P-glycoprotein (PGP), the product of the multidrug resistance gene (MDR1), acts as an energy-dependent efflux pump that exports its substrates out of the cell. PGP expression is an important factor regulating absorption of a wide variety of medications. It has also been associated with intrinsic and acquired cross resistance to a number of structurally unrelated anticancer drugs. A single nucleotide polymorphism (SNP) in exon 26 of the MDR1 gene, C3435T, was recently correlated with PGP protein levels and substrate uptake. Individuals homozygous for the T allele have more than four-fold lower PGP expression compared with CC individuals. As overexpression of PGP has been associated with altered drug absorption, therapy-resistant malignancies, and lower concentrations of HIV-1 protease inhibitors, this SNP may provide a useful approach to individualize therapy. To facilitate clinical application throughout the world, 1280 subjects from 10 different ethnic groups were evaluated for this SNP using the polymerase chain reaction-restriction fragment length polymorphism assay and the genotype and allele frequency for each group were ascertained. Marked differences in genotype and allele frequency were apparent between the African populations and the Caucasian/Asian populations (P < 0.0001). The Ghanaian, Kenyan, African American and Sudanese populations studied had frequencies of 83%, 83%, 84% and 73%, respectively, for the C allele. The British Caucasian, Portuguese, South-west Asian, Chinese, Filipino and Saudi populations had lower frequencies of the C allele compared to the African group (48%, 43%, 34%, 53%, 59%, and 55%, respectively). The high frequency of the C allele in the African group implies overexpression of PGP and may have important therapeutic and prognostic implications for use of PGP dependent drugs in individuals of African origin.

Past studies of the use of soil fertility management strategies by farmers usually model input use decisions based on the neoclassical utility/profit maximization principle in which farmers use soil fertility management inputs primarily to increase revenues and profits. However, there is, to date, no study that explains exactly how this decision-making process occurs and the role which personal values play in driving the choice of soil fertility management inputs. This article systematically maps the relationship between choice of soil fertility management strategy (attributes), its outcomes (consequences) and the personal values that motivate the choice. It specifically uses the means-end chain approach to construct hierarchical value maps that relate the attributes to consequences, and ultimately to the personal values. The study finds that the use of soil fertility management strategies by peri-urban fresh vegetable growers is driven by five personal values, namely happiness, comfortable life, independence, good/healthy life and achievement of life goals. It also finds that while farmers seek to increase profit (hence incomes), profit maximization is not the end driver of the use of soil fertility management inputs. It concludes that a lot more goes into farmers’ decision-making process relating to the use of soil fertility management practices than can be explained by the neoclassical profit/utility maximization principle. The study discusses the policy implications of these findings.

Peri-urban farmers play a significant role in the production of vegetables consumed in the urban centers in most African countries. The production of vegetables in the peri-urban areas in these countries is strategic with most farmers targeting the lucrative and better-paying urban markets. However, the decline in agricultural land in the peri-urban due to competition from housing for urban workers has led peri-urban farmers to use intensive means of agricultural production. Decreasing land sizes imply that peri-urban lands are continuously under production resulting in the build-up of pests and diseases. Further, the tropical climate generally increases the outbreak and rapid multiplication of pests and diseases. These problems and the urban consumers’ demand for clean and spotlessness vegetables encourage the excessive use of pesticides. Additionally, the desire to reduce losses and waste can cause farmers to violate the recommended intervals between pesticide application and harvest. Consequently, there have been concerns about the excessive application of pesticides in vegetables produced in the peri-urban areas. The study applies the Means-End Chain (MEC) approach accompanied by the laddering technique to assess the motivations for peri-urban farmers to use pesticides as opposed to other crop protection methods in the production of fresh vegetables. It specifically examines the relevant attribute econsequenceevalue relations by setting up relevant hierarchical value maps. The study is based on a random sample of 54 kale farmers in three peri-urban areas of Nairobi. It finds that farmers apply pesticides at different times mainly for the purpose of improving their efficacy in protecting kale against pests and diseases. Protection of kale improves its aesthetic quality attributes resulting in higher prices and hence profit margins. Examination of the hierarchal value maps further reveals that the other motivations for pesticide use include benevolence value (being helpful and honest to trading partners), power (social recognition or good reputation as a good farmer), hedonism (happiness for being a successful farmer), security (having good health) and self-direction (independence or being self-supporting from vegetable income). Clearly, the motivations suggest a dilemma in safe use of pesticides. While some motivators dictate less use of pesticides, others can promote indiscriminate use of pesticides. The study discusses the implication of these findings for sustainable and environmentally friendly production of safe leafy vegetables in peri-urban areas.

No abstract available

1. Pediatr Infect Dis J. 2014 Mar 10. [Epub ahead of print]

Measles Seropositivity in HIV-Infected Kenyan Children on Antiretroviral Therapy.

Newman LP(1), Njoroge A, Ben-Youssef L, Merkel M, Gatuguta A, Ton Q, Obimbo EM,
Wamalwa D, Lohman-Payne B, Richardson BA, Nduati R, Farquhar C.

Author information:
(1)a Department of Epidemiology, c Department of Medicine, g Department of Global
Health, e Department of Biostatistics, University of Washington, Seattle, WA, USA
b Department of Public Health, d Department of Paediatrics and Child Health,
University of Nairobi, Nairobi, Kenya f Division of Vaccine and Infectious
Disease, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

This paper describes results from a cross-sectional study among HIV-infected
children 15 months to 12 years of age who were receiving antiretroviral therapy.
We found a low prevalence of measles IgG seropositivity (45.7%) and identified
CD4% ≥ 25 as a predictor. Most HIV-infected children on ART were not measles
seropositive and might benefit from revaccination.

PMID: 24618938 [PubMed - as supplied by publisher]

This paper describes results from a cross-sectional study among HIV-infected children 15 months to 12 years of age who were receiving antiretroviral therapy. We found a low prevalence of measles IgG seropositivity (45.7%) and identified CD4% ≥ 25 as a predictor. Most HIV-infected children on ART were not measles seropositive and might benefit from revaccination.

The smallholder tea sub-sector in Kenya is considered the largest and one of the most successful smallholder schemes in the world. However, tea productivity in this sub-sector has been persistently low when compared with the estate sub-sector. Despite the smallholders planting high yielding clonal teas, the national average yield in the sub-sector was only 2,075 kg made tea/hectare (mt/ha) compared to 3,954 kg mt/ha in the estate sub-sector in 1998. This study investigated some of the factors contributing to low tea productivity in the sub-sector. Cross sectional data gathered in Kirinyaga, Nyambene, Nandi and Nyamira Districts in 1999 were used. It was hypothesized that the extend of rationality in allocation of resources in the smallholder tea enterprise is relatively low. Hence, smallholder tea productivity has remained relatively lower than in the estate sub-sector, high yielding clones and useful agronomic recommendations extended in the smallholder sub-sector notwithstanding. To determine \"the extend of economic rationality\", \"A Test of Economic Rationality Model\" was used whereby, the index of economic rationality, ρ is the product moment coefficient of correlation between log (total variable costs-excluding labour costs) and log (labour-in mandays) for each tea district and region. The results showed that the product moment coefficient of correlation, ρ was:- 0.647 in Kirinyaga District, 0.651 in Nyambene District, 0.793 in Nandi District, 0.743 in Nyamira District, 0.595 in East Rift Valley Region, 0.752 in West Rift Valley Region and 0.674 for all farms surveyed. It was noted that the lowest value of ρ was 0.595 in East Rift Valley Region. It means that at least 59 percent of the variance in the logs of both inputs is due to the variation in the systematic profit-maximizing component of these inputs. The balance of 41 percent is the maximum that could be occasioned not only by poor technology and/or knowledge gaps but also by errors in the model and noise in the universe. The null hypothesis was rejected in favour of the alternative hypothesis. The conclusion is that smallholder tea farmers in Kenya seem to be quite price efficient in tea production.

Operations Research techniques involving modelling a situation or a problem and finding an optimal solution for it. These tools are not designed nor intended to replace managerial decision making, but rather their purpose is to aid in the decision-making process by providing a quantitative basis for decision making. Unfortunately, the proliferation of OR tools in organizational decision making has been lacking, with concerns been expressed about the limited awareness of the business community of OR's potential and capability. Current study was based in the premise that students provide an appropriate avenue, as agent of change, in sensitizing and demonstrating the potential and capacity of OR tools/techniques in resolving various problems, both in public and private sector. Study aimed at evaluating the use of OR as tools of data analysis at MBA level. A sample of 100 MBA research projects undertaken between 2005 and 2007 was randomly selected and their objectives and selected data analysis tools recorded. Where OR tools were not used, the research evaluated if there was a possibility of using OR tools. Results indicated low usage of OR as data analysis, though there was a high potential for the use of OR tools.

A prospective study of serial serum C-reactive protein (CRP) concentrations was made on 21 patients who had received renal allografts. CRP was raised during 27 of 32 rejection episodes and in all of five episodes of rejection associated with infection. CRP values were persistently elevated in three irreversible rejection episodes. Significantly raised CRP concentrations were documented in 14 of 20 episodes of infection. In some cases CRP was a predictive indicator of rejection or infection. In all cases of infection or rejection associated with a rise in CRP, CRP values fell following successful treatment with appropriate agents. Serial CRP measurement used in conjunction with other clinical and biochemical parameters appears to be valuable clinically following renal transplantation.

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

Introduction Ambient air pollution is a growing global health concern tightly connected to the rapid global urbanization. Health impacts from outdoor air pollution exposure amounts to high burdens of deaths and disease worldwide. However, the lack of systematic collection of …

Thousands of surveys on rural livelihoods in developing countries are being done every year. Unfortunately, many suffer from weaknesses in methods and problems in implementation. Quantifying households' dependence on multiple environmental resources (forests, bush, grasslands and rivers) is particularly difficult and often simply ignored in the surveys. The results therefore do not reflect rural realities. In particular, 'the hidden harvest' from natural resources is generally too important to livelihoods for development research, policies and practice to ignore. Fieldwork using state-of-the-art methods, and in particular well-designed household questionnaires, thus becomes an imperative to adequately capture key dimensions of rural welfare. This book describes how to do a better job when designing and implementing household and village surveys for quantitative assessment of rural livelihoods in developing countries. It covers the entire research process from planning to sharing research results. It draws on the experiences from a large global-comparative project, the Poverty Environment Network (PEN), to develop more robust and validated methods, enriched by numerous practical examples from the field. The book will provide an invaluable guide to methods and a practical handbook for students and professionals.

To examine the effects of animal-source foods on toddler growth.

Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, CA 90095, USA. cneumann@mednet.ucla.edu

A randomized, controlled school feeding study was conducted in rural Embu District, Kenya to test for a causal link between animal-source food intake and changes in micronutrient nutrition and growth, cognitive, and behavioral outcomes. Twelve primary schools were randomly assigned to 1 of 4 groups. Children in Standard I classes received the local plant-based dish githeri as a midmorning school snack supplemented with meat, milk, or fat added to equalize energy content in all feedings. The Control children received no feedings but participated in data collection. Main outcome measures assessed at baseline and longitudinally were 24-h food intake recall, anthropometry, cognitive function, physical activity, and behaviors during school free play. For cognitive function, the Meat group showed the steepest rate of increase on Raven's Progressive Matrices scores and in zone-wide school end-term total and arithmetic test scores. The Plain githeri and Meat groups performed better over time than the Milk and Control groups (P < 0.02-0.03) on arithmetic tests. The Meat group showed the greatest increase in percentage time in high levels of physical activity and in initiative and leadership behaviors compared with all other groups. For growth, in the Milk group only younger and stunted children showed a greater rate of gain in height. The Meat group showed near doubling of upper midarm muscle area, and the Milk group a smaller degree of increase. This is the first randomized, controlled feeding study to examine the effect of meat- vs. milk- vs. plant-based snacks on functional outcomes in children.

PMID: 17374691 [PubMed - indexed for MEDLINE]

The present study examines the effect of animal-source-food (ASF) intake on arm muscle area growth as part of a larger study examining causal links between ASF intake, growth rate, physical activity, cognitive function and micronutrient status in Kenyan schoolchildren. This randomised, controlled feeding intervention study was designed with three isoenergetic feeding interventions of meat, milk, and plain traditional vegetable stew (githeri), and a control group receiving no snack. A total of twelve elementary schools were randomly assigned to interventions, with three schools per group, and two cohorts of 518 and 392 schoolchildren were enrolled 1 year apart. Children in each cohort were given feedings at school and studied for three school terms per year over 2 years, a total of 9 months per year: cohort I from 1998 to 2000 and cohort II from 1999 to 2001. Food intake was assessed by 24 h recall every 1-2 months and biochemical analysis for micronutrient status conducted annually (in cohort I only). Anthropometric measurements included height, weight, triceps skinfold (TSF) and mid-upper-arm circumference (MUAC). Mid-upper-arm muscle area (MAMA) and mid-upper-arm fat area (MAFA) were calculated. The two cohorts were combined for analyses. The meat group showed the steepest rates of gain in MUAC and MAMA over time, and the milk group showed the next largest significant MUAC and MAMA gain compared with the plain githeri and control groups (P< 0·05). The meat group showed the least increase in TSF and MAFA of all groups. These findings have implications for increasing micronutrient intake and lean body mass in primary schoolchildren consuming vegetarian diets.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

Background: Human immunodeficiency virus is currently estimated to have infected 40 million people globally, 28.5 million of whom reside in sub Saharan Africa. It has affected all sectors of society. Identification of indices associated with clinical progression of HIV to AIDS would facilitate development of effective management strategies. We evaluated the relationship between Natural killer, N cell counts to CD4+/CD8+ cell rations during HIV infection and clinical progression to AIDS and measured with activities of selected liver and kidney function enzymes and metabolites with the view of determining the cause of anaemia in AIDS patients. Methods: Blood samples (10mls) were drawn twice by veni-puncture at six months intervals from 17 anti-retroviral na

Variations among silk of four African wild silkmoths, Argema mimosae, Anaphe panda, Gonometa postica, and Epiphora bauhiniae, was studied regarding their mechanical properties and thermal degradation behaviors. Cocoon shells and individual degummed fibers were examined using tensile testing, thermogravimetric analysis, and scanning electron microscope (SEM). A. mimosae and G. postica cocoon shells had marginally higher initial moduli and strains at maximum stress. The stress–strain curves of Bobmyx mori and A. panda degummed fibers lacked clear yielding points. G. postica fibers had the highest breaking energy (76.4 J/cm3) and breaking strain (41.3%). The ultimate tensile strength was the highest for B. mori (427 MPa). Fiber pull-out and detachment was predominant in fracture surfaces of both the cocoon shells and the fibers. Wild cocoon shells and degummed fibers had higher temperature for dehydration loss than B. mori. A. mimosae fibers (11.9%) and G. postica cocoon shells (13.3 %) had the highest weight loss due to dehydration. E. bauhinae cocoon shells and B. mori fibers had the highest total weight losses of 97.2 and 93.4%, respectively. The African silks exhibited variations in their mechanical and thermal degradation properties related to their physical and chemical structure and composition. © 2012 Wiley Periodicals, Inc. J. Appl. Polym. Sci., 2013

The study applies critical state soil mechanics to model the mechanical behavior of luvisol soils. Field work involved sampling and soil physical characterization to obtain undisturbed and disturbed specimens

Five plaster of Paris casting bandages including Nairobi Enterprises, Salvagyps, Helm, Plasrun-gyps and Veronese, available on the Kenyan market were evaluated based on breaking strength. Helm plaster of Paris had a significantly higher mean maximum load compared to all the other products (p

Five plaster of Paris casting bandages including Nairobi Enterprises, Salvagyps, Helm, Plasrum-gyps and Veronese, available on the Kenyan market were evaluated based on breaking strength. Helm plaster of Paris had a significantly higher mean maximum load compared to all the other products (p-0.050. Plasrun-gyps supported the highest mean maximum load per unit thickness. Based on this study, Helm and Plasrun-gyps are recommended as more suitable for cast application on the basis of their superior breaking strength.

Films of buffalo and elephant running, and detailed measurements on dissected legs, have been used to estimate the maximum stresses which occur in locomotion, in certain muscles, tendons and bones. These stresses are similar to stresses previously determined for some other, smaller mammals.

Background & objectives: Bancroftian filariasis in Kenya is endemic in coastal districts with anestimated number of 2.5 million people at risk of infection. The main mosquito genera involved intransmission of Wuchereria bancrofti in these areas are Anopheles, Culex and Mansonia. Thestudy was envisaged to compare the infectivity rates of Bancroftian filariasis vectors between thehigh transmission (wet) and the low transmission (dry) seasons.Methods: Mosquitoes were sampled from houses and compounds from two study sites, Gazi andMadunguni, on the Kenyan coast. Day resting indoor collection (DRI), pyrethrum spray catch(PSC) and CDC light traps were used to collect mosquitoes. After identification, female mosquitoeswere dissected to search for W. bancrofti III stage larvae.Results: A total of 1832 female mosquitoes were dissected. Infectivity rates of vectors in Madunguniwere 1.49 and 0.21% in wet and dry seasons respectively, whereas in Gazi, these were 1.69 and0%, respectively. There was a significant difference in the infectivity rates between the two seasonsin both Madunguni and Gazi villages (p <0.05). Anopheles gambiae s.l. was the main vector inboth study sites followed by Culex quinquefasciatus and An. funestus.Conclusion: There was a difference in infectivity rates of Bancroftian filariasis vectors betweenthe wet and dry seasons. The abundance of An. gambiae s.s. during the transmission season couldbe responsible for the increased infectivity rates of vectors in this season.

Ostriches have been filmed running fast in their natural habitat. A female ostrich has been dissected and the principal bones, muscles and tendons in a leg have been measured. It is calculated that stresses up to 240 kN m−2 and 40 MN m−2, respectively, act in the digital flexor muscles and their tendons during running. Tensile and compressive stresses up to about 70MNm−2 and 110 MNm−2 act in the tibiotarsus. A large proportion of the energy which would otherwise be required for running is probably saved by elastic storage in tendons. Comparisons are made with the legs of flying birds and of antelopes

Six insulin-requiring diabetics were studied after insulin had been withheld for 24 hours. On three separate occasions each received a two-hour infusion of insulin at a low dose (2.6 U/h) and a high dose (10.6 U/h) and an infusion of saline as control. The rates of production and utilisation of glucose were measured isotopically. The rate of fall of plasma glucose concentration was faster on the high-dose infusion of insulin than on the low, whereas the fall in plasma free fatty acids, glycerol, and keton bodies was the same on both insulin infusions. The mechanism whereby the two rates of insulin administration lowered plasma glucose concentration differed: during the low-dose infusion the decrease in the glucose concentration was produced entirely by a fall of hepatic glucose output, whereas during the high-dose insulin infusion the glucose concentration fell because both the rate of glucose production fell and the rate of glucose utilisation rose. In all experiments there was a direct relation between a fall in serum potassium concentration and the fall in plasma glucose concentration irrespective of the mechanism that reduced the glucose concentration.These results indicate that in uncontrolled diabetics low-dose insulin infusions lower the blood glucose concentration entirely by reducing glucose production from the liver and that the effect of insulin on potassium transport is independent of its effect on glucose uptake.

Eye-specific visual connections are a prominent model system for exploring how precise circuits develop in the CNS and, in particular, for addressing the role of neural activity in synapse elimination and axon refinement. Recent experiments have identified the features of spontaneous retinal activity that mediate eye-specific retinogeniculate segregation, the synaptic events associated with this process, and the importance of axon guidance cues for organizing the overall layout of eye-specific maps. The classic model of ocular dominance column development, in which spontaneous retinal activity plays a crucial role, has also gained new support. Although many outstanding questions remain, the mechanisms that instruct eye-specific circuit development are becoming clear.

Patterns of synaptic connections in the visual system are remarkably precise. These connections dictate the receptive field properties of individual visual neurons and ultimately determine the quality of visual perception. Spontaneous neural activity is necessary for the development of various receptive field properties and visual feature maps. In recent years, attention has shifted to understanding the mechanisms by which spontaneous activity in the developing retina, lateral geniculate nucleus, and visual cortex instruct the axonal and dendritic refinements that give rise to orderly connections in the visual system. Axon guidance cues and a growing list of other molecules, including immune system factors, have also recently been implicated in visual circuit wiring. A major goal now is to determine how these molecules cooperate with spontaneous and visually evoked activity to give rise to the circuits underlying precise receptive field tuning and orderly visual maps.

Patterns of synaptic connections in the visual system are remarkably precise. These connections dictate the receptive field properties of individual visual neurons and ultimately determine the quality of visual perception. Spontaneous neural activity is necessary for the development of various receptive field properties and visual feature maps. In recent years, attention has shifted to understanding the mechanisms by which spontaneous activity in the developing retina, lateral geniculate nucleus, and visual cortex instruct the axonal and dendritic refinements that give rise to orderly connections in the visual system. Axon guidance cues and a growing list of other molecules, including immune system factors, have also recently been implicated in visual circuit wiring. A major goal now is to determine how these molecules cooperate with spontaneous and visually evoked activity to give rise to the circuits underlying precise receptive field tuning and orderly visual maps.

Approaches to providing sustainable energy in cities have generated considerable interest in academic and policy circles. The development of this body of work, however, has not shed much light on the modes of intermediation that are needed to reconfigure urban energy systems towards sustainability in energy-poor countries. This paper focuses on the role of academics as knowledge intermediaries who can trigger cross-sector collaborations around innovations for a sustainable energy transition in African cities. The research presented here was generated by an interdisciplinary research team made up of partners in Kenya, Uganda and South Africa. The research partners set out to better understand how sustainable energy transitions can be achieved through collaborative efforts between community members, experts and policy actors in the three countries. This paper provides evidence-based reflections on how the research partners used participatory methods to facilitate solution co-design and knowledge co-production over a period of two years under the Leading Integrated Research for Agenda 2030 in Africa (LIRA 2030) program. A key knowledge outcome of the research partnership is an improved understanding of how transdisciplinary research across the sub-region can be used to unearth the socio-spatial, cultural and political dimensions of energy in relation to other urban services such as health and housing. Based on this understanding, the paper proposes transdisciplinary co-design as a promising approach to providing sustainable energy in urban informal settlements in Sub-Saharan Africa.

There is little documentation on the role of absorptive capacity on the relationship between FDI and performance of firms. This paper investigates the mediating role of absorptive capacity on the relationship between FDI and performance of manufacturing firms in Kenya. The population of study comprised 100 companies registered with Kenya Association of Manufacturers that had over 10 percent foreign ownership as at the time of data collection in 2019. The respondents were the CEOs of organization or their designated officers. The study used a structured questionnaire to collect primary data. The respondent were required to indicate how the introduction of FDI impacted on organizations capital flow, advanced production technology, marketing expertise and management knowhow. They were also to indicate the extent their Organisation had invested in absorptive capacity and the effect absorptive capacity had on the relationship between FDI and local firm performance. Descriptive and inferential statistics were both used to analyze the data. The results revealed that absorptive capacity has statistically significant mediating effect on the relationship between FDI and firm performance. This imply that an incremental change in the absorptive capacity would generate growth in company’s performance. As such Kenyan and other sub-Sahara African countries government need to come up with polices geared to supporting improvement of firms absorptive capacities so as to spur the growth of their key sectors of the economy.

This study sought to establish the influence of quality drivers on the satisfaction of direct
business customers within large Maize Flour Mills in Nairobi and assess the mediation effect of
customer perception on this relationship. The quality drivers studied were product quality,
service quality, complaints handling, ease of doing business and product price. Customer
perception constructs studied were customer’s desire for features critical to quality, brand
imagery, firm imagery and reference to competitive substitutes. Primary data were collected in
February 2013 by use of questionnaires from 81 direct Business Customer firms randomly
selected from 13 Maize Flour Mills in the study area grinding at least 15 MT of maize per day.
Results showed that the influence of quality drivers on customer satisfaction is both direct and
partially mediated by customer perception, both influences being positive and statistically
significant (p< 0.01). Quality of service significantly influenced customer satisfaction (β= 0.441,
p< 0.01) and most of the other quality drivers and intention to recommend. Brand imagery
significantly influenced satisfaction (β= 0.531, p< 0.01) followed by desire for features critical to
quality (β= 0.259, p< 0.01). These results have implications for marketing theory. The finding
that customer perception partially mediated the process of customer satisfaction agrees with the
consumer attitude theories which postulate that attitude and subjective norms in conjunction
with cognitive and emotional considerations influence intentions which in turn give impetus for
action. The study contributes to the evolution and adaptation of customer satisfaction models by
adding customer perception as mediator variables. Further, the results have implications useful
at national policy level. Kenya’s strategy for revitalizing agriculture and vision 2030 both aspire
to increase the country’s regional and global trade through improved efficiency and
competitiveness at firm level, agro-processing and the marketing system including the wholesale
and retail sectors. The volume of trade within the East African Community is expected to
increase as member states reduce trade barriers. This will open new trade opportunities but
could increase competition. Training local firms on the issues of quality drivers and customer
perception can help to improve their regional and global competitiveness. For managerial
practice, the results demonstrate that frequent feedback on customer perception is necessary
and that improvements in the quality of service go a long way in improving customer perception
concerning other quality drivers and satisfaction. It is concluded that customer satisfaction
enhancement programs and evaluation models need to integrate primary drivers of quality with
key drivers of customer perception. The study was limited in a number of ways. Due to time,
cost and other constraints a cross-sectional research design was used and focused on firms in
Nairobi. Data were collected from respondents once to get their views and perceptions concerning a limited number of variables and constructs. However, perceptions vary over time and across markets or regions as influenced by changes in consumer preferences or economic changes that influence purchase and consumption patterns. Opportunities therefore exist for longitudinal and wider studies in the same area of research. Key Words:Quality drivers, customer perception, customer satisfaction (CS), Nairobi, Kenya

No abstract available

The early success of the President's Emergency Plan for AIDS Relief (PEPFAR) in delivering antiretroviral medications in poor countries unmasked the reality that many lacked sufficient health workers to dispense the drugs effectively. The 2008 reauthorization of PEPFAR embraced this challenge and committed to supporting the education and training of thousands of new health workers. In 2010 the program, with financial support from the US National Institutes of Health and administrative support from the Health Resources and Services Administration, launched the Medical Education Partnership Initiative to fund thirteen African medical schools and a US university. The US university would serve as a coordinating center to improve the quantity, quality, and retention of the schools' graduates. The program was not limited to training in the delivery of services for patients with HIV/AIDS. Rather, it was based on the principle that investment in medical education and retention would lead to health system strengthening overall. Although results are limited at this stage, this article reviews the opportunities and challenges of the first year of this major transnational medical education initiative and considers directions for future efforts and reforms, national governmental roles, and the sustainability of the program over time.

The early success of the President's Emergency Plan for AIDS Relief (PEPFAR) in delivering antiretroviral medications in poor countries unmasked the reality that many lacked sufficient health workers to dispense the drugs effectively. The 2008 reauthorization of PEPFAR embraced this challenge and committed to supporting the education and training of thousands of new health workers. In 2010 the program, with financial support from the US National Institutes of Health and administrative support from the Health Resources and Services Administration, launched the Medical Education Partnership Initiative to fund thirteen African medical schools and a US university. The US university would serve as a coordinating center to improve the quantity, quality, and retention of the schools' graduates. The program was not limited to training in the delivery of services for patients with HIV/AIDS. Rather, it was based on the principle that investment in medical education and retention would lead to health system strengthening overall. Although results are limited at this stage, this article reviews the opportunities and challenges of the first year of this major transnational medical education initiative and considers directions for future efforts and reforms, national governmental roles, and the sustainability of the program over time.

Department of Public Health, University of California, Los Angeles 90024-1772.

Because medical illness is associated with malnutrition, it might contribute to the poor outcomes seen in malnourished children. This study explored relations between frequency of mild illness and development in 133 mild-to-moderately malnourished school-age Kenyan children. Morbidity information was collected for one year. Concurrent assessments of cognitive status and playground behaviors were obtained. Nutritional and environmental variables were also assessed. Girls with more reported days of mild illness performed less well on developmental measures than did their healthier female peers. They were less cognitively advanced, and, on the playground, girls with more mild illness were less active, happy, and social. Furthermore, relations between frequency of mild illness and playground behaviors (but not cognitive score) in the girls remained statistically significant when other variables, such as socioeconomic status, parental literacy, food intake, and anthropometry, were considered. For the boys, frequency of mild illness was not related to cognition or play behaviors.

PMID: 1469106 [PubMed - indexed for MEDLINE]

Two cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision.

Benign prostatic hyperplasia (BPH) is a common disease affecting elderly men with 70% of men over 70 years showing microscopic evidence of hyperplasia. Transurethral resection of the prostate is the gold standard treatment. Medical management of BPH has involved the use of plant extracts, amino acids, kampo and animal organ preparations in various countries with unsatisfactory results. The use of alpha adrenergic antagonists dates back twenty years representing a major breakthrough in the treatment by relaxation of the dynamic contraction of smooth muscle component of prostatic obstruction. The evolution of alpha antagonist therapy resulted in clinical trials with selective antagonists such as prazosin, alfuzosin, indoramin, terazosin and doxazosin all of which achieve similar effective relief of obstructive symptoms as phenoxybenzamine, but with fewer side effects related to postural hypotension. 5-alpha reductase inhibitors, finasteride and episteride, recently synthesised act on the static component of obstruction caused by the enlarging prostate. They inhibit conversion of testosterone to the potent intracellular androgen dihydrotestosterone (DHT) resulting in the reduction of prostate volume and improvement of obstructive symptoms. Clinical trials with finasteride for three years indicate that 63% of patients had a reduction of greater than 20% in prostatic volume and 42% had a decrease of greater than 30% with a mean increase peak flow rate of 2.4 mls/s equivalent, to 20 years reversal of disease progression.