Objectives: To describe the psychiatric services offered at Kenyatta National Hospital and the types
of patients and cases seen at Kenyatta National Hospital.
Design: A retrospective study based on case notes and other hospital records.
Settings: Kenyatta National Hospital, Nairobi, Kenya.
Subjects : All patients seen in the various psychiatric clinics and those who attended the Patient
Support Centre Unit in the hospital in the year 2002.
Results : In the year 2002, 598,119 patients were treated at KNH out of which 6,878 (1.15%) were
seen in the psychiatric clinics: 1,709 adults and 1,412 children were referred to the various psychiatric
clinics. At the hospital's Patient Support Centre (PSC) 3,454 patients were seen, mostly for pre and
post-HIV test counselling. Consultations from the wards accounted for 332 (9.6%) of the cases referred
to PSC. The main diagnoses among the latter in order of frequency were alcohol related psychiatric
disorders, acute and transient psychoses, depressive disorders, dissociative and conversion disorders
and dementia.
Conclusion : In view of the high load of acute and transient psychotic states, as well as substance
related disorders, it is recommended that the hospital should establish acute wards for the
comprehensive management of such patients. An alcohol and drug detoxification and rehabilitation
centre should also be developed at the hospital. Services to those with HIV related disorders should also
be improved.

A description is given of a novel liquid phase immunoassay for the measurement of testosterone in peripheral venous plasma from men and women. The procedure involves: (i) competitive binding of the analyte and tritiated antigen to specific antibodies; (ii) enzymatic conjugation of the free ligand with glucuronic acid; and (iii) separation of the antibody-bound and free ligand by partition of the reactants into an organic and aqueous phase. The technique has been called ligand differentiation immunoassay (LIDIA). The mean sensitivity was 5 pg/tube (equivalent to 0.35 nmol/l female plasma; 0.87 nmol/l male plasma). The mean reagent blank (+/- SD) was 0.24 (0.12) nmol/l female plasma; 0.61 (0.30) nmol/l male plasma. A precision profile gave values less than 50%; the within batch variation was less than 8.3% and the between batch variation over three months was 12.3%. An accuracy profile between the second and penultimate points on the calibration curve gave values between 77 and 103%. The correlation coefficient 'r' between LIDIA and a heterogeneous radioimmunoassay was 0.92 when applied to plasma from men and 0.95 to samples from women.

Immunoglobulins were eluted from ovine placentae and characterized by immunoprecipitation, electrophoresis, western blotting and ELISA.IgG was shown to comprise the bulk of placental-bound immunoglobulins while smaller amounts of IgM and only trace amounts of IgA were demonstrated.Results suggest that ovine placental IgG eluted by surgical cannulation of the uterine blood vessels in situ is similar to that eluted from postpartum placentae in vitro, implying that there may be some transfer of antibodies across the maternal side of the placental barrier to the trophoblast.These antibodies are rich in IgG1 and IgG2, have a relative molecular weight of 158 kDa, and bind to an 80 kDa peptide prepared from pre-acidified ovine placental cotyledons.We propose that the binding of placental IgG to the 80 kDa antigen may prevent immunological rejection of the foetus by competitively excluding cytotoxic cells of maternal origin such as NK cells.Also, given that a similar antigen (80 kDa) has been reported in humans and equines, and shown to be saturated with IgG in term placentae, we propose that this antigen may be conserved in several mammalian species for reproductive purpose.Consequently, we suggest that the ovine placental IgG and the 80 kDa antigen may be suitable as models for the study of maternal-foetal interactions in mammalian pregnancies.

A paper prepared for the United Nations Economic Commission for Africa (UNECA),

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

{ OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers. METHODS: A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994. RESULTS: With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, had similar feeding practices and similar growth status and patterns. However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their husband's first wife (79% vs. 91%

Ethics exist within a social context, which makes ethical decision making a complex process. Including an ethical perspective as a foundation of all kinds of research is vital. Researchers need to follow standards of professional conduct to ensure the welfare of participants and uphold the integrity of social science research. Social science scholars encounter ethical challenges when studying and dealing with human behaviour. The genesis of research ethics was the atrocities experienced in clinical trials such as medical experimentation carried out by Nazi physicians in the Second World War and the Tuskegee Syphilis Study (Samantaray and Sahu, 2008: Babbie,2007:Robson,2002). Samantary et al (2008) posits that a reading of social science research journals provide little guidance on ethical responsibilities toward research participants, which should be considered when undertaking research. They argue that there are seldom detailed discussions of ethical principles that guide interaction with participants. However, there are general principles that most researchers would agree on. Unlike scientists who conduct their work under controlled conditions, social science researchers conduct their studies in the field. To study the society, an array of research methods is employed and for collected data to be useful it has to be honestly collected, it should be reliable and collected with informed consent. Research participants should be respected while the principles of beneficence and justice should be upheld. Some of the ethical issues in social science research include deception, confidentiality, preconceived notions, and recruitment methods, security of data, falsification of data, acceptable standards, conflict of interest, plagiarism, rationale and presentation of results (Robson, 2002). This paper intends to examine the genesis of research ethics, examine ethical issues in social science research and to provide suggestions for maintaining integrity in social science research. The purpose of this paper is to perpetuate dialogue with scholars and practitioners concerning the place of ethics in research so that it can be applied in social science research for the benefit of participants. The significance of this study is to enhance understanding and consideration of ethical issues in social science research. Data will be collected through document desk review. Findings from the desk review will inform social science researchers and equip them with knowledge to attend to risk of potential harm and consider the potential benefit of research to individuals and society and minimize risks which could be psychological, sociological, emotional, and financial and legal.

With the proliferation of mobile devices, provision of M-health care services has become feasible even in the remotest villages of Africa. Research however shows that many M-health initiatives have not been adopted and used effectively especially in rural communities. Some of the factors contributing to this range from a lack of knowledge with regard the use of technology, literacy challenges, possible fear of technology, to a lack of information regarding these interventions.
In this paper, we demonstrate that an initiative designed to recognize usability as its core function plays a critical role in the use and adoption of M-health interventions in rural communities. Two versions of an M-health intervention were developed and two interface design principles that may have an impact on users' emotions applied, namely affective design and anthropomorphism.
Using the Sethakeng rural community in the Northern Cape (South Africa) as the case study, we were able to determine the extent to which both anthropomorphism and affective design influence the adoption of an M-Health application. Further, the research revealed that because of its ability to include human-like qualities to non-living objects, anthropomorphism is a more effective method for designing M-Health applications targeting rural communities.

Drylands Research Working Papers present, in preliminary form, research results of studies carried out in association with collaborating researchers and institutions. This working paper is part of a study which aims to relate long-term environmental change, population growth and technological change, and to identify the policies and institutions which are conducive to sustainable development. The study builds upon an earlier project carried out by the Overseas Development Institute (ODI) in Machakos District, Kenya, whose preliminary results were published in a series of ODI Working Papers in 1990-91. This led to a book (Mary Tiffen, Michael Mortimore and Francis Gichuki, More people, less erosion: environmental recovery in Kenya, John Wiley, 1994), which was a synthesis and interpretation of the physical and social development path in Machakos. The book generated a set of hypotheses and policy recommendations which required testing in other African dryland environments. Using compatible methodologies, four linked studies are now being carried out in: Kenya Makueni District Senegal Diourbel Region Niger Maradi Department (in association with ODI) Nigeria Kano Region (in association with ODI) For each of these study areas, there will be a series of working papers and a synthesis, which will be reviewed at country workshops. An overall synthesis will be discussed at an international workshop in London in 2000.

The investments in soil conservation made by farmers in Makueni District, Kenya over the period 1950-1998, and the policy and institutional framework under which the investments were made are explored. An assessment of the scale and impact of these measures is presented. In general, very few signs of erosion were observed, so the area is considered to have low erosion status. Soil and water conservation measures include the use of crop residues in trash lines, contour ridging, grass strips, fanya juu terraces and cut-off drains. Crop residue management and tillage are the main practices used to facilitate in situ moisture conservation. Most farmers practise contour ridging. Physical soil conservation measures are used to complement cultural practices that conserve rainwater in situ by trapping and preventing further runoff. A key constraint to the expansion of soil and water conservation measures by households is the shortage of hired and family labour. Grazing land has received very little investment because there farmers perceive a low return. In Makueni District farmers have been able to make long-term investments in soil conservation partly because their land tenure was secure. Training and extension in soil and water conservation has been a major external input.

The author illustrates how qualitative data from open-ended interviews, pile sorts, and triad sorts can be used to test quantitatively for intracultural variation in norms. Specifically, the author tests whether Gusii men and women in the Suneka Division of Kisii District in southwest Kenya have developed a common set of standards in response to symptoms of malaria. In this small sample, the focus is on internal, rather than external, validity. While the findings about Gusii responses to malaria are not generalizable beyond the village where the data were collected, the method described may be used to study cultural similarities across socioeconomic, gender, and other groups.

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Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up. Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes. Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address them. Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of
practical environmental and entomological skills for malaria control by communities at grassroots
level and should be supported to fulfil this neglected role.

Ecological factors have contributed to increased malaria transmission in sub-Sahara Africa. This study was designed to document perceived and actual ecological changes in Gusii over the last three decades; to document changes in the malaria burden and to collect ethnographic data to understand folk causal linkages between environmental change and disease patterns. Over a 12-month period data was collection using malaria focused-ethnographic interviews, historical narratives and a review of statistical health records. A total of 103 people were interviewed. Historical narratives reveal a decline in landholdings over three decades. Hospital health records show that over this period, the burden of malaria has increased. Ethnographic interviews and hospital records show that the period during which malaria is most intense is between May and August, with July as the peak period. Ethnographic data point to weather changes, changes in landholdings and land use as the primary factors in the observed changes in the malaria patterns in Gusii. In conclusion, in the absence of documented data folk knowledge is a useful substitute for constructing trends.

Institute of African Studies, University of Nairobi, Nairobi, Kenya. This article assesses knowledge, attitudes, and practices regarding cervical cancer among rural women of Kenya. One hundred and sixty women (mean age 37.9 years) who sought various health care services at Tigoni subdistrict hospital, Limuru, Kenya, were interviewed using a semistructured questionnaire. In addition, three focus group discussions (25 participants) were held, five case narratives recorded, and a free list of cervical cancer risk factors obtained from a group of 41 women respondents. All women were aged between 20 and 50 years. About 40% knew cervical cancer, although many still lack factual information. A history of sexually transmitted diseases (61.5%), multiple sexual partners (51.2%), and contraceptive use (33%) were identified as risk factors. Other factors mentioned include smoking, abortion, and poor hygiene standards. High parity, early sexual debut, and pregnancy were not readily mentioned as risk factors. We propose a folk causal model to explain the link between these factors and cervical cancer. Lack of knowledge constrains utilization of screening services offered at the clinics. Consequently, respondents support educating women as a way to tackling issues on cervical cancer. It is recommended that an integrated reproductive health program that addresses comprehensively women's health concerns be put in place.

Fresh blood lymphocytes from nine health donors have been compared with samples from the same donors, recovered after period of 2 to 21 months storage in liquid nitrogen, for the capacity to respond to a range of mitogens in vitro. A microculture assay was used, requireing aliquots of only 25,000 cells. The mean levels of 14C-thymidine uptake for fresh and frozen samples were closely comparable when the cells had been stimulated by PHA, Pokeweed or mitomycin-C-treated allogeneic lymphoblastoid cells. Lymphocytes from six East African donors, frozen by a very simple technique, were recovered after 3 or more years storage in liquid nitrogen. Five of the samples were in good condition as judged by cell viability and the capacity to form spontaneous 'E' rosettes with sheep erythrocytes. These five samples also responded extremely well to PHA, PWM and mitomycin-C-treated allogeneic lymphoblastoid cells using the microculture assay. This study extends the range of applications of cell banks in which small aliquots of blood lymphocytes are stored in liquid nitrogen for periods of several years.

Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision.

Evidence for efficacy of male circumcision as an HIV prevention measure is increasing, but there is serious concern that men who are circumcised may subsequently adopt more risky sexual behaviors.

No a ABSTRACT.
Ten males,6 of whom were azoospermic and 4 oligospermic were studied for their subfertilityor infertility after the gynaecologist had proven wives normal and referred them to urology clinic for further tests .Study showed that the causes of subfertility or infertility are uncorrectable and in the few that can be corrected, the results of the improved fertility in so far as getting child is concerned has no workable formula.
bstract yet

This prospective study investigated the relationship between male antenatal clinics (ANC) involvement and infant HIV-free survival.

ackground: Male partner involvement in antenatal voluntary HIV counseling and testing (VCT) has been shown to increase
uptake of interventions to reduce the risk of HIV transmission in resource-limited settings. We aimed to identify methods for
increasing male involvement in antenatal VCT and determine male correlates of accepting couple counseling in these
settings.
Methodology/Principal Findings: We invited women presenting to a Nairobi antenatal clinic to return with their male
partners for individual or couples VCT. Male attitudes towards VCT and correlates of accompanying female partners to
antenatal clinic and receiving couple counseling were determined. Of 1,993 women who invited their partner, 313 (16%)
returned with their partners to ANC. Men attending antenatal clinic were married (.99%), employed (98%), and unlikely to
report prior HIV testing (14%). Wanting an HIV test (87%) or health information (11%) were the most commonly cited
reasons for attending. Most (95%) men who came to antenatal clinic accepted HIV testing and 39% elected to receive
counseling as a couple. Men who received counseling with partners were younger, had fewer children, and were less
knowledgeable about prevention of mother-to-child HIV transmission (PMTCT) than those who received counseling
individually (p,0.05). Only 27% of men stated they would prefer HIV testing at a site other than the ANC. There was
agreement between male and female reports for sociodemographic characteristics; however, men were more likely to
report HIV preventive behaviors and health communication within the partnership than their partners (p,0.05).
Conclusions/Significance: Offering VCT services to men at antenatal clinic with options for couple and individual
counseling is an important opportunity and acceptable strategy for increasing male involvement in PMTCT and promoting
male HIV testing.

Male partner involvement in antenatal voluntary HIV counseling and testing (VCT) has been shown to increase uptake of interventions to reduce the risk of HIV transmission in resource-limited settings. We aimed to identify methods for increasing male involvement in antenatal VCT and determine male correlates of accepting couple counseling in these settings.

The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up (LTFU) from an antiretroviral therapy (ART) clinic in Nairobi, Kenya.

Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. 2007 Wiley-Liss, Inc

Aim: To determine the prevalence and pattern of occurrence of malocclusion and
traumatic injuries to permanent anterior teeth and establish any association
between traumatic injuries, over-jet and lip posture.
Design: This was a descriptive cross-sectional survey.
Setting: The study was carried out in public primary schools in the City of
Nairobi, Kenya over a period of three months.
Subjects and methods: A sample of 1382 boys and girls aged 12-15 years was
obtained by multi-stage random sampling of children in 8 divisions, then 16
zones, then schools were interviewed. Registration for malocclusion was done
using the Dental Aesthetic Index (DAI) and tae variables sought included missing
teeth, crowding, over-jet and antero-posterior molar relations. Two hundred and
twenty two children with history of traumatic dental injuries were identified. A
structured questionnaire was used to obtain information on the trauma,
symptoms associated, cause, site of trauma and if any treatment was sought.
The data was collected by clinical examination of permanent anterior teeth of the
children based on a modification of the WHO criteria with some variables sought
including: number of teeth injured, type of teeth injured, classification of the
trauma and type of treatment if any. Data was analysed aided by computer using
the Statistical Package for Social Sciences (SPSS) programme. Chi-square and
odds ratios statistical tests were done to determine the differences in
malocclusion and trauma experience between males and females and the
difference in trauma experience by different overjet groupings and lip posture.
Student's t-test was used to determine difference in mean overjet between
Xll
children who had sustained traumatic dental injuries and those who had not. A p
value of less than 0.05 was considered significant.
Results: Seven hundred and thirty two (53.0%) of the children examined had
either no abnormality or only minor malocclusion, 318(23%) had definite
malocclusion, 176(12.7%) and 156(11.3%) had severe malocclusion and very
severe or handicapping malocclusion respectively. The mean OAI was 26.6.
Prevalence and severity of malocclusion for male and female children did not
differ significantly (p=0.139). The prevalence of TOls was 16.1%. Males had
experienced a significantly higher prevalence of trauma (18.8%) than females
(13.5%) p=0.008. Amongst the male children, falls were the leading cause of
TOls (37.3%). Approximately half (44.8%) of the females did not remember the
•
cause of injury while 31(36.5%) had sustained TOls due to falls. One hundred
and seventy two (77.5%) children who had experienced TOls had no symptoms
associated with the traumatized teeth. Ninety six (43.2%) of the children were
injured while in the home environment. The maxillary central incisors were the
most commonly traumatized teeth accounting for 220(73.5%) out of 299 injured
teeth. The most frequently observed type of dental trauma was enamel fracture
206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%)
children had not sought treatment for TOls. When frequency of TOls in the
children was related to overjet, it was found that out of the 886 children with
overjet of 0-3 mm 104(11.8%) had experienced TOls. Out of the 502 children with
overjet greater than 3 mm, 118 (23.5%) were found to have TOI. The prevalence
of TOls in children with overjet greater than 3 mm was significantly higher than
that in children with overjet of 3 mm and less (p=O.OOO).A significantly higher
prevalence of TOls was found when children with incompetent lips 124(55.9%)
were compared to those with competent lips 98(44.1%), (p=O.OOO).
Conclusion: There was an overall high prevalence of malocclusion among the
children with no significant gender difference for most of the traits. The OAI
criteria produced a mean OAI score of 26.6, with 11.3% of subjects exhibiting
handicapping malocclusion. Overall traumatized permanent incisors were found
to occur fairly frequently with 68.9% of the injured teeth having sustained enamel
injuries. A very high proportion of traumatized teeth were untreated. Male
gender, overjet greater than 3 mm and incompetent lips were found to be
statistically significant risk factors for traumatic dental injuries.
Recommendation: Facilities and personnel should be put in place so that
children with very severe or handicapping malocclusion can benefit from
subsidized orthodontic therapy by specialists. There is need to improve oral
health policies in Kenya so as to incorporate periodic checks ups in order to
promptly diagnose and give advice on treatment of TOIs. The high proportion of
untreated dental trauma among the children calls for improvement in children,
parents and teacher education.

Caecal digestive functions were compared in 22 species of East African herbivores. Comparisons were made between ruminant pseudo-ruminant, and non-ruminant herbivores to assess the relative in vitro fermentation rate and composition of caecal contents from these species observed in their natural habitat. Measurements were made of caecal fermentation rate, organic acid composition, osmolality, pH and dry matter content. The data were compared by foregut structure, feed preference and body weight of the herbivores

This essay looks at Somali oral poetry, using poetry now committed to writing primarily from B. W. Andrzejewski and I. M. Lewis