH greater than 7.3, and mental alertness, were not different in the two groups nor were the p50 or lactate measurements. The experimental group exhibited significantly lower plasma ionized calcium values during therapy. We conclude that phosphate therapy may accelerate regeneration of erythrocyte 2,3-DPG but in the relatively small number of patients studied it had no demonstrable influence on tissue oxygenation or clinical response to low dose insulin therapy of DKA. Furthermore, the exaggeration of hypocalcemia seen in phosphate-treated patients may be reason for caution in the use of such therapy.

Vaginal infections are common, frequently recur, and may increase women's risk for sexually transmitted infections (STIs). We tested the efficacy of a novel regimen to prevent recurrent vaginal infections.

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Center for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Belgium.
Abstract
Our objectives were to describe the baseline findings of a trial of antibiotic prophylaxis to prevent sexually transmitted infections (STIs) and HIV-1 in a cohort of Nairobi female sex workers (FSWs). A questionnaire was administered and a medical examination was performed. HIV-negative women were randomly assigned to either one gram azithromycin or placebo monthly. Mean age of the 318 women was 32 years, mean duration of sex work 7 years and mean number of clients was 4 per day. High-risk behaviour was frequent: 14% practised anal intercourse, 23% sex during menses, and 3% used intravenous drugs. While 20% reported condom use with all clients, 37% never use condoms. However, STI prevalence was relatively low: HIV-1 27%, bacterial vaginosis 46%, Trichomonas vaginalis 13%, Neisseria gonorrhoeae 8%, Chlamydia trachomatis 7%, syphilis 6% and cervical intraepithelial neoplasia (CIN) 3%. It appears feasible to access a population of high-risk FSWs in Nairobi with prevention programmes, including a proposed trial of HIV prevention through STI chemoprophylaxis.
PMID:
11138916
[PubMed - indexed for MEDLINE]

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

This paper briefly presents a methodology for planning development in arid and semi-arid areas. It highlights the issues of problem identification and assessment of the natural and socio-economic environment, and describes the database contained in the Range Management Handbook. The handbook makes available baseline data for planning development in arid and semi-arid areas following a successful Farm Management Handbook that covers the high- and medium-potential areas of Kenya. In three parts, the Range Management Handbook covers: the status, principles and applications in Kenya; texts and maps relating to climate, landforms and soils, vegetation types, water sources, range unit inventory, livestock marketing and human ecology; special reports (guide to tolerant plants, pictorial key for goat stocking rates, large scale remote monitoring of vegetation, and a survey method for classification of range conditions) relevant to land planning and use in arid and semi-arid areas

This paper briefly presents a methodology for planning development in arid and semi-arid areas. It highlights the issues of problem identification and assessment of the natural and socio-economic environment, and describes the database contained in the Range Management Handbook. The handbook makes available baseline data for planning development in arid and semi-arid areas following a successful Farm Management Handbook that covers the high- and medium-potential areas of Kenya. In three parts, the Range Management Handbook covers: the status, principles and applications in Kenya; texts and maps relating to climate, landforms and soils, vegetation types, water sources, range unit inventory, livestock marketing and human ecology; special reports (guide to tolerant plants, pictorial key for goat stocking rates, large scale remote monitoring of vegetation, and a survey method for classification of range conditions) relevant to land planning and use in arid and semi-arid areas