Preface
I have taught research methods in several universities and colleges. During that period, the need for a simplified style of delivery of the course has been evident. Firstly due to the diversity of backgrounds of the students, but also the fear of everything numerical that seems to emanate from high school misconceptions about maths. The objective of the book on “qualitative and quantitative Research Methods simplified” was to provide a mellowed version while avoiding this dilemma.
Simply put, the purpose of research is to discover answers to questions through the application of scientific procedures. The main aim of research is to find out the truth which is hidden and which has not been discovered as yet. Though each research study has its own specific purpose, we may think of research objectives as falling into a number of following broad groupings:
Aims and Objectives of Research Methodology
1. To gain familiarity with a phenomenon or to achieve new insights into it (studies with this object in view are termed as exploratory or formulative research studies);
2. To portray accurately the characteristics of a particular individual, situation or a group(studies with this object in view are known as descriptive research studies);
3. To determine the frequency with which something occurs or with which it is associated with something else (studies with this object in view are known as diagnostic research studies);
4. To test a hypothesis of a causal relationship between variables (such studies are known as hypothesis-testing research studies).

Research Methods Learning Objectives
Specifically, in this book, the following learning objectives have been prepared to assist you in your preparation for the comprehensive examination in the area of research methods. A review of content related to these learning objectives should provide you with the foundation required for a successful understanding of the content.
1. Students should understand a general definition of research design.
2. Students should know why educational research is undertaken, and the audiences that profit from research studies.
3. Students should be able to identify the overall process of designing a research study from its inception to its report.
4. Students should be familiar with ethical issues in educational research, including those issues that arise in using quantitative and qualitative research.
5. Students should know the primary characteristics of quantitative research and qualitative research.
6. Students should be able to identify a research problem stated in a study.
7. Students should be familiar with how to write a good introduction to an educational research study and the components that comprise such an introduction.
8. Students should be familiar with conducting a literature review for a scholarly educational study:
a. The steps in the overall process.
b. The types of databases often searched.
c. The criteria for evaluating the quality of a study.
d. The ways of organizing the available material.
e. The different types of literature reviews.
9. Students should be able to distinguish a purpose statement, a research question or hypothesis, and a research objective.
10. Students should be able to define the meaning of a variable, and to be able to identify independent, dependent, and mediating variables.
11. Students should be able to distinguish between categorical and continuous measures. 12. Students should be able to define theory use in quantitative research.
13. Students should be able to design a good quantitative purpose statement and good quantitative research questions and hypotheses.
14. Students should be able to define a central phenomenon in qualitative research.
15. Students should be able to design a good qualitative purpose statement and a good central question in qualitative research.
16. Students should know the steps in the process of quantitative data collection.
17. Students should be able to distinguish between a population and a sample.
18. Students should know the various types of quantitative sampling and which ones present the most rigorous approach to use.
19. Students should understand the link between quantitative research questions and data collection and how research questions are operationalized in educational practice.
20. Students should be familiar with the steps involved in identifying and selecting a good instrument to use in a study
To meet all the objectives listed above, the author divided the book into fifteen chapters. Each chapter is introduced with learning objectives and keywords to help you pick the titles suitable for every research session. The same are also listed in detail under the table of contents to enable the reader to identify even the subtitles quickly as appropriate.
It is my believe that after reading this book, the reader will be able to first of all appreciate research methods as doable and then utilise the various components for their examination or research needs.

Samuel Mwituria Maina PhD, IDR, OGW

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Kenya like other developing countries requires foreign exchange to meet the many challenges facing it and relies heavily on agriculture for this. The pig population in Kenya constitutes 5% of livestock contributing less than 1.0% Agricultural domestic product. The pig industry provides employment and supplies pork and pork products to the tourist sector, exports to other African countries, Middle East- Bahrain & South Arabia. Export to the world markets is encouraged and to this end, Farmer\'s Choice a private company produces and processes pork and its products for both domestic and export markets. Therefore, in order to comply with the World Trade Organization [WTO] Sanitary Phytosanitary [SPS] regulations, this Risk Analysis was conducted in response in order to assure USDA-APHIS and FSIS that export of smoked and cooked pork frankfurters from Kenya will not introduce Foot and Mouth Disease [FMD] to USA. The risk factors considered were: Authority, structure/Organization and infrastructure of Kenya's Veterinary Services; Policy, Law and Infrastructure of Disease Control; Disease outbreak history and prevalence status; Diagnostic Laboratory capabilities; Active disease control Programmes; Surveillance: Type and extent; Vaccination Status. Livestock Demographics and Marketing practices; Disease outbreak history and Prevalence in adjacent regions; Control of the movement of animals from regions of high risk. A critical analysis of all the risk factors determined that, the likelihood of infected meat from a pig carcass being exported to the United States was minimal. Further, it is prudent to conclude that, pork frankfurters processed through the Farmers Choice farms and facilities and exported to the United States pose minimal risk.

This study explored barriers to consistent condom use among heterosexual HIV-1 serodiscordant couples who were aware of the HIV-1 serodiscordant status and had been informed about condom use as a risk reduction strategy. We conducted 28 in-depth interviews and 9 focus group discussions among purposively selected heterosexual HIV-1 serodiscordant couples from Thika and Nairobi districts in Kenya. We analyzed the transcribed data with a grounded theory approach. The most common barriers to consistent condom use included male partners' reluctance to use condoms regardless of HIV-1 status coupled with female partners' inability to negotiate condom use, misconceptions about HIV-1 serodiscordance, and desire for children. Specific areas of focus should include development of skills for women to effectively negotiate condom use, ongoing information on HIV-1 serodiscordance and education on safer conception practices that minimize risk of HIV-1 transmission.

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This 2018 study, conducted in six Tusky's supermarkets in Nairobi, Kenya, combined the Just-About-Right, Penalty and Mean-End-Chain analyses to examine the quality and psychosocial factors influencing the purchase of a novel bread made from orange-fleshed sweet potato (OFSP), a biofortified crop, focusing on sixty-one male and eighty female urban OFSP bread buyers recruited at point of purchase. It finds that sensory and psychosocial factors drive purchasing decisions and that some of the bread's sensory characteristics are misaligned with consumers' expectations. It also finds that women and men's evaluations of the bread's characteristics are different, as are their motivations for purchase. However, good sensory attributes and the knowledge of the bread's nutritional value were key drivers. Some misaligned characteristics reveal levers for the reformulation of the bread and present opportunities for segmenting the market. Several other implications of the findings for policy and future improvement of the bread are discussed.

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.

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.

Background: Pregnancy and childbirth are usually a time of celebration in most parts of the world and is often marked with rituals in all societies. However this period of time can be the hardest of all experiences with anxiety and concern for some women. This is because a number of pregnant women end up with disabilities or even death due to pregnancy related complications. Pre eclampsia is one of the conditions that are responsible for maternal morbidity and mortality. Screening and monitoring in pregnancy are some of the strategies used by health care providers to identify high risk pregnancies so that they can provide more targeted and appropriate treatment and follow up care, and to monitor fetal well being in both low and high risk pregnancies.
Purpose: The aim of the study was to identify whether blood pressure and urinalysis are done for mothers seeking antenatal and delivery services at Moi Teaching and Referral Hospital Eldoret.
Methods: A review of records at the antenatal, labor and delivery units at Moi Teaching and Referral Hospital.
Findings: over 96% of women came for first visit and had their Blood Pressure taken, 48.7% of women came for the second visit and had their blood pressure taken, 17.8% of women came for the third visit and had their blood pressure taken and 5.6% of women came for the fourth visit and had their blood pressure taken . All women admitted to the labor ward had blood pressure measured and recorded. 40% of the women admitted to labor ward had urinalysis done.
Conclusion: Blood Pressure and urinalysis are key in the early diagnosis and management of Pre eclampsia and other hypertensive states in pregnancy. There is need that they are done as routine procedures.

The viability of production of good quality and acceptable bread with substitution of wheat flour with Dolichos lab lab (Lab lab purpureus) was investigated. The bread was analyzed for protein, moisture, general bread quality and sensory properties. The protein content of bread was elevated by up to about 20% and the moisture content reduced by about 10% without significant changes in bread taste, odor, volume and general bread quality. Substitution levels of up to 10% produced bread with quality characteristics not significantly different from the control. Sensory evaluation showed no significant differences between the control bread and the Dolichos supplemented breads up to 15% in the sensory attributes of aroma, crumb appearance, texture, crust colour, loaf shape, taste and general acceptability (p < 0.05). The crumb colour changed from creamish white to dull brown and a gradual hardening of crumb texture was observed as the addition of Dolichos lab lab bean flour increased. Above 15% substitution levels, the acceptability declined because of the compact texture of the crumb and the strong beany flavor of the product. Results indicate that acceptable breads can be produced by substitution of up to 15% wheat flour with dolichos bean flour

The viability of production of good quality and acceptable bread with substitution of wheat flour with Dolichos lab lab (Lab lab purpureus) was investigated. The bread was analyzed for protein, moisture, general bread quality and sensory properties. The protein content of bread was elevated by up to about 20% and the moisture content reduced by about 10% without significant changes in bread taste, odor, volume and general bread quality. Substitution levels of up to 10% produced bread with quality characteristics not significantly different from the control. Sensory evaluation showed no significant differences between the control bread and the Dolichos supplemented breads up to 15% in the sensory attributes of aroma, crumb appearance, texture, crust colour, loaf shape, taste and general acceptability (p < 0.05). The crumb colour changed from creamish white to dull brown and a gradual hardening of crumb texture was observed as the addition of Dolichos lab lab bean flour increased. Above 15% substitution levels, the acceptability declined because of the compact texture of the crumb and the strong beany flavor of the product. Results indicate that acceptable breads can be produced by substitution of up to 15% wheat flour with dolichos bean flour

                                    Abstract

The use of traditional and herbal medicines is gaining recognition globally. To safeguard the patient, there are legitimate demands that all medicines be safe, efficacious and of good quality. The required parameters for their quality evaluation include assessment for inorganic matter(dust),absence of adulteration microbial load, identification and profile of contents and where possible quantitation of the active compound or marker compounds. Also of importance are heavy metals, pesticides and product stability. The mixture of portions of herbs in traditional medicines complicates the quality control tests of these preparations. The content profile becomes difficult to replicate from batch to batch, while quantification of the active compound(s) in such multi-component products would require prior processing to isolate and identify the chemical compounds

The use of traditional and herbal medicines is gaining recognition globally. To safeguard the patient, there are legitimate demands that all medicines be safe, efficacious and of good quality. The required parameters for their quality evaluation include assessment for inorganic matter(dust),absence of adulteration microbial load, identification and profile of contents and where possible quantitation of the active compound or marker compounds. Also of importance are heavy metals, pesticides and product stability. The mixture of portions of herbs in traditional medicines complicates the quality control tests of these preparations. The content profile becomes difficult to replicate from batch to batch, while quantification of the active compound(s) in such multi-component products would require prior processing to isolate and identify the chemical compounds

The use of traditional and herbal medicines is gaining recognition globally. To safeguard the patient, there are legitimate demands that all medicines be safe, efficacious and of good quality. The required parameters for their quality evaluation include assessment for inorganic matter(dust),absence of adulteration microbial load, identification and profile of contents and where possible quantitation of the active compound or marker compounds. Also of importance are heavy metals, pesticides and product stability. The mixture of portions of herbs in traditional medicines complicates the quality control tests of these preparations. The content profile becomes difficult to replicate from batch to batch, while quantification of the active compound(s) in such multi-component products would require prior processing to isolate and identify the chemical compounds

Introduction:
Methods used by Kenyan herbalists to identify plants and preserve herbal drugs are unclear.
Objective:
To assess the accuracy of plant identification, microbial and heavy metal contamination in hypoglycemic herbal preparations.
Method:
Four herbalists were identified by purposeful sampling and key informant interviews were carried out. Ethnobotanical walks were used to collect herbs and a botanist checked the accuracy of scientific names. Herbalists were asked to submit formulations. Microbial contamination was evaluated using selective and non-selective cultural media. Levels of heavy metals were evaluated by atomic absorption.
Analysis:
Content thematic approach was used to analyze key informant interviews. Degree of agreement between the names assigned by the herbalists and botanists was measured using percentage.
Results:
Plant identification relied heavily on macroscopic qualities aided by the plant’s geographical location. Both indigenous and botanical names were used. Naming errors using botanical names were recorded. Three formulations were submitted and one of them recorded contamination by Candida albicans,
Escherichia coli and Klebsiella pneumoniae. Heavy metal contamination was not detected.
Conclusion:
Plant identification by herbalists by use of botanical names may be inaccurate. Herbalist should be trained on good manufacturing practices.

During the period 2011-2015, the Drug Analysis and Research Unit (DARU) analyzed 1972 drug samples. The samples consisted of 21.5% locally manufactured and 78.2% imported products while the origin of 0.3% of products was indeterminate. Samples were subjected to compendial and/or in-house analytical specifications. The overall non-compliance rate was 4.5% comprising 2.5% local products and 2.0% imports. High failure rates were recorded for uterotonics (37.5%), hemostatics (33%), anthelmintics (17%) and anticancers (10.5%) while ophthalmic, immunomodulatory, musculoskeletal and endocrine drugs all complied with the quality acceptance criteria. Erectile dysfunction drugs, received by the laboratory for the first time, all complied with specifications. The results obtained demonstrate an improvement in the quality of samples submitted to DARU when compared to previous performance.

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During the five-year period covering 2016-2020, the Drug Analysis and Research Unit (DARU) received and processed 326 drug samples. Of these samples, 32.5% were locally manufactured, 65.7% imported and 1.8% of undeclared origin. Samples were analyzed according to compendial and/or in-house specifications. The overall non-compliance rate was 1.8% (0.6% locally manufactured, 0.9% imported and 0.3% drugs of undeclared origin). Full analytical compliance was recorded with anti-emetics. spasmolytics, antihypertensives, ophthalmics, anti-infectives, analgesics, anti-inflammatory agents, anti-epileptics, nootropics, anaesthetics, respiratory drugs, genitourinary drugs, anticancers, dermatologicals, immunomodulatory drugs, vaccines and excipients. However, one sample each of anti-ulcers, hypoglycemics, opioids and herbals as well as two samples of antiseptics did not comply with specifications. This represents the lowest failure rate of samples analyzed in DARU and presented as pentad reports since the year 1991.

During the 2013-2017 period, the MEDS laboratory received and processed 6853 samples. Samples were sourced from Kenya and other sub-Saharan Africa countries. The samples submitted comprised Kenyan manufactured (31.9%) and internationally manufactured products (67.9%) while nine samples were of unknown origin. Analysis was carried out according to compendial and/or in-house specifications. The non-compliance rate was 5.1% consisting of 1.2 % local and 3.8% imports. The top ten drug classes with high failure rates were antimyasthenics (50.0%), antiseptics/disinfectants (24.7%), anthelminthics (22.0%), thyroid/antithyroid drugs (20.0%), nutrient mixtures (18.5%), uricosurics (12.5%), waters (11.6%), mixed anti-infectives (11.1%), hemostatics (10.0%) and nootropics (10.0%). Full compliance was however, recorded with laxatives, antidiarrheals, antihemorrhoidals, prokinetics, antithrombotics, antithrombocytopenia agents, vasopressors, anti-arrhythmic drugs, anti-anginal drugs, disease modifying antirheumatic drugs, antimigraine drugs, vertigolytics, muscle relaxants, bisphosphonates, joint lubricants, hormones, anticholinergics, osmotic diuretics, hypophosphatemics, lubricants, minerals, amino acids/peptides, immunomodulatory agents, choleretics, antidotes, lozenges, ear drops, proteins/glycoproteins, herbal products, X-ray contrast media, vaccines, environmental monitoring, medical devices/equipment and cleaning validation swabs. A total of 23 substandard and falsified medicines devoid of active ingredients were encountered over the five-year period. The results obtained demonstrate the need to strengthen regulatory stringency in order to curb incidences of substandard and falsified medicines.

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.

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The demand for university education has continued to grow and hence there has been a phenomenal expansion in enrolments that is not matching with the expansion of facilities. Several policy reports commissioned by the Government of Kenya highlight the importance of affordable, accessible and quality education through e-learning platforms to achieve education for all as envisaged by the Millennium Development Goals (MDGs). In particular, The Government of Kenya Policy Framework for Education, Training and Research highlights the unexploited means of access to education such as Open Distance and E-learning (ODeL) and virtual institutions particularly in higher education and training; unregulated
examination and certification of Distance Education eLearning (DEeL) programmes and lack of national capacity for curriculum design for ICT-supported educational programmes to facilitate access to quality education to learners at all levels of the education system. As institutions of higher learning gear up to offer their academic programmes by DEeL mode of instructional delivery, there are concerns from stakeholders about the quality of the diploma and degree awards. This can be attributed to inadequate quality assurance standards to assess the quality and value of DEeL academic programmes. This paper is aimed at identifying critical factors influencing Distance Education and e-Learning (DEeL) in higher education in Kenya and to develop an appropriate framework for assessing quality indicator measures.
Keywords: DEeL, e-learning, technological, educational, ICT-supported learning, distance education

Ogutu EO. A 10-year (1976-1986) retrospective study was done on 30 cases with histological diagnosis of pancreatic carcinoma. The male to female ratio was 1.3:1 and the peak incidence was in the 6th and 7th decades. The head of the pancreas was involved in 96% of cases while solid adenocarcinoma of duct cell origin accounted for 73.3% of cases, followed by anaplastic carcinoma (23.3%). The commonest complications were distinct metastasis (86.6%), obstructive jaundice (73.3%) and upper gastrointestinal bleed (13.6%).

The paper describes a participatory action-based case research to analyze the effect of the easier-to-apply quality management core practices on the operational performance incontexts in which the harder-to-apply socio-behavioural infrastructure practices are indeficit. Uses collaborative core action research cycle built around thematic concerns of a workgroup and a reflection cycle to experience, reflect and interpret the outcomes of actions relating to the specific core practices. Bivariate correlation analysis is used on the data collected from survey of a group of employees, structured observations and objective data analysis to examine the relationships between the different quality management practices’ categories and operational performance dimensions. Proposes that organizations should not have to wait for the socio-behavioural management, employee, customer, and supplier based infrastructure practices to be in place before applying the mechanistic and technical process and information-based quality practices.

The emergence of the COVID-19 pandemic has propelled the use of alcohol-based hand sanitizers to the fore as a SARS-CoV-2 control measure. To be effective these products must comply with relevant quality parameters such as alcohol concentration, methanol limits and purity. The current study was designed to determine the quality of alcohol-based hand sanitizer products in the Nairobi metropolitan area. For this purpose, 74 commercially marketed samples were collected and subjected to analysis by gas chromatography. Only three samples (4.1%) complied with the regulatory specifications for alcohol content, methanol limits and pH. Five samples (6.8%) complied with the specification for alcohol content but did not meet methanol or pH limits. A total of 44 (59.5%) samples had methanol levels that exceeded threshold limits. Eleven samples (14.9%) were found with methanol substitution (i.e., methanol, instead of ethanol or isopropanol, was the main alcohol component). The results show that users of alcohol-based hand sanitizers are being exposed to substandard and falsified products which in addition to being non-efficacious pose harm due to unacceptable levels of toxic impurities. Regular, routine post-market surveillance is needed to prevent such products from reaching the market.

Ampicillin products, 20 capsules, 2 tablets and 23 dry suspensions were evaluated for quality by liquid chromatography at theDrug Analysis Unit University of Nairobi. Four capsule formulations failed limits on content. The Ampicillin content in 5 suspensions dropped below 80% on storage, but had no correlation to decrease in chemical content
 
Ampicillin is semi-synthetic penicillin used in the management of infections caused by sensitive microorganisms. Microbial resistance against ampicillin is well documented and cross-resistance is a common problem among the penicillins. Development of resistance is always associated with exposure of microorganisms to sub-lethal levels of drugs. The quality administered and especially low content of ampicillin in dosage form could therefore contribute to the development of resistance.
 
Work on the quality of drugs in the period 1982 to 1992 has shown presence of poor quality penicillin products in the market [1-4]. This observation was recently reinforced by the findings on quality of phenoxymethylpenicillin syrups [5]. The extensive use of ampicillin in kenya as one of the drugs on the essential drugs list of Ministry of Health [6] led to observed increase in resistance. It was recently replaced by amoxicillin.
 
The communication presents findings on the quality of ampicillian capsules and tablets and dry syrups found on the Kenyan market using liquid chromatography (LC). The preparations were from private and public sources including those submitted to the ministry of Health drug regulatory authority. The latter are intended for marketing in Kenya after registration, and for the purpose of this paper are treated as being on the market.

Background:
Malaria is a major health problem in sub-Saharan Africa where over 90% of the world’s malaria cases occur. Artemisinin-based combination therapy (ACT) is recommended by the World Health Organization as first-line and second-line treatments for uncomplicated falciparum malaria. However, there are a growing number of reports of sub-standard and falsified anti-malarial medicines in sub-Saharan Africa.

Methods:
A cross-sectional study was conducted in Embu County, Kenya on the quality of anti-malarial medicines available in public and private facilities. Sampling of anti-malarial medicines from public and private hospitals, health centers and pharmacies was conducted between May and June 2014. Quality control tests were performed at the Drug Analysis and Research Unit, University of Nairobi, using ultraviolet spectrophotometry and high-performance liquid chromatography. A test for microbial load was also conducted for suspension formulations.

Results:
A total of 39 samples were collected from public and private facilities across the Embu County. A visual inspection of the medicines showed no signs of sub-standard or falsification. All ACT passed identification, assay and dissolution tests. Of 11 suspension samples collected, none failed the microbial load test although one sample had 50 colony forming units (cfu). No oral artemisinin monotherapy medicines were encountered during the survey. Amodiaquine and chloroquine monotherapy products accounted for 5% of the collected samples, despite their ban in Kenya. Two herbal anti-malarial formulations were collected during the survey. Sulfadoxine/pyrimethamine (SP) was also found to be available use for malaria treatment, not in accordance with malaria treatment guidelines.

Conclusion:
All the anti-malarial drugs analysed in this study passed the quality control tests. This is encouraging given the high malaria burden in Kenya. Regulatory actions are required to counter SP and herbal products for malaria treatment.

Description
Fuel briquettes are made by compressing biomass material into a uniform solid and present an opportunity for good quality cooking fuel. The study evaluated the quality of locally produced fuel briquettes in Kenya and their combustion properties, chemical composition and emissions of gases and fine particulate matter. Briquette made from charcoal dust bonded with paper, soil or corn starch and sawdust briquettes bonded with gum arabica were studied. Charcoal dust briquettes bonded with corn starch or paper had the highest calorific values of 23.6 kJ/g and 21.4 kJ/g respectively. Contaminants comprising of chromium, mercury and lead were high in briquettes made from material sourced from garbage heaps in informal settlements and dumpsites. Charcoal dust briquettes bonded with soil was the safest in terms of indoor air concentrations of carbon monoxide and fine particulate matter when burned. Burning …

BACKGROUND: Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. OBJECTIVE: To determine the glycaemic control of ambulatory diabetic patients. DESIGN: Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. SETTING: Kenyatta National Hospital. METHODS: Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. RESULTS: A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c < or = 8% while 60.5% had HbA1c > or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. CONCLUSION: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and deteriorating diabetes. There is need to empower patients with knowledge and resources to enhance their individual participation in diabetes self-care. Diabetes care providers and facilities also need capacity building to improve care of patients with diabetes.

BACKGROUND: Treatment of diabetes mellitus is based on the evidence that lowering blood glucose as close to normal range as possible is a primary strategy for reducing or preventing complications or early mortality from diabetes. This suggests poorer glycaemic control would be associated with excess of diabetes-related morbidity and mortality. This presumption is suspected to reach high proportions in developing countries where endemic poverty abets poor glycaemic control. There is no study published on Kenyan patients with diabetes mellitus about their glycaemic control as an audit of diabetes care. OBJECTIVE: To determine the glycaemic control of ambulatory diabetic patients. DESIGN: Cross-sectional study on each clinic day of a randomly selected sample of both type 1 and 2 diabetic patients. SETTING: Kenyatta National Hospital. METHODS: Over a period of six months, January 1998 to June 1998. During routine diabetes care in the clinic, mid morning random blood sugar and glycated haemoglobin (HbA1c) were obtained. RESULTS: A total of 305 diabetic patients were included, 52.8% were females and 47.2% were males. 58.3% were on Oral Hypoglycaemic Agent (OHA) only, 22.3% on insulin only; 9.2% on OHA and insulin and 4.6% on diet only. 39.5% had mean HbA1c < or = 8% while 60.5% had HbA1c > or = 8%. Patients on diet-only therapy had the best mean HbA1c = 7.04% while patients on OHA-only had the worst mean HbA1c = 9.06%. This difference was significant (p=0.01). The former group, likely, had better endogenous insulin production. The influence of age, gender and duration of diabetes on the level of glycaemic control observed did not attain statistically significant proportions. CONCLUSION: The majority of ambulatory diabetic patients attending the out-patient diabetic clinic had poor glycaemic control. The group with the poorest level of glycaemic control were on OHA-only, while best control was observed amongst patients on diet-only, because of possible fair endogenous insulin production. Poor glycaemic control was presumed to be due to sub-optimal medication and deteriorating diabetes. There is need to empower patients with knowledge and resources to enhance their individual participation in diabetes self-care. Diabetes care providers and facilities also need capacity building to improve care of patients with diabetes.

Quality of health education during STD case management in Nairobi was assessed in 142 healthcare facilities, through interviews of 165 providers, observation of 441 STD patients managed by these providers, and 165 visits of simulated patients. For observations, scores were high for education on contact treatment (74-80%) and compliance (83%), but unsatisfactory for counselling (52%) and condom promotion (20-41%). The World Health Organization (WHO) indicator for STD case management Prevention Indicator 7 (PI7) (condom promotion plus contact treatment) was poor (38%). Public clinics strengthened for STD care generally performed best, whereas pharmacies and mission clinics performed worst. Compared with observations, scores were higher during interviews and lower during simulated patient visits, indicating that knowledge was not fully translated into practice. Interventions to improve the presently unsatisfactory service quality would be wide distribution of health education materials, ongoing training and supervision of providers, implementation of STD management checklists, and the introduction of pre-packaged kits for STD management.

Given the high mortality associated with neonatal illnesses and severe malnutrition and the development of packages of interventions that provide similar challenges for service delivery mechanisms we set out to explore how well such services are provided in Kenya.

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

Metronidazole benzoate is an ester derivative of metronidazole utilized in the formulation of oral suspensions owing to its palatability. The drug is liable to hydrolytic degradation during shelf life which could lower assay values and increase free metronidazole content. A medicine quality survey study was carried out in Nairobi County whereby 32 metronidazole benzoate samples representing 13 brands were collected from retail pharmacies. The samples were subjected to British Pharmacopoeia specifications for pH, free metronidazole content and assay. From the results obtained, only nine samples (28.1%) passed all the quality tests performed while five (15.6%), seven (21.9%) and 18 (56.3%) did not comply with pH, metronidazole content and assay specifications respectively. The results obtained demonstrate the existence of substandard metronidazole benzoate products in the market. This underscores the need for regular post market surveillance surveys and execution of appropriate regulatory actions.

Background: The oral cavity harbors many microbes that may cause diseases, including dental caries and periodontal diseases. Progressive inflammation from periodontal diseases may lead to gum detachment from the teeth. Povidone-iodine and chlorhexidine mouth rinses and gargles are broad-spectrum antimicrobial products that effectively manage dental caries and periodontal diseases and eliminate plaques. This study was conducted in Nairobi County, Kenya to establish the quality of povidone-iodine and chlorhexidine oral care products by determining the content of the active pharmaceutical ingredient and compliance with labeling requirements.
Methods: A total of 34 samples (from 15 brands) of povidone-iodine and 15 samples (from nine brands) of chlorhexidine were collected from retail pharmacies using convenience sampling. All samples were subjected to labeling analysis, identity, and assay tests. Potentiometric titration was used to assay povidone-iodine in the samples, while chlorhexidine was assayed using high-performance liquid chromatography (HPLC) according to British Pharmacopeia 2017 specifications.
Results: All samples complied with identification tests. Moreover, 47.1% of povidone-iodine and 66.7% of chlorhexidine products complied with pharmacopoeial assay specifications. Five povidone-iodine (14.7%) and four chlorhexidine (26.7%) samples had missing label information on the storage conditions and the address of the manufacturer.
Conclusions: Strict adherence to current Good Manufacturing Practices (cGMP) by manufacturers of povidone-iodine and chlorhexidine mouthwashes/gargles is necessary to guarantee quality assured products in the market. Regular post-market surveillance and regulatory enforcement of standards are instrumental in minimizing the circulation of poor-quality products.

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The quality of milk collected by dairy cooperative societies in Kiambu District from farmers for marketing was determined. Analysis was done for specific gravity, total viable bacteria counts, coliform counts, resazurin test, alcohol test and test. Approximately 5.2% of farmers and 9.7% of cooperative samples had a specific gravity less that 1.026 indicating adulteration by addition of water. Forty four percent(44.3%) of farmers and 86.2% of cooperative  can samples had total viable counts more  than 105 cfu/ml milk, while 10,5% of farmers and 50% of cooperative can samples had more than 50,000 counts/ml of milk respectively. Seven percent of milk samples from farmers cans and 36% of milk samples from cooperative cans were considered of poor quality by use of a ten minutes resazurin test. Again 7.0% of farmers and 11.0% of cooperative can milk samples tested positive with the alcohol test, while no samples clotted on boiling in both cases. The study found that most farmers in the district supply to dairy cooperative societies relatively good quality milk, but the quality of the milk deteriorates while in the hands of the management of dairy cooperative societies which could be attributed to long milk collection rounds coupled with high ambient temperatures and inadequate cleaning of cans after use due to enough portable water. The ten minutes resazurin test was thought to be the most appropriate test for use in screening for poor quality milk at the cooperative level, while alcohol te

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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.

To assess the quality of recording critical events in the intrapartum period in Kakamega Provincial General Hospital (PGHK).

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Quality of health education during STD case management in Nairobi was assessed in 142 healthcare facilities, through interviews of 165 providers, observation of 441 STD patients managed by these providers, and 165 visits of simulated patients. For observations, scores were high for education on contact treatment (74-80%) and compliance (83%), but unsatisfactory for counselling (52%) and condom promotion (20-41%). The World Health Organization (WHO) indicator for STD case management Prevention Indicator 7 (PI7) (condom promotion plus contact treatment) was poor (38%). Public clinics strengthened for STD care generally performed best, whereas pharmacies and mission clinics performed worst. Compared with observations, scores were higher during interviews and lower during simulated patient visits, indicating that knowledge was not fully translated into practice. Interventions to improve the presently unsatisfactory service quality would be wide distribution of health education materials, ongoing training and supervision of providers, implementation of STD management checklists, and the introduction of pre-packaged kits for STD management.

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BACKGROUND: The quality of life of cancer patients is likely to be influenced by psychological reactions of the cancer patients yet there are no documented issues related to quality of life in cancer patients in Kenyan hospitals. OBJECTIVE: To investigate issues which affect the quality of life in male cancer patients. DESIGN: Prospective cross sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. METHODS AND SUBJECTS: Cancer patients above 12 years of age were interviewed during the course of their stay in the hospital, specifically to gather information on; semi structured questions and a modified Beck's 24 item depression inventory with a view to solicit for their reaction on issues which pertains to quality of life. MAIN OUTCOME MEASURES: Age group, level of education, tribe, geographical place (province) of birth, chief complains, main concerns, views on doctors, contact with psychiatrist and psychologist, the anatomic site of cancer, treatment given and responses on modified Beck's depression inventory. RESULTS: Forty two patients were studied, their age range 13-72 years, mean 43.2 and peak 13-26 years. Forty seven per cent of cases had no formal education. The cancers were gastrointestinal tract 33%, blood and lymphoid tissue (26%), bone and muscle (11.9%), skin (9.4%) and genitourinary tract (4.8%). Treatment given was chemotherapy, radiotherapy and surgery. Ninety three per cent were unable to cope. Chief complaints were pain, inability to work, feeling miserable and concerns were families, health and work retardation. Modified Beck's depression score was 20%, with major issues being; work retardation, insomnia, weight loss, and anorexia. Most affected were, age group 27-35 years (and least 13-26 years), uneducated, living in Nairobi (city), having carcinomas, treatment with combined surgery and radiotherapy. Low education level and residence in Nairobi coped poorly. Radiation therapy group appeared to cope better than other modalities. CONCLUSION: The issues affecting the quality of life of male cancer patients stated were pain, inability to work, poor coping with cancer and psychological reactions of work retardation, insomnia, weight loss, fatigability and depression. Gambling, suicidal ideas and social withdrawal were minimal. Other concerns were families, health and work.

BACKGROUND: The quality of life of cancer patients is likely to be influenced by psychological reactions of the cancer patients yet there are no documented issues related to quality of life in cancer patients in Kenyan hospitals. OBJECTIVE: To investigate issues which affect the quality of life in male cancer patients. DESIGN: Prospective cross sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. METHODS AND SUBJECTS: Cancer patients above 12 years of age were interviewed during the course of their stay in the hospital, specifically to gather information on; semi structured questions and a modified Beck's 24 item depression inventory with a view to solicit for their reaction on issues which pertains to quality of life. MAIN OUTCOME MEASURES: Age group, level of education, tribe, geographical place (province) of birth, chief complains, main concerns, views on doctors, contact with psychiatrist and psychologist, the anatomic site of cancer, treatment given and responses on modified Beck's depression inventory. RESULTS: Forty two patients were studied, their age range 13-72 years, mean 43.2 and peak 13-26 years. Forty seven per cent of cases had no formal education. The cancers were gastrointestinal tract 33%, blood and lymphoid tissue (26%), bone and muscle (11.9%), skin (9.4%) and genitourinary tract (4.8%). Treatment given was chemotherapy, radiotherapy and surgery. Ninety three per cent were unable to cope. Chief complaints were pain, inability to work, feeling miserable and concerns were families, health and work retardation. Modified Beck's depression score was 20%, with major issues being; work retardation, insomnia, weight loss, and anorexia. Most affected were, age group 27-35 years (and least 13-26 years), uneducated, living in Nairobi (city), having carcinomas, treatment with combined surgery and radiotherapy. Low education level and residence in Nairobi coped poorly. Radiation therapy group appeared to cope better than other modalities. CONCLUSION: The issues affecting the quality of life of male cancer patients stated were pain, inability to work, poor coping with cancer and psychological reactions of work retardation, insomnia, weight loss, fatigability and depression. Gambling, suicidal ideas and social withdrawal were minimal. Other concerns were families, health and work.

BACKGROUND: The quality of life of cancer patients is likely to be influenced by psychological reactions of the cancer patients yet there are no documented issues related to quality of life in cancer patients in Kenyan hospitals. OBJECTIVE: To investigate issues which affect the quality of life in male cancer patients. DESIGN: Prospective cross sectional study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. METHODS AND SUBJECTS: Cancer patients above 12 years of age were interviewed during the course of their stay in the hospital, specifically to gather information on; semi structured questions and a modified Beck's 24 item depression inventory with a view to solicit for their reaction on issues which pertains to quality of life. MAIN OUTCOME MEASURES: Age group, level of education, tribe, geographical place (province) of birth, chief complains, main concerns, views on doctors, contact with psychiatrist and psychologist, the anatomic site of cancer, treatment given and responses on modified Beck's depression inventory. RESULTS: Forty two patients were studied, their age range 13-72 years, mean 43.2 and peak 13-26 years. Forty seven per cent of cases had no formal education. The cancers were gastrointestinal tract 33%, blood and lymphoid tissue (26%), bone and muscle (11.9%), skin (9.4%) and genitourinary tract (4.8%). Treatment given was chemotherapy, radiotherapy and surgery. Ninety three per cent were unable to cope. Chief complaints were pain, inability to work, feeling miserable and concerns were families, health and work retardation. Modified Beck's depression score was 20%, with major issues being; work retardation, insomnia, weight loss, and anorexia. Most affected were, age group 27-35 years (and least 13-26 years), uneducated, living in Nairobi (city), having carcinomas, treatment with combined surgery and radiotherapy. Low education level and residence in Nairobi coped poorly. Radiation therapy group appeared to cope better than other modalities. CONCLUSION: The issues affecting the quality of life of male cancer patients stated were pain, inability to work, poor coping with cancer and psychological reactions of work retardation, insomnia, weight loss, fatigability and depression. Gambling, suicidal ideas and social withdrawal were minimal. Other concerns were families, health and work.

The quality of a drug product is determined by product design, manufacturing process as well as storage and distribution practices [1]. Effective quality control testing entails use of compendial or validated in-house methods [2]. The Frost and Sullivan report of 2008 revealed that 72% of the drug products in the Kenyan market were imported and majority (58.7%) of the drugs in circulation were generics [3]. The limited investment in the local pharmaceutical manufacturing industry is mainly attributable to the high cost of production which undermines competitiveness in the market [4].
Market authorization for pharmaceuticals in Kenya is granted by the national drug regulatory authority, the Pharmacy and Poisons Board after requisite evaluation of drug registration applications. The applicants are required to submit a certificate of analysis from a recognized independent laboratory operating within Kenya or the East African Community. The three Kenyan laboratories accredited to carry out pre-registration analysis for this purpose are the National Quality Control Laboratory (NQCL), Drug Analysis and Research Unit (DARU) and Mission for Essential Drugs and Supplies (MEDS) laboratory [5].
Drug quality control in DARU has been conducted since 1980 [6]. The laboratory has published periodic reports on the quality performance of drug samples analyzed therein. Previous reports have shown a continued improvement in the quality of products analyzed in DARU. In the 1980s the overall failure rate ranged from 21.6% to 31.4%, dropping to 17.6-21.1% in the 1990s and 6.1% in the years 2001-2005 [6-16]. The number of samples submitted to the DARU laboratory has gradually increased over the years due to enhanced consumption by the growing Kenyan population and drive for enhanced exports [17,18]. This paper reports on the quality performance of samples analyzed in DARU during the period 2006-2010.

During the period 2006-2010, the Drug Analysis and Research Unit analyzed 583 samples. The samples comprised 50.6% local and 49.4% imported products. Samples were subjected to compendial or in-house specifications. The failure rate was 12.2% for local products and 14.2% for imports. Antibacterial products recorded the highest failure rate (21.6%) while anticancers and drugs acting on the gastrointestinal, respiratory and reproductive systems all passed in the tests performed. The failure rate for antiprotozoals, antimalarials, antifungals, anthelminthics and analgesics was 14.3%, 12.5%, 11.8%, 8.9% and 11.5%, respectively.

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The in vitro performance of metronidazole tablet product by different manufacturers avallable on the Kenyan market was evaluated. It was found that a number of generic metronidazole tablet products have quality performance equal to that of FlagylR-the Innovator product. All products confirmed to pharmacopoelal speciflcations, Three products with percent weight loss of 1.4, 11.08 and 14.93 fulled the crucial friability test, for multidose packs. Two products failed the dissolution test releasing 46.8% and 45.8% of drug In 40 minutes. Drug release from tablet was found to vary between batches for one product. Ageing appears to decrease amount of drug released from tablets but longer storage periods and more samples are required before def1nlte conclusions are drawn

Quality protein maize (QPM) has increased levels of lysine and tryptophan, limiting amino acids for monogastric animals, so its use in animal feed reduces the need for more expensive high-protein sources. The authors, through the application of a linear programming optimization model with the composition and prices of feed components used at the coast, show that the cost reduction from substituting QPM for regular maize in poultry feed for Kenya is 5% (mainly as a result of a reduction in fishmeal). The optimal ratios based on QPM and regular maize were calculated and formulated, and trials showed that broilers raised with either mixture had the same food intake, mortality and growth. Moreover, when the chickens were fried in the style popular at the coast, there was no difference in the taste of the meat between the two batches. If QPM were to replace regular maize in broiler feed in Kenya, a 5% cost reduction would translate into a gain of US$300,000. If the cost reduction were passed on to the broiler producers as a reduction in feed price, producers would be expected to gain on average US$32 per year. If the cost reduction were not passed on to the broiler producers, it would result in an extra profit for the feed industry.

The quantification of carbon stocks is vital for decision making in forest management, carbon stock change assessment and scientific applications. We applied the land degradation surveillance framework (LDSF) method with a sentinel site of (10 km × 10 km) to assess carbon stock levels and tree diversity in the Marsabit Forest Reserve (MFR). The above ground (ABG) carbon stock was estimated at 12.42 t/ha, while soil organic carbon (SOC) was 12.51 t/ha, with SOC densities increasing with increasing depth. The mean ABG carbon and SOC densities were higher in the least disturbed strata than the disturbed strata. The estimated ABG carbon and SOC stocks were significantly lower than the range observed in a typical dry tropical forest. Twenty-one tree species were recorded belonging to twelve families with the disturbed areas recording nine tree species while the least disturbed recording twelve species. Rubiaceae and Rutaceae were the richest families with four species each while Boraginaceae, Capparaceae, Flacourtiaceae, Tiliaceae, Violaceae, and Ochnaceae the least frequent with one species each. The most common tree species were, Croton megalocarpus, Drypetes gerrardii, Ochna insculpta, Strychnos henningsii and Vangueria madagascariensis. The forest recorded a basal diameter of 14.09 ± 12.15 cm, basal area of 0.016 m 2/ha with a mean height of 8.69 m. The basal size class distribution declined monotonically indicative of a stable population. Livestock grazing, selective logging, and firewood collection were the primary forms of anthropogenic activities recorded in the MFR despite the moratorium imposed on consumptive utilisation of forest products by the Marsabit County security committee. The Pearson correlation coefficient returned an inverse relationship between forest disturbance with SOC and ABG carbon in the disturbed strata suggesting that anthropogenic activities reduced carbon stocks in the MFR. Concerted efforts to mitigate anthropogenic impacts on the MFR could significantly increase its terrestrial carbon sequestration potential and the provision of critical ecosystem goods and services.

The quantification of carbon stocks is vital for decision making in forest management, carbon stock change assessment and scientific applications. We applied the land degradation surveillance framework (LDSF) method with a sentinel site of (10 km × 10 km) to assess carbon stock levels and tree diversity in the Marsabit Forest Reserve (MFR). The above ground (ABG) carbon stock was estimated at 12.42 t/ha, while soil organic carbon (SOC) was 12.51 t/ha, with SOC densities increasing with increasing depth. The mean ABG carbon and SOC densities were higher in the least disturbed strata than the disturbed strata. The estimated ABG carbon and SOC stocks were significantly lower than the range observed in a typical dry tropical forest. Twenty-one tree species were recorded belonging to twelve families with the disturbed areas recording nine tree species while the least disturbed recording twelve species. Rubiaceae and Rutaceae were the richest families with four species each while Boraginaceae, Capparaceae, Flacourtiaceae, Tiliaceae, Violaceae, and Ochnaceae the least frequent with one species each. The most common tree species were, Croton megalocarpus, Drypetes gerrardii, Ochna insculpta, Strychnos henningsii and Vangueria madagascariensis. The forest recorded a basal diameter of 14.09 ± 12.15 cm, basal area of 0.016 m 2/ha with a mean height of 8.69 m. The basal size class distribution declined monotonically indicative of a stable population. Livestock grazing, selective logging, and firewood collection were the primary forms of anthropogenic activities recorded in the MFR despite the moratorium imposed on consumptive utilisation of forest products by the Marsabit County security committee. The Pearson correlation coefficient returned an inverse relationship between forest disturbance with SOC and ABG carbon in the disturbed strata suggesting that anthropogenic activities reduced carbon stocks in the MFR. Concerted efforts to mitigate anthropogenic impacts on the MFR could significantly increase its terrestrial carbon sequestration potential and the provision of critical ecosystem goods and services.

Theileria parva is the etiologic agent of East Coast fever, an economically important disease of cattle in sub-Saharan Africa. This protozoan parasite is biologically transmitted by Rhipicephalus appendiculatus (Neumann) (Acari: Ixodidae). An understanding of the vector-parasite interaction may aid the development of improved methods for controlling transmission. We developed quantitative polymerase chain reaction (qPCR) and nested PCR (nPCR) assays targeting the T. parva-specific p104 gene to study T. parva pathogenesis in two strains of R. appendiculatus that had previously been selected to be relatively more (Kiambu) or less (Muguga) susceptible to infection. Nymphs from both strains were fed simultaneously to repletion on acutely infected calves. Nymphs from the Kiambu strain showed significantly higher engorgement weights compared with Muguga strain nymphs. Immediately after engorgement qPCR confirmed that nymphal Kiambu ticks had significantly higher parasite loads at repletion than Muguga nymphs. By 12 d postengorgement, parasites were below quantifiable levels but could be detected by nPCR in 83-87% (Muguga and Kiambu, respectively) of nymphs. After the molt, adult feeding on naïve cattle stimulated parasite replication in the salivary glands. PCR detected significantly more infected ticks than microscopy, and there was a significant difference between the two tick strains both in the proportion of ticks that develop salivary gland infections, and in the number of parasites within infected salivary glands. These data confirm that although both tick strains were competent vectors, Kiambu is both a significantly more susceptible and a more efficient host for T. parva than Muguga. The mechanisms that contribute to the levels of susceptibility and efficiency are unknown; however, this study lays the groundwork for a comparison of the transcriptome of these tick strains, the next step toward discovering the genes involved in the tick-parasite interaction.

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A study of malaria on the Kano Plain, Kisumu District, Western Kenya, was carried out between April and August, 1985. The study included a knowledge, attitudes and practices (K.A.P.) survey on malaria illness and the mosquito vector. Overall knowledge about malaria illness was found to be good. However, treatment and prevention practices of malaria were found to be poor. Knowledge of the mosquito and its relationship to malaria was found to be high. Knowledge of methods of prevention of mosquito bites was also found to be high but actual use of the methods was low. Knowledge of traditional methods of prevention of mosquito bites was also found to be high. Actual use was again found to be low.

Fluxes of dissolved inorganic nutrients: NH+4, NO-2, N-3, PO34 and Si(OH)4 from near shore sediments of Gazi Bay were measured in situ within mangrove, sea grass and coral reef biotopes using benthic flux bell-jar chambers of cross-sectional area 0.066 m2 and volume 0.0132 m3. The objectives were: (1) to determine the influence of benthic fluxes, fluvial discharge and seasonal variations on the nutrient budget in the Bay waters; (2) to determine the effect of tidal and spatial variations on nutrient loads in the water column and (3) to establish the relative importance of the nutrient sources with regard to total community production of the Bay.
The directly measured fluxes ranged from -270 to +148 µmol NH+4-N/m2/h; -60 to +63 µmol NO-2-N/m2/h; -79 to +41 µmol N-3-N/m2/h; -79 to +75 µmol PO34-P/m2/h and +30 to +350 µmol Si(OH)4-Si/m2/h for and respectively. It was established that benthic fluxes are the major sources of dissolved inorganic NH+4, NO-2and Si(OH)4 while fluvial sources are important for N-3 and PO34into Gazi Bay waters. Seasonal variations had an appreciable effect on the PO3-4, fluxes, N:Si ratio, river nutrient discharge, plankton productivity and important environmental factors such as salinity and temperature. Tidal and spatial variations had no significant effect on nutrient concentrations and net fluxes within the water column. The results imply that benthic fluxes are largely responsible for the nutrient dynamics of the near shore coastal ecosystems especially where direct terrestrial inputs do not contribute significantly to the nutrient budget.
© 2002 Elsevier Science Ltd. All rights reserved.
Keywords: Gazi bay; Nutrient sources; Benthic fluxes; Fluvial discharge; Community production; Coastal ecosystems

Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

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.

BACKGROUND: CD8 T lymphocytes are important in HIV-1 control and mediate virus-specific immunity in the blood and genital tract. The induction and monitoring of mucosal CD8 cell responses will be an important component of HIV-1 vaccine trials, but information regarding the frequency, phenotype and function of genital tract CD8 cell responses is lacking. METHODS: Simultaneous blood and cervical cytobrush samples were obtained from 16 HIV-1-infected Kenyan sex workers. Epitope-specific CD8 T lymphocyte frequencies in the blood and genital tract were analysed after short-term peptide incubation and intracellular cytokine staining for interferon-gamma (IFN gamma). RESULTS: Cervical sampling resulted in adequate cell numbers for analysis in 10/16 women. Background IFN gamma production was higher in CD3+/CD8+ lymphocytes from the genital tract than from blood (0.48% versus 0.1%; P < 0.01). Responses to staphylococcal enterotoxin B were detected in cervical CD8 lymphocytes from 10/10 women, at a similar frequency to blood (16.7% in cervix and 13.3% in blood; P = 0.4). HIV-1-specific responses were detected the cervix of 8/10 women, with a trend to higher response frequencies in the genital tract than blood (2.1% versus 0.8%; P = 0.09). Co-expression of integrin CD103 (alpha E beta 7), a mucosal marker, was used to confirm the mucosal origin of cervical responses. CONCLUSIONS: Cytobrush sampling and intracellular cytokine staining is well suited to the analysis of cervical CD8 cell responses. The frequency of functional virus-specific CD3+/CD8+ T cells is similar in the genital tract and blood of HIV-1-infected women. The role of genital tract CD8 cell responses in HIV-1 control warrants further investigation.

BACKGROUND: CD8 T lymphocytes are important in HIV-1 control and mediate virus-specific immunity in the blood and genital tract. The induction and monitoring of mucosal CD8 cell responses will be an important component of HIV-1 vaccine trials, but information regarding the frequency, phenotype and function of genital tract CD8 cell responses is lacking. METHODS: Simultaneous blood and cervical cytobrush samples were obtained from 16 HIV-1-infected Kenyan sex workers. Epitope-specific CD8 T lymphocyte frequencies in the blood and genital tract were analysed after short-term peptide incubation and intracellular cytokine staining for interferon-gamma (IFN gamma). RESULTS: Cervical sampling resulted in adequate cell numbers for analysis in 10/16 women. Background IFN gamma production was higher in CD3+/CD8+ lymphocytes from the genital tract than from blood (0.48% versus 0.1%; P < 0.01). Responses to staphylococcal enterotoxin B were detected in cervical CD8 lymphocytes from 10/10 women, at a similar frequency to blood (16.7% in cervix and 13.3% in blood; P = 0.4). HIV-1-specific responses were detected the cervix of 8/10 women, with a trend to higher response frequencies in the genital tract than blood (2.1% versus 0.8%; P = 0.09). Co-expression of integrin CD103 (alpha E beta 7), a mucosal marker, was used to confirm the mucosal origin of cervical responses. CONCLUSIONS: Cytobrush sampling and intracellular cytokine staining is well suited to the analysis of cervical CD8 cell responses. The frequency of functional virus-specific CD3+/CD8+ T cells is similar in the genital tract and blood of HIV-1-infected women. The role of genital tract CD8 cell responses in HIV-1 control warrants further investigation.

BACKGROUND: CD8 T lymphocytes are important in HIV-1 control and mediate virus-specific immunity in the blood and genital tract. The induction and monitoring of mucosal CD8 cell responses will be an important component of HIV-1 vaccine trials, but information regarding the frequency, phenotype and function of genital tract CD8 cell responses is lacking. METHODS: Simultaneous blood and cervical cytobrush samples were obtained from 16 HIV-1-infected Kenyan sex workers. Epitope-specific CD8 T lymphocyte frequencies in the blood and genital tract were analysed after short-term peptide incubation and intracellular cytokine staining for interferon-gamma (IFN gamma). RESULTS: Cervical sampling resulted in adequate cell numbers for analysis in 10/16 women. Background IFN gamma production was higher in CD3+/CD8+ lymphocytes from the genital tract than from blood (0.48% versus 0.1%; P < 0.01). Responses to staphylococcal enterotoxin B were detected in cervical CD8 lymphocytes from 10/10 women, at a similar frequency to blood (16.7% in cervix and 13.3% in blood; P = 0.4). HIV-1-specific responses were detected the cervix of 8/10 women, with a trend to higher response frequencies in the genital tract than blood (2.1% versus 0.8%; P = 0.09). Co-expression of integrin CD103 (alpha E beta 7), a mucosal marker, was used to confirm the mucosal origin of cervical responses. CONCLUSIONS: Cytobrush sampling and intracellular cytokine staining is well suited to the analysis of cervical CD8 cell responses. The frequency of functional virus-specific CD3+/CD8+ T cells is similar in the genital tract and blood of HIV-1-infected women. The role of genital tract CD8 cell responses in HIV-1 control warrants further investigation.

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The effects of visual deprivation upon dorsal lateral geniculate (DLG) cell size were compared for seven kittens reared with monocular lid-suture (MD), seven with binocular lid-suture (BD), and six with one eye lid-sutured and the other eye enucleated soon after birth (MD-E). Six additional kittens were reared normally for comparison. For each kitten the cross-sectional areas of 300 cells were measured in one or both nuclei. Measurements were taken from the binocular segment of laminae A and A1 and the monocular segment of lamina A. In agreement with previous studies, cells in the binocular segment of the deprived laminae of MD cats were smaller (33-34%) than those in the non-deprived laminae. Comparisons with normal animals indicated that this difference was due to an increase (10-15%) in size of cells in the non-deprived laminae as well as a decrease (23-25%) in size of cells in the deprived laminae. Cells in the monocular segment also were affected by deprivation in MD cats, and this effect increased with the age (and duration of the deprivation) of the animal. However, it was always smaller than the decrease in cell size in the binocular portion of the DLG. In BD kittens, DLG cells were smaller (7-12%) than normal in all portions of the nucleus, including both the binocular and monocular segments. Direct comparisons between the deprived laminae of MD and BD kittens indicated that the decrease in cell size was greater for MD kittens in the binocular segment, but tended to be greater for BD kittens in the monocular segment. In MD-E kittens, DLG cells in the deprived laminae were smaller (11-17%) than normal in all portions of the nucleus, including both the binocular and monocular segments. Thus, the effects of deprivation were similar to those in BD kittens, even though inputs from the deprived eye had been placed at a competitive advantage in MD-E kittens. These results indicate that two factors may affect cell size in the DLG of visually deprived cats: deprivation per se and abnormal binocular competition. Finally, separate analyses for the ten largest and the ten smallest cells in each lamina of each cat were carried out in an attempt to determine if the changes in cell size were limited to the largest cells. In every case, differences observed for the total sample of cells were paralleled by differences from normal of both the largest cells present and the smallest cells present in the deprived laminae. Since at least two alternative interpretations can account for this finding, the question of whether the large cells are selectively affected by visual deprivation remains unanswered in the cat.

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JASPA Working Paper, ILO, Addis Ababa

Examines the marketing of domestically produced dairy products in sub-Saharan Africa, including imported but locally reconstituted whole milk powder and butter oil, and discusses trends in the imports of other dairy products over the last two decades in order to assess the impact of various dairy development and marketing policies of governments on the production & consumption of dairy products in the region.

Valepotriates, mainly isovaltrate and valtrate, have been separated and quantitatively estimated by reversed-phase HPLC in the leaves, flowers, stems and rhizomes of Valeriana kilimandascharica. The isovaltrate/valtrate concentration reaches a maximum of 5.89% in the leaves, 3.84% in the flowers, 3.17% in the stems and 5.15% in the rhizomes.

PIP: This survey was conducted at the Kenyatta National Hospital between March-June 1988 to assess the attitudes, basic knowledge and personal use of contraceptives among the nursing staff and to determine how these would influence family planning utilization in the country. In 1987, a similar survey was conducted among the physicians at this same hospital. A total of 432 nurses were interviewed; 64.4% of the nurses were currently using contraceptives and 7.7% had used them continuously. The IUD was used by 47.1% of the nurses. 62.3% of the nurses indicated that they would be able to discuss contraceptive use with their teenage daughters but only 29.6% would provide contraceptives. 66.7% of the nurses had extensive knowledge of contraceptives (over 60% knowledge) but knowledge concerning male contraceptives and newer methods such as Norplant was poor. author's modified

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

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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.

Results of four years' studies from a number of hospitals in Kenya have shown that nosocomial infections in burns units are due to Methicillin Resistant Staphylococcus aureus (MRSA). Through chromosomal DNA and plasmid DNA, the stain is highly resistant to sulphonamide ointment and other antibiotics. 90% of patients admitted in burns units get colonized or infected with MRSA. The strain prolongs the duration of patients in hospitals. The burns degenerate to second and third degree burns, thereby necessitating skin grafting. The environment has been found to be contaminated with this strain with some staff members having chronic throat infections. Minocycline was found to be effective in treating the infected staff members. Cleaning this environment with Sodium dichloroisocyanurate (precepts)/Sodium hypochlorite (JIK) reduced drastically the mechanical transmission of bacteria in the units. The duration of stay of the patient was reduced. This shows that MRSA which is spread in government and private hospitals can cheaply be controlled by the proper use of disinfectants, antiseptics, and use of effective antibiotics when necessary.

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

To characterise the urban livestock keeping practices and constraints in Kisumu municipality, Kenya, a questionnaire survey was carried out. Thirty-four contact farmers were interviewed on general farm characteristics and production constraints. The farming activities were categorised as either livestock only (41%), or mixed crops and livestock (59%). The surveyed farmers kept mainly cattle (100%), chickens (82%) and goats (74%). Most (94%) of the farmers had kept livestock for prolonged periods mainly for income generation (97%) and domestic consumption (59%). These data show that livestock keeping was popular and could be harnessed to increase food security, although the farmers kept mainly low-producing indigenous cattle (98%) which were grazed on unutilised land. The main production constraints mentioned by farmers included diseases (100%), poor fertility (68%) and lack of feed (56%). The diseases varied with species of ruminants and included lumpy skin disease (71%), diarrhoea (65%) and helminthosis (62%). The source of advice on management and treatment of the livestock was almost equally from private and government veterinary personnel. To improve livestock productivity, it is recommended that key stakeholders address the constraints mentioned in this study and in particular that the occurrence of diseases should be investigated with a view to developing sustainable control strategies