Department of Pharmacology and Toxicology, University of Nairobi, Kenya. The relative bioavailabilities of three carbamazepine tablet formulations available in the Kenyan market (Temporal(R), Taver(R) and Carbamazepine Lincoln) compared with the innovator formulation (Tegretol(R)) were evaluated in seven healthy African volunteers (5 males, two females; aged 22-36 years), according to a randomised fourway crossover study design, following oral administration of single 200 mg doses with a three week washout period. In vitro dissolution profiles of the tablets were also evaluated. Relative bioavailabilities ((F)rel) of Temporal(R), Taver(R) and Carbamazepine Linocoln were 101.2%, 82.2% and 71.6% respectively, compared with Tegretol(R). Percent drug content dissolved in vitro after I hour were 91.3%, 75.9% and 39.3% for Temporal(R), Taver(R) and Carbamazepine Lincoln, respectively. It was concluded that Temporal(R) was bioequivalent to Tegretol(R) while Taver(R) and Carbamazepin Lincoln were bioinequivalent to Tegretol(R). Administration of Taver(R) or Carbamazepine Lincoln might lead to poor control of epileptic seizures.

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

Background: Diabetes mellitus (DM) is a disease that has significant morbidity and mortality worldwide resulting from complications arising from poor control. 1,3
There is no local data to show the level of diabetic patients' knowledge on this disease at KNH, an important aspect in DM management. In the present cross-sectional study, determination of the diabetic patient's knowledge of his/her disease was undertaken for the first time at KNH.
Study Objectives: To determine the proportion of KNH DM outpatients with adequate knowledge on the disease and to determine the level of provision of diabetic education to the DM outpatients.
Study design: This was a descriptive cross-sectional study from September 2007 to January 2008.105 DM patients (above 18 years) who had given informed consent were interviewed to determine the level of their knowledge on OM and hence the proportion of respondents with adequate knowledge. Codes were manually assigned to all questions and the respective answers. Five randomly selected KNH OM OPO healthcare providers were also interviewed to determine the level of KNH preparedness in the provision of diabetic education to the OM outpatients. A sequential sampling procedure was used to interview the diabetic patients. Every Wednesday during the course of the study one different OM healthcare provider was picked and interviewed.
Data Analysis: The data obtained were captured using Epi-data computer software which was then exported to SPSS version 15.0 for analysis. Statistical significance was determined using the Pearson Chi Square at p<0.05, at 95% confidence limit. Results: 105 diabetic patients aged 18 years and above were interviewed; 53(50.5%) were males and 52 (49.5%) females. The age categories 18-30, 31-40,41-50, 51-60, 61-70 and above 70 years accounted forl2 (11.4%), 24 (22.9%), 21 (20.0%),21 (20.0%),22 (21.0°) and 5(4.8%) OM patients respectively. The highest education levels; College/University, Secondary, Primary and Non-formal accounted for 27(25.7%), 42(40.0%), 25(23.8%) and 11(10.5%) DM patients respectively. 52 (49.5%)patients had sufficient knowledge on the diabetes mellitus disease itself, 64(61%) on DM complications, 35 (33.3%) on DM medications, 84 (80%), on the importance of dietary control, 73 (70%) on the importance of doing exercises and 11 (10.5%) on the importance of DM Affiliate Associations.
Patients with highest academic level had the highest proportion of patients with adequate knowledge on the disease (p=O.OOO 1), dietary control (p=O.O 1) and exercise (p=0.03). Patients' age influenced the proportion of patients with adequate knowledge on OM complications (p=0.03). The study also showed that diabetic patients' education was conducted mainly verbally at OPO clinic once a week for two hours and only one healthcare provider conducted the training at each education session though the number of staff was ten. Conclusion: Patients were mainly taught verbally. Two-thirds to three-quarter of the patients had sufficient knowledge on the OM disease, importance of dietary requirements and exercise programs.90% of patients had insufficient knowledge on diabetes organizations and two-thirds on rational use of DM medications. Recommendation: Hospital's training and education on rational use of DM medications should be improved. The hospital should make the healthcare providers and the DM patients aware of the DM' associations for patients' benefit. More research involving larger samples over longer periods should be carried out in order to reflect what happens over a longer period of time.

Abstract Objectives: To evaluate after 2 years, the survival rate of glass ionomer cement (GIC) sealants placed in primary molars of 6-8 year-olds and as part of proximal ART restoration. Study design: A longitudinal clinical study. Setting: Matungulu/Kangundo rural divisions, Machakos district. Participants: A total of 804 six to eight year-olds from rural Kenya received sealants as part of proximal restorations placed in primary molars using the atraumatic restorative treatment (ART) approach. Trained operators, using the ART approach, placed the proximal restorations and the sealants using Fuji IX, Ketac Molar Easymix and Ketac Molar Aplicap, together with rubber dam and cotton roll tooth-isolation methods. Evaluation to determine the survival of the sealants was done soon after placement (within 2 hours of placing them) and after 2 years. The data were analyzed using SPSS 14.0 computer programme, and the survival results related to the materials and the isolation-methods used. Results: The 2-year cumulative survival of the sealants was 10.9%, and the survival of the sealants was not significantly affected by the GIC material brand and the tooth-isolation method used. However, slightly more sealants survived when Fuji IX and rubber dam tooth-isolation method were used. Conclusion: The two-year survival rate of the sealants was poor and was not significantly influenced by the GIC material or the tooth-isolation method used.

Savanna ecosystems and origins of modern human behavior Hekima III (1) 27-42: (Journal of the Humanities and Social Sciences, University of Nairobi).

OBJECTIVE: To determine the dental caries experience and knowledge on the causes and preventive measures for dental diseases. DESIGN: A community based cross-sectional descriptive study. SETTING: Elwak sub-district hospital, North Eastern Province, Kenya. SUBJECTS: One hundred and forty one adults who presented themselves during a dental check up at a sub-district hospital and gave written consent. MAIN OUTCOME MEASURES: Dental caries status and knowledge on its causes and preventive measures. The importance of outreach programmes in obtaining information as well as helping to alleviate the pain and suffering caused by dental diseases among communities living in remote areas is also revealed. RESULTS: Of the one hundred and forty one individuals, who were included in the study, 63.1% were women and 36.9% were men. Their ages ranged between 18 and over 65 years. 41.1% were in the 18-24-year age bracket. Regarding the oral health knowledge, 43% did not know any causes of dental diseases while 36%, 17% and 12% knew that diet, "dirt" on teeth and bacteria were possible causes, respectively. Fifty percent did not know any preventive measures for dental diseases while the rest indicated abstention from the consumption of sugary foods; and only 0.8% mentioned use of fluoridated toothpaste as a preventive measure for dental caries. 56.7% of the subjects were caries free. The mean DMFT for all ages was 3.4. Of those with caries 72.1% were women. CONCLUSION: There is a low level of oral health awareness and a moderately high level of dental caries experience in this community with women apparently carrying the biggest burden of dental caries.

Many businesses make profit yearly and tend to invest some of the profit so that they can cushion their organizations against any future unknown events that can affect their current profit making. Since future happenings in businesses cannot be predicted accurately, estimates are made using experience or past data which are not exact. The probability element (which is normally determined by experience or past data) is important in investment decision making process since it helps address the problem of uncertainty. Many of the investment decision making methods have incorporated the expectation and risk of an event in making investment decisions. Most of those that use risk account for diversifiable risk (non-systematic risk) only thus limiting the predictability element of these investment methods since total risk are not properly accounted for. A few of these methods include the certainty (probability) element. These include value at risk method which uses covariance matrices as total risk and the binning system which always assumes normal distribution and thus does not take care of discrete cases. Moreover comparison among various entities lacks since the probabilities derived are for individual entities and are just quantile values. Finite investment decision making using real market risk (non-diversifiable risk) was undertaken in this study. Non-diversifiable risk (systematic risk) estimates of a portfolio of stocks determined by a real risk weighted pricing model are used as initial data. The variance of non-diversifiable risk is estimated as a random variable referred to as random error (white noise). The estimator is used to calculate estimates of …

In previous studies, Knowledge Management (KM) strategies have been examined as objects of organizations, instead of scrutinizing their characteristics or relative quality and content. This study aims to examine the key characteristics of KM strategies in Agricultural Research Organizations (AROs) in East Africa in terms of what exists, what does not exist and why. To comprehensively answer the research questions and understand the phenomena under investigation the study adopted a pragmatism paradigm to allow facts and concerns to arise from the context. Qualitative and quantitative methods were employed using semi-structured Key Informant Interviews (KIIs) and a questionnaire respectively. A novel empirical description and explanation of the key characteristics of KM strategies in AROs in East Africa is presented. The study identifies the key concepts and gaps in the characteristics of KM strategies and elucidates what AROs in East Africa should do differently to coherently formulate and execute KM strategies in practice. The main characteristics of KM strategies in AROs in East Africa are practicability, technology-focus, alignment, implementation processes and relevance. Through abstraction and theorization of the key concepts, a detailed description and explanation as a reference for scholars and practitioners in the KM field is provided. Further, the study highlights context as an important and relevant perspective in particularizing the characteristics of a KM strategy and interpretation of related empirical findings. Future studies can use the concepts presented in this study to develop a theoretical framework for analyzing the characteristics of KM strategies in organizations. The idea of linking the study outcome to an empirical situation is a novel contribution. The findings of this study shed new insights that confirm that understanding characteristics of KM strategies is beneficial to practitioners and scholars.

Keywords agricultural research organizations, characteristics, East Africa, knowledge management, KM strategies

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Manufacturing safety is a key priority in the success of any business, as it can affect both the present and future competitive position of an organization. Organizations must measure safety in order to find areas of weakness, and then implement actions aimed at raising safety levels. Industrial accidents in the chemical industry indicate a need for both leading and lagging indicators of safety in the workplace.

The purpose of this study was to formulate and validate a set of key performance indicators that can be used in the measurement and reporting of manufacturing safety, and ensure a safe working environment for the workers on a continuous basis. The final results consisted of 21 Key Performance Indicators (KPIs), with fire safety being the most relevant KPI. The information gathered during a manufacturing safety performance measurement exercise can be used to implement activities directed towards reducing the level of worker exposure to health and safety risks within the factory, and thereby recommend application of these KPIs in managing of manufacturing safety in paint manufacturing and allied products industries.

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Knowledge on HPV Vaccine and Cervical Cancer Facilitates Vaccine Acceptability among School Teachers in Kitui County, Kenya.

Masika MM, Ogembo JG, Chabeda SV, Wamai RG, Mugo N

BACKGROUND: Vaccines against human papillomavirus (HPV) infection have the potential to reduce the burden of cervical cancer. School-based delivery of HPV vaccines is cost-effective and successful uptake depends on school teachers' knowledge and acceptability of the vaccine. The aim of this study is to assess primary school teachers' knowledge and acceptability of HPV vaccine and to explore facilitators and barriers of an ongoing Gavi Alliance-supported vaccination program in Kitui County, Kenya.
METHODS: This was a cross-sectional, mixed methods study in Central Division of Kitui County where the Ministry of Health is offering the quadrivalent HPV vaccine to grade four girls. Data on primary school teachers' awareness, knowledge and acceptability of HPV vaccine as well as facilitators and barriers to the project was collected through self-administered questionnaires and two focus group discussions.
RESULTS: 339 teachers (60% female) completed the survey (62% response rate) and 13 participated in 2 focus group discussions. Vaccine awareness among teachers was high (90%), the level of knowledge about HPV and cervical cancer among teachers was moderate (48%, SD = 10.9) and females scored higher than males (50% vs. 46%, p = 0.002). Most teachers (89%) would recommend the vaccine to their daughter or close relatives. Those who would recommend the vaccine had more knowledge than those who would not (p = <0.001). The main barriers were insufficient information about the vaccine, poor accessibility of schools, absenteeism of girls on vaccine days, and fear of side effects.
CONCLUSIONS: Despite low to moderate levels of knowledge about HPV vaccine among school teachers, vaccine acceptability is high. Teachers with little knowledge on HPV vaccine are less likely to accept the vaccine than those who know more; this may affect uptake if not addressed. Empowering teachers to be vaccine champions in their community may be a feasible way of disseminating information about HPV vaccine and cervical cancer.

PLoS One. 2015 Aug 12;10(8):e0135563. doi: 10.1371/journal.pone.0135563. eCollection 2015.