Background: Anaemia is the leading haematological abnormality in HIV/AIDS and an
independent contributor to morbidity and mortality. HAART has been shown to be effective
in reversing anaemia in HIV/AIDS, however a significant proportion of patients remain
anaemic despite being on antiretroviral therapy. Deficiency of erythropoietin has been
demonstrated as a cause of anaemia in HIV infected HAART naïve patients. The levels of
erythropoietin have not been studied in anaemic patients who are on HAART.
Objectives: To describe serum EPO levels of HIV infected anaemic patients who have been
on HAART for more than six months.
Design: Cross sectional descriptive study.
Setting: The study was carried out at a national hospital HIV treatment and follow-up
outpatient facility: Comprehensive Care Centre, Kenyatta National Hospital.
Methods: A total of 196 HIV elisa positive HAART experienced patients with anaemia
visiting the Comprehensive Care Centre were consecutively recruited. They were evaluated
by total blood counts, CD4 count, documented WHO clinical stage and serum erythropoietin
levels. Serum erythropoietin levels were measured by IMMULITE 2000 Elisa method.
Accrued data was entered in SPSS version 17 and analyzed therein.
Results: A total of 196 HIV positive adult patients with anaemia and who had been on
HAART for more than six months were evaluated. A total of 181 (92.3%) were found to
have a deficient erythropoietin response to anaemia in HIV, (EPO < 500IU/L). In this study
Hb was the main predictor of erythropoietin response.
Conclusion: Erythropoietin deficiency is nearly universal in anaemic patients on HAART
for more than six months.

Background: Considerable epidemiological, in vitro, in vivo and clinical data support an association between vitamin D deficiency and prostate cancer risk and outcome. Few studies have examined t his association in African men with p rostate cancer. The vitamin D status in pat ients with prostate cancer in Kenya is unknown. This study aimed to determine the profile of vitamin D levels in patients with prostate cancer and to correlate this to patient and disease characteristics. Methods: H ospital - based cross - sectional study that evaluated black African men with incident or 3 - month prevalent histologically confirmed prostate cance r seeking ambulatory care at KNH . M edical history was obtained by direct interview and the information recorded in questionnaires. Treatment history , pre - diagnostic serum PSA and Gleason score were abstracted from patient records. Every participant had their anthropometric measurements taken and plasma samples drawn for 25 - hydroxyvitamin D (25 - VD) concentrations using the LIAISON® 25 - OH automated chem iluminescent immunoassay method . The relationship between age, body mass index, pre - diagnostic serum PSA and Gleason score on vitamin D status was evaluated using bivariate and multivariate analysis. Results: 162 black African men were evaluated. The mean 25 - VD was 19.15 ng/ml and 144 (88. 9 %) men had vitamin D deficiency (25 - VD < 30ng/ml). 29 (17.9%) were severely deficient (25 - VD < 10ng/ml), 115 (71%) were moderately deficie nt (10 - < 30 ng /ml) and 18 (11.1%) were normal ( 30 - 100ng/ml). Gleason scores > 7 (OR 2.9 ; 95% CI 1.5 - 5.5 , p = 0.001) and serum PSA ≥ 50ng/ml (OR 2.2 ; 95% CI 1.7 - 5.1 , p = 0.014) were associated with vitamin D deficiency (25 - VD < 20ng/ml) whereas age and BMI were not. Adjusted for age, BMI and serum PSA l evels, having Gleason scores > 7 was independently associated with vitamin D deficiency (OR 2.5 ; 95% CI 1.2 – 4.9 , p = 0.01). Conclusion: Vitamin D deficiency is very common in black African men with prostate cancer, p articularly in those with higher Gleason scores.

Abstract:

Background: Considerable epidemiological, in vitro, in vivo and clinical data support an association between vitamin D deficiency and prostate cancer risk and outcome. Few studies have examined this association in African men with prostate cancer.The vitamin D status in patients with prostate cancer in Kenya is unknown. This study aimed to determine the profile of vitamin D levels in patients with prostate cancer and to correlate this to patient and disease characteristics.

Methods: Hospital-based cross-sectional study that evaluated black African men with incident or 3-month prevalent histologically confirmed prostate cancer seeking ambulatory care at KNH. Medical history was obtained by direct interview and the information recorded in questionnaires. Treatment history, pre-diagnostic serum PSA and Gleason score were abstracted from patient records. Every participant had their anthropometric measurements taken and plasma samples drawn for 25-hydroxyvitamin D (25-VD) concentrations using the LIAISON® 25-OH automated chemiluminescent immunoassay method. The relationship between age, body mass index, pre-diagnostic serum PSA and Gleason score on vitamin D status was evaluated using bivariate and multivariate analysis.

Results: 162 black African men were evaluated. The mean 25-VD was 19.15 ng/ml and 144 (88.9%) men had vitamin D deficiency (25-VD < 30ng/ml). 29 (17.9%) were severely deficient (25-VD < 10ng/ml), 115 (71%) were moderately deficient (10-<30 ng/ml) and 18 (11.1%) were normal (30-100ng/ml). Gleason scores >7 (OR 2.9; 95% CI 1.5-5.5, p = 0.001) and serum PSA ≥ 50ng/ml (OR 2.2; 95% CI 1.7-5.1, p = 0.014) were associated with vitamin D deficiency (25-VD < 20ng/ml) whereas age and BMI were not. Adjusted for age, BMI and serum PSA levels, having Gleason scores > 7 was independently associated with vitamin D deficiency (OR 2.5; 95% CI 1.2 – 4.9, p = 0.01).

Conclusion: Vitamin D deficiency is very common in black African men with prostate cancer, particularly in those with higher Gleason scores.

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

n/a

Kenya Nurs J. 1981 Dec;10(2):13-5.
Setting the pace: new approaches in nursing practice: paper presented to the International Council of Nurses Congress at the 17th ICN Quadrennial Congress held in Los Angeles in June, 1981.
Ngugi EN.
PMID:
6921385
[PubMed - indexed for MEDLINE]

Field work for this study was conducted between the months of November 1989 and February 1990. Its purpose was to establish the direction and magnitude of change that had occurred among the resettled farmers, socially and economically.To achieve that goal, it became necessary to document and analyze the socio-economic changes among the settlers in the scheme. The demonstration model was the theoretical orientation that was used to guide and inform this study. It presupposes that for any meaningful changes to be effected, government change agents such as veterinary and agricultural extension workers should have dialogue with the farmers. It is indicated that the demonstration model is viable for planned social change. The methodology that was used to collect data in this study was documentary library search, focus group discussion, interviews and participant observation methods. The respondents were randomly selected using systematic random sampling, in which every 5th household head was interviewed. The household was the unit of analysis.The findings indicate that, on the overall, Abagusii farmers in Nyansiongo settlement have undergone significant socioeconomic transformations. They enjoy a higher standard of living than they did in the pre-settlement area. They now have bigger pieces of land that they utilize in the production of more food and cash crops. Most of them derive adequate income from their farming activities which they invest in both farming and non-farming ventures. It was also established that, socially, there settlers have to a large extent adapted to the new environment by leading lifestyles that tend to be urban oriented, characterized by investing in the environment, being more individualistic and self-reliant. In brief, they have taken farming as a commercial activity.

A 46-year-old man presented to the emergency room with severe metabolic alkalosis, hypokalemia, and respiratory failure requiring intubation and mechanical ventilation. The cause of his acid-base disorder was initially unclear. Although alkalosis is common in the intensive care unit, metabolic alkalosis of this severity is unusual, carries a very high mortality rate, and requires careful attention to the pathophysiology and differential diagnosis to effectively evaluate and treat the patient. A central concept in the diagnosis of metabolic alkalosis is distinguishing chloride responsive and chloride nonresponsive states. Further studies are then guided by the history and physical examination in most cases. By using a systematic approach to the differential diagnosis, we were able to determine that a high-grade gastric outlet obstruction was the cause of the patients' alkalosis and to offer effective therapy for his condition. A literature review and algorithm for the diagnosis and management of metabolic alkalosis are also presented.

In this study, we sought describe the incidence and outcomes of severe metabolic or mixed acidemia in critically ill patients as well as the use of sodium bicarbonate therapy to treat these illnesses. PMID: 21995879

Road traffic Injury (RTI) is a rapidly growing, yet preventable, public health problem worldwide (1-1) that is projected to become the third leading cause of morbidity and mortality by the year 2020~. Road crashes have enormous impact on national economies and represent a major human tragedy. In 1985 alone, motor vehicle crashes cost United States more than 75 billion US dollarsQ. It has been estimated that there are over 1.18 million road traffic injury related deaths amrually world wide, with 74% occurring in developing countries 1,1. The young and socio-economically disadvantaged tend to experience disproportionately higher RTI fatality rates.8,.2. In East Africa, road traffic crashes are among the top causes of death from ~uries. Fatality from RTI in Kenya is estimated to have increased by 578% between 1962 and 1992, rising from 7.3 to 8.6 per 100,000 population Most of the road traffic crashes occurred on major rural roads and were associated with higher case fatality rate than those occurring in urban areas 10,11. Reports of fatal crashes on roads in Kenya have continued to feature prominently in the local dailies and electronic media in the form of news flashes and editorials. Despite the public health importance of RTI, there is little, if any, published infurmation on how RTI casualties are handled at the crash scenes, evacuated to health facilities or received and managed at the facilities. This survey was motivated by the need to map out the magnitude of road traffic ~uries in Kenya in order to provide baseline data to policy makers and other stakeholders who may wish to undertake interventions to improve road safety in the country. The aim of this study was therefore, to determine access and quality of health care fur road traffic ~ury (RTI) casualties in Kenya. We also undertook to :find out the extent to which health care facilities in Kenya were prepared to manage RTI emergencies. Since the time when this study was conducted, there have not been any targeted efforts to address this concern in the country. While availability of medical supplies may have some how improved as an indirect result of rising economic growth realized over the last few years, access to care and quality of services are unlikely to have changed much.

The effects of the level of seriousness of consequences of a subordinates performance and the nature of a subordinate's work history on leader attribution and response were investigated in a 2 x 3 factorial design with a sample of 46 male and 38 female junior and middle-level managers. The subjects were randomly assigned to one of six experimental conditions. Two variables, "consequences" of subordinate's performance and subordinate's "work history" were manipulated in a laboratory setting. As expected, (1) the level of internal attribution and response directed at the subordinate increased with the increase in the seriousness of consequences; (2) Internal attribution and the level of response directed at the subordinate were greater in the "poor work history" situation than in the "good work history" situation. Contrary to expectation, however, there was no significant difference between the two levels of serious consequences, i.e., "serious" and "serious with consequences" for the manager.

Diameter of the coronary sinus ostium is important in the designing of cannulation devices used in cardiac
resynchronization therapy and percutaneous mitral valve annuloplasty. Population variation of the
diameter may account for the failure rate of these procedures. Studies of the coronary sinus ostium from
African populations are scarce and altogether absent for Kenya. Therefore, this study aimed at
determining sex differences in the diameter of coronary sinus ostium and its correlation with the weight
of the heart. Seventy-four hearts of adult black Kenyans [43 male, 31 females; age range 20 – 70 years]
obtained during autopsy at the Department of Human Anatomy, University of Nairobi, Kenya were
weighed. The coronary sinus ostium was identified and its transverse and supero-inferior diameters
measured in millimeters. The measurements were analyzed using SPSS version 17. Sex comparison was
established using student’s t test. Association between diameter and heart weight was established using
Pearson’s correlation test and considered significant at a p-value of ≤0.05. Data were presented using
scatter plots. Transverse and supero-inferior diameters of the ostium were 11.04±1.88mm and
9.50±1.80mm respectively. The mean diameter was 10.27 mm. These correlated positively with weight
of the heart. When corrected for weight of the hearts, the transverse and supero-inferior diameters were
larger in females (0.042 and 0.036 respectively) than in males (0.034 and 0.03 respectively). The
diameter of coronary sinus ostium is larger in females and shows positive correlation with weight of the
heart. These data should be considered during design and use of cardiac devices introduced through
the coronary sinus.

Knowledge of sex differences in the histomorphology of the carotid body is important in understanding observed differences in respiratory function and disorders. There are few studies on sex differences in the carotid body. This study therefore aimed at describing these differences in the histomorphology features of the human carotid body.
Thirty six random carotid bodies from cardiovascular disease free individuals (20 male, 16 female) obtained during autopsy at the Department of Human Anatomy, University of Nairobi were studied. Specimens obtained within 48 hours of death were fixed in 10% formaldehyde solution and processed routinely for paraffin embedding. Seven micron thick serial sections were stained with H&E, Mason’s trichrome and examined with light microscope. Stereology was done to determine area occupied by parenchyma, stroma and vasculature. Data were analyzed using SPSS version 13.0. The student’s t test was used to compare sex differences. The data are represented using tables and macrographs.
The human carotid body is highly cellular with two varieties of cells namely; chief and sustentacular. It is heavily vascularised and densely innervated. Females showed higher concentration of chief cells, more profuse vascularization and denser innervation when compared with their aged matched male counterparts. The aging changes characterized by fibrosis, cellular degeneration vascular and neural attenuation are less severe in females.
Sex histomorphological differences in the human carotid body characterized by higher population of chief cells, density of vascularity, innervation and blunted age related morphological attenuation underpin differences in its function and disease.
Keywords: gender differences, carotid body, cells, vascularization

Craniometric parameters including cranial and orbital indices have been employed to determine the sex of a person in forensic medicine. These parameters are usually population specific. However, they have not been documented for a black Kenyan population. This study aimed at calculating the sex differences in the cranial and orbital indices. The cranial vault height, glabellomaximal length and orbital height and length were measured from 150 crania (80 male and 70 female) using a sliding vernier caliper. Cranial and orbital indices were calculated and the results were analyzed. The cranial index was 71.04 for the male and 72.37 for the female (P=0.095). The orbital index was 82.57 and 83.48 for the male and female, respectively (P=0.472). From these results, although the cranial and orbital indices are within range of previously reported values for an African population, they cannot be used independently in sexing of black Kenyan crania

Craniometric parameters including cranial and orbital indices have been employed to determine the sex of a person in forensic medicine. These parameters are usually population specific. However, they have not been documented for a black Kenyan population. This study aimed at calculating the sex differences in the cranial and orbital indices. The cranial vault height, glabellomaximal length and orbital height and length were measured from 150 crania (80 male and 70 female) using a sliding vernier caliper. Cranial and orbital indices were calculated and the results were analyzed. The cranial index was 71.04 for the male and 72.37 for the female (P=0.095). The orbital index was 82.57 and 83.48 for the male and female, respectively (P=0.472). From these results, although the cranial and orbital indices are within range of previously reported values for an African population, they cannot be used independently in sexing of black Kenyan crania.

Sex preparation and diaphragm acceptability in sex work in
Nairobi, Kenya

Anjali Sharma A , B r H , J I Elizabeth Bukusi A , B , C I Samuel Posner 0 I Doug/as Feldman E ,
Elizabeth Ngugi F and Craig R. Cohen G

A Centre for Microbiology Research, Kenya Medical Research Institute,. Kenyatta National Hospital,
PO Box 19464-00202, Nairobi, Kenya. ,
B Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE
Pacific St, Box 356460, Seattle, WA 98195, USA.
c Department of Obstetrics and Gynecology, University of Nairobi, Kenyatta National Hospital, PO
Box 19676, Nairobi, Kenya.
o Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
E Department of Anthropology, State University of New York College, 350 New Campus Drive,
Brockport, NY 14420, USA.
F Department of Community Health Sciences, University of Nairobi, Kenyatta National Hospital, PO
Box 19676, Nairobi, Kenya.
G Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, 50 Beale
St, San Francisco, CA 94105, USA.
H Present address: Suite 311, 3rd Floor, Theodak Plaza, National Hospital Road, Off Constitution
Ave, Central Business District, P.M.B. 69, Garki, Abuja, Nigeria.
I Corresponding author. Email: aSharma@csrtkenya.orgoranjali_sharma@hotmail.com

Abstract

Background: Women in sex work stand to benefit if the contraceptive diaphragm alone or
combined with a microbicide proves to be an effective barrier method against HIV and sexually
transmissible infection CSTI). Currently, contraceptive diaphragm users are advised to leave the
diaphragm in situ without concomitant use of other intravaginal substances for at least 6 h after
intercourse. Methods: We conducted in-depth interviews on sexual behaviour including post-coital
intravaginal practices with 36 women in sex work and 26 of their clients and held two focus-group
discussions, each with 10 women. Results: The women described a.gapting several potentially
harmful substances, such as cloth and soapy water, for post-coital vaginal use to ensure personal
hygiene, disease prevention and client pleasure. Some wanted to clean themselves and remove
the diaphragm early, fearing exposure to HIV infection for themselves and their subsequent
clients. Clients indicated their desire for 'dry sex', vaginal cleanliness and reduced risk of infection
through vaginal cleaning. Conclusions: The diaphragm as a female-controlled barrier method for
HIVjSTI prevention may have limited acceptability among women in sex work if its effectiveness - ,
depends on a 6-h post-coital wait before removal, along with avoidance of concomitant use of
intravaginal substances. In keeping with the beliefs of the the female sex workers and their needs
and practices, alternative intravaginal substances and modes of insertion that will not disrupt
vaginal flora, injure vaginal epithelium, damage the diaphragm or counteract potentially beneficial
effects of microbicides are needed. The possibility of removing the diaphragm sooner than the
recommended 6 h for contraception should be further studied.

Sexual Health 3(4) 261-268

Submitted: 23 March 2006 Accepted: 6 August 2006 Published: 17 November 2006

Full text 001: lO.1071/SH06021

@ (SIRO 2006

hrtp:/!www.publish.csiro.aulindex.cfm?paper=SH06021 11127/2007

SUMMARY: Mitral valve cusps consist mainly of connective tissue and myocardium. Connective tissue fibres within the cusps have been demonstrated to exhibit sex variations in organisation. Mitral prolapse, a disease attributed to defects within the cusps occurs more commonly in females. Sex variations in valvular myocardium however remain to be studied. Possible variations in its organisation may enhance understanding of sex differences in prevalence of mitral prolapse. The aim of this study was to determine anatomical variations of mitral valvular myocardium by sex; by mean a comparative cross-sectional study. A total of 48 (27 male and 21 female) adult heart specimens obtained during autopsy at Nairobi City and Chiromo mortuaries after ethical approval were used. Valvular cusps were then harvested. Four – millimetre sections were made at the area of maximum width for both anterior and posterior cusps. These were processed for paraffin-embedding and sectioning and stained with Masson’s trichrome and Weigert’s resorcin fuchsin with Van Gieson counterstain to demonstrate cardiac muscle, collagen and elastic fibres. Both anterior and posterior cusps demonstrated three histological laminae, that is, atrialis, fibrosa and ventricularis. Only lamina atrialis contained cardiac muscle. This lamina in males was characterised by a transversely oriented subendothelial myocardial strip while that in females contained compact longitudinal elastic fibres but no muscle. The presence of cardiac muscle in the lamina atrialis may be relatively rotective against mitral valve prolapse in males compared to females.

KEY WORDS: Mitral valve; Cusp; Structure; Variation; Sex.

Atrioventricular annuli are important in haemodynamic flexibility, competence, and support for tricuspid and mitral valves. The anatomical features of the annuli, such as circumference, organisation of connective tissue fibres, myocardium, and cellularity, may predispose to annular insufficiency and valvular incompetence. These pathologies occur more commonly in females, although the anatomical basis for this disparity is unclear. Sex variation in the structure of the annuli is important in providing a morphological basis for the patterns of these diseases. This study therefore aimed to determine the sex variations in the structure of human atrioventricular annuli. One hundred and one hearts (48 males, 53 females) obtained from the Department of Human Anatomy of the University of Nairobi were studied. Annular circumferences were measured using a flexible ruler and corrected for heart weight. Results were analysed using SPSS version 17.0 and sex differences determined using student's t-test. A p-value of less than 0.05 was considered significant. For light microscopy, specimens were harvested within 48 hours post-mortem, processed, sectioned, and stained with Masson's trichrome and Weigert's elastic stain with van Gieson counterstaining. Females had significantly larger annular circumferences than males after correcting for heart weight (p ≤ 0.05). Histologically, myocardium was consistently present in all male annuli while this was absent in females except in one specimen. The annuli were more elastic and cellular in males especially in the annulo-myocardial and annulo-valvular zones, respectively. The corrected larger annular circumference in females may limit heart valve coaptation during cardiac cycle and may be a risk factor for valvular insufficiency. The predominance of myocardium, annular cellularity, and elasticity may be more protective against heart valve incompetence in males than in females

Atrioventricular annuli are important in haemodynamic flexibility, competence, and support for tricuspid and mitral valves. The anatomical features of the annuli, such as circumference, organisation of connective tissue fibres, myocardium, and cellularity, may predispose to annular insufficiency and valvular incompetence. These pathologies occur more commonly in females, although the anatomical basis for this disparity is unclear. Sex variation in the structure of the annuli is important in providing a morphological basis for the patterns of these diseases. This study therefore aimed to determine the sex variations in the structure of human atrioventricular annuli. One hundred and one hearts (48 males, 53 females) obtained from the Department of Human Anatomy of the University of Nairobi were studied. Annular circumferences were measured using a flexible ruler and corrected for heart weight. Results were analysed using SPSS version 17.0 and sex differences determined using student's t-test. A p-value of less than 0.05 was considered significant. For light microscopy, specimens were harvested within 48 hours post-mortem, processed, sectioned, and stained with Masson's trichrome and Weigert's elastic stain with van Gieson counterstaining. Females had significantly larger annular circumferences than males after correcting for heart weight (p ≤ 0.05). Histologically, myocardium was consistently present in all male annuli while this was absent in females except in one specimen. The annuli were more elastic and cellular in males especially in the annulo-myocardial and annulo-valvular zones, respectively. The corrected larger annular circumference in females may limit heart valve coaptation during cardiac cycle and may be a risk factor for valvular insufficiency. The predominance of myocardium, annular cellularity, and elasticity may be more protective against heart valve incompetence in males than in females

Atrioventricular annuli are important in haemodynamic flexibility, competence, and support for tricuspid and mitral valves. The anatomical features of the annuli, such as circumference, organisation of connective tissue fibres, myocardium, and cellularity, may predispose to annular insufficiency and valvular incompetence. These pathologies occur more commonly in females, although the anatomical basis for this disparity is unclear. Sex variation in the structure of the annuli is important in providing a morphological basis for the patterns of these diseases. This study therefore aimed to determine the sex variations in the structure of human atrioventricular annuli. One hundred and one hearts (48 males, 53 females) obtained from the Department of Human Anatomy of the University of Nairobi were studied. Annular circumferences were measured using a flexible ruler and corrected for heart weight. Results were analysed using SPSS version 17.0 and sex differences determined using student's t-test. A p-value of less than 0.05 was considered significant. For light microscopy, specimens were harvested within 48 hours post-mortem, processed, sectioned, and stained with Masson's trichrome and Weigert's elastic stain with van Gieson counterstaining. Females had significantly larger annular circumferences than males after correcting for heart weight (p ≤ 0.05). Histologically, myocardium was consistently present in all male annuli while this was absent in females except in one specimen. The annuli were more elastic and cellular in males especially in the annulo-myocardial and annulo-valvular zones, respectively. The corrected larger annular circumference in females may limit heart valve coaptation during cardiac cycle and may be a risk factor for valvular insufficiency. The predominance of myocardium, annular cellularity, and elasticity may be more protective against heart valve incompetence in males than in females.

A 24-week feeding experiment was conducted to assess whether males and females of Oreochromis niloticus exhibit differences in
their hematological responses and organosomatic indices to dietary AFB1 contamination. Triplicate groups of O. niloticus (initial
body weight: 24.1 ± 0.6 g) were fed with four diets (Diets 1 to 4) containing 0, 20, 200, and 2,000

matina ma nguku

OBJECTIVE: To determine the pattern of growth and development of institutionalised infants and to compare the outcome with that of infants living with their biological mothers. DESIGN: A cross-sectional survey. SETTING: Seven children's homes; Kenyatta National Hospital's New Born Unit and Well Baby Clinics in Nairobi, Kenya. PARTICIPANTS: Eighty-two abandoned babies who fulfilled the selection criteria were recruited and for each abandoned baby two mothered babies matched for age and sex were selected from the well baby clinics. MAIN OUTCOME MEASURES: Anthropometric measures of weight, length, head circumference and left mid arm circumference (LUMAC) were taken and the mean values and Z scores determined to demonstrate growth pattern and nutritional status of the babies. The Revised Denver Development Screening Test (RDDST) was used to assess the development pattern of infants. RESULTS: Seventy per cent of infants were below six months old and 73% were abandoned within the first week of life. Abandoned babies were significantly thinner with the mean LUMAC of 10.8 cm versus 12.3 cm (p = 0.02) Institutionalised babies were significantly wasted (p = 0.00001) and stunted (p = 0.00001). Abandoned babies were significantly delayed in development (p < 0.0001). In all the four sectors tested for, institutionalised babies showed significant delay, p < 0.0001 in each sector. CONCLUSION: This study demonstrates that infants under institutional care have poorer growth and development compared to mothered infants. PIP: This cross-sectional study examined the pattern of growth and development of infants in some of the baby institutions in Nairobi and compared the outcome with that of infants living with their biological mothers. The participating institutions included the Kenyatta National Hospital and 7 children's homes within the city. The study recruited 82 abandoned babies aged 1-18 months who had been abandoned for at least 2 weeks. Each abandoned baby was paired with 2 mothered babies matched for age and sex. Anthropometric measures of weight, length, head circumference, and left mid arm circumference (LUMAC) were taken. The mean values and Z scores were determined to assess growth pattern and nutritional status of the babies. The results showed that abandoned babies were significantly thinner, with a mean LUMAC of 10.8 cm vs. 12.3 cm. Moreover, abandoned babies were significantly wasted (p = 0.00001), stunted (p = 0.00001), and delayed in development (p 0.0001). These findings indicate that institutionalized infants have poorer growth and development compared to mothered infants.

Background Aneurysms of the anterior cerebral and anterior communicating arteries are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Objective The purpose of this study was to evaluate variations of the anterior cerebral and anterior communicating arteries. Methods: Thirty six cadaveric brains (72 hemispheres) were studied by gross dissection for the pattern of arterial blood supply. Results The anterior cerebral artery (ACA) was observed to originate from the ipsilateral internal carotid artery (ICA) in all the cases studied. The most common type of termination of the ACA was bifurcation into pericallosal (PerA) and callosomarginal (CMA) arteries with the PerA-CMA junction being supracallosal (60%), infracallosal (27%) or precallosal (5%). Unique variations observed include an accessory ACA from the ACoA, 'bihemispheric pericallosal arteries', intertwining course of the A2 segments of the ACAs and crossing branches from 1 hemisphere to another. Variations of the ACoA were also observed including fenestration (26%) and duplication (13%). Conclusions The majority of ACA bifurcations, in the current study, were supracallosal suggesting the need for exploration of the interhemispheric fissure during surgical corrections of distal ACA aneurysms. Further, the incidence of the callosomarginal artery in this series appears to be at variance with other studies highlighting the need to standardize the definition of the artery. Anterior communicating artery fenestration was the most common variation raising concern as this has been shown to compromise collateral flow and predispose to aneurysm formation. Key Words: Anterior Cerebral artery, Anterior Communicating Artery, Kenya, Variations

The sexual transmission of human immunodeficiency virus type 1 (HIV-1) continues at an alarming rate in sub-Saharan Africa despite the fact that awareness of AIDS is high. One explanation for this alarming rate may be that individuals do not believe that they are personally at risk for AIDS and are not sufficiently motivated to make changes in their behavior. We conducted a cross-sectional study of men with genital ulcer disease to assess their sexual behavior and their perceived risk of AIDS. We studied 787 men between the ages of 17 and 54 years who presented to a referral clinic for sexually transmitted diseases (STDs) in Nairobi, Kenya. Of these 787 men, 188 (24%) were infected with HIV-1. Awareness of AIDS was essentially universal in this population; however, only 64 men (8%) thought that they were personally at risk of developing AIDS. A logistic regression analysis found that men who believed they were personally at risk knew someone with AIDS (odds ratio [OR], 8.9; 95% confidence interval [CI], 4.0-19.7), received information about AIDS from television or video (OR, 3.0; 95% CI, 1.7-5.5), or had previously had an STD (OR, 2.2; 95% CI, 1.2-4.1). Except for a modest increase in condom use, there was no significant difference in sexual behavior between the group who considered themselves to be at risk for AIDS and the group who did not consider themselves to be at risk. The results of this study challenge the current strategies on HIV/AIDS education and prevention for urban men in Kenya.

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

Sexually transmitted diseases have long been recognized as a major public health problem in Kenya. They are among the most common presenting complaints W ,Z!iji of adults at outpatient health facilities, ,Xid: representing 5% to 10% of the caseload at many clinics.' Gonorrhea, syphilis, chancroid, chlamydial infection, genital herpes infection, and human immunodeficiency virus type 1 (HIV-1) infection are the t, ;; most important sexually transmitted diseases in Kenya. The overall prevalence of these infections in the general population is unknown, but in antenatal populations in Nairobi, the prevalence of sexually transmitted diseases has recently been ..a shown to be in excess of 20%, with prevalence rates for gonorrhea, syphilis, and HIV-1 infection among pregnant women on the order of 5%, 8%, and 15%, respectively.2Sexually transmitted infections and their sequelae contribute significantly to morbidity and mortality. Syphilis in pregnancy is a major cause of spontaneous abortion, stillbirths, and neonatal morbidity and mortality. Gonorrhea and chlamydial infections in women are responsible for acute and chronic pelvic inflammatory disease, infertility, adverse p!!; pregnancy outcomes, and ophthalmia neonatorum.Perhaps even more important, treatable bacterial diseases, particularly those such as chancroid that cause genital ulceration, have been found to facilitate HIV-1 transmission.

Introduction: The present study was planned to determine sexual dimorphism in the morphometry of the tibial plafond and medial malleolus in a sample Kenyan population.
Materials and methods: A hundred and fifty six tibiae from the Department of Human Anatomy, University of Nairobi and the osteology collection of the National Museums of Kenya, Nairobi were used. Measurements were taken directly from the bone using a digital pair of vernier calipers (Sealey Professional ToolsTM). Means and frequencies were determined and compared using Student’s t-test. Data are presented using tables.
Results: The mean width of the tibial plafond was 26.55 mm ± 2.18 mm (range 21.7-35.4 mm). The average the length of the tibial plafond was 28.61 mm ± 2.29 mm (range 21.7-36.2 mm). The average height of the medial malleolus was 14.19±1.89mm, whilst the average breadth of the medial malleolus was 21.88±2.22 mm. There were statistically significant differences between males and females in these dimensions with males having larger measurements of the same.
Conclusion: These are baseline data on the osteometric characteristics of the tibial component of the talocrural joint in adult Kenyans. The statistically significant differences in these dimensions in males and females are important in interpreting diagnostic images and guiding the continued design of ankle joint prostheses.

Sexual dysfunction can impact a person’s ability to form or sustain intimate relationships and co morbidity between sexual dysfunction and anxiety as well as depression has been reported. Yet epidemiological, etiological, and health association to sexual dysfunction has only begun to be explored in Kenya. To determine the prevalence, types of sexual dysfunction and their socio demographic correlate in diabetic patients. Descriptive cross- sectional study The study was conducted at the outpatient diabetic clinic of Kenyatta National Hospital. This is the main referral hospital in Kenya. A total of 350 participants were enrolled in the study. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used to evaluate sexual dysfunctions in female and male patients respectively. The participants were composed of 164 females aged between 18-74 years and 186 males aged between 19- 100 years. In males, prevalence of sexual dysfunctions were: erectile dysfunction (68.8%); orgasmic dysfunction (48.4%); sexual desire (81.7%); intercourse satisfaction (86.6%) and overall satisfaction (68.4%).The female sexual dysfunction was 36.6% and was categorized as mild (17.1%); moderate (18.3%) and severe (1.2%). Diabetic patients have a high prevalence of sexual dysfunction

Sexual dysfunction can impact a person’s ability to form or sustain intimate relationships and co morbidity between sexual dysfunction and anxiety as well as depression has been reported. Yet epidemiological, etiological, and health association to sexual dysfunction has only begun to be explored in Kenya. To determine the prevalence, types of sexual dysfunction and their socio demographic correlate in diabetic patients. Descriptive cross- sectional study The study was conducted at the outpatient diabetic clinic of Kenyatta National Hospital. This is the main referral hospital in Kenya. A total of 350 participants were enrolled in the study. The Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF) questionnaires were used to evaluate sexual dysfunctions in female and male patients respectively. The participants were composed of 164 females aged between 18-74 years and 186 males aged between 19- 100 years. In males, prevalence of sexual dysfunctions were: erectile dysfunction (68.8%); orgasmic dysfunction (48.4%); sexual desire (81.7%); intercourse satisfaction (86.6%) and overall satisfaction (68.4%).The female sexual dysfunction was 36.6% and was categorized as mild (17.1%); moderate (18.3%) and severe (1.2%). Diabetic patients have a high prevalence of sexual dysfunction

Sex Transm Infect. 2004 Dec;80(6):435-9.
Sexual patterning and condom use among a group of HIV vulnerable men in Thika, Kenya.
Ferguson A, Pere M, Morris C, Ngugi E, Moses S.
Source

Department of Medical Microbiology, University of Manitoba and Strengthening STD/HIV Control in Kenya Project, PO Box 19676, Nairobi, Kenya. alanf@stdhivkenya.org
Abstract

Background/aim: A composite sample of 37 peer educators and 215 members of self help groups of male informal sector workers in Thika, Kenya, targeting HIV/AIDS prevention, were interviewed about their sexual behaviour, using a customised template, as part of a broader survey on gender attitudes and peer pressure.
METHOD:

Details on each sexual partner reported by each man over a 12 month recall period included type of partner, months during which sexual relations took place, and condom use.
RESULTS:

The men reported 471 sexual partners over the recall period, with a range of 0-16 partners, and an average of just under two partners. 8% of men had had no sexual partner, half were monogamous, and 3% had multiple partners with whom they used condoms exclusively, leaving 39% at varying degrees of risk. Condom use increased significantly with reduced intimacy of partner. 16% of men reported having at least one liaison with a female sex worker and two thirds of such liaisons were exclusively protected by condom use. Younger, single men had significantly more partners, but were more likely to use condoms. Duration of membership in self help groups was strongly associated with exclusive use of condoms with casual or FSW partners. Recorded attitudes corresponded somewhat with practice, but the data showed large gaps between the two, and low levels of gender sensitivity.
CONCLUSION:

There is some evidence that group membership has resulted in increased condom use and partner reduction, but there are doubts as to the extent to which the "ABC" strategy can be successful in stemming the HIV/AIDS epidemic. It may be necessary for interventions to target contextual issues, particularly gender relations, if the approach is to be more successful.

PMID:
15572609
[PubMed - indexed for MEDLINE]
PMCID:
PMC1744931

Free PMC Article

Shifting arenas of dance performance and youths’ counterculture have brought the twerk to the internet, thus exposing it to the discourse of cultural imperialism, appropriation, and cultural resistance. This has changed the symbolism of the art form: from a performance meant for celebration, to a dance of sexual rage. The media associates the dance with bottom provocation, prostitution or celebrity achievement stories − rarely celebrating the intellect, aesthetics or the expression of freedom in it. From a western point of view, twerking is overly sexualised and the performers participants in a cultural notoriety – thus, objectifying it. However, in its original context it is primarily a dance for festive celebrations. As a form of artistic expression resisting cultural destruction in Kenya, twerk is a way of re-politicising the African female body, and decolonising it from the male, western influenced gaze. Sexual expression in it is …

Kenya Nurs J. 1985 Dec;13(2):5-9.
Sexually transmitted diseases in Kenya.
Ronald AR, Ngugi EN, Da Costa.
PMID:
3854890
[PubMed - indexed for MEDLINE]

More new HIV-1 infections occur within stable HIV-1-discordant couples than in any other group in Africa, and sexually transmitted infections (STIs) may increase transmission risk among discordant couples, accounting for a large proportion of new HIV-1 infections. Understanding correlates of STIs among discordant couples will aid in optimizing interventions to prevent HIV-1 transmission in these couples. METHODS: HIV-1-discordant couples in which HIV-1-infected partners were HSV-2-seropositive were tested for syphilis, chlamydia, gonorrhea, and trichomoniasis, and HIV-1-uninfected partners were tested for HSV-2. We assessed sociodemographic, behavioral, and biological correlates of a current STI. RESULTS: Of 416 couples enrolled, 16% were affected by a treatable STI, and among these both partners were infected in 17% of couples. A treatable STI was found in 46 (11%) females and 30 (7%) males. The most prevalent infections were trichomoniasis (5.9%) and syphilis (2.6%). Participants were 5.9-fold more likely to have an STI if their partner had an STI (P<0.01), and STIs were more common among those reporting any unprotected sex (OR = 2.43; P<0.01) and those with low education (OR = 3.00; P<0.01). Among HIV-1-uninfected participants with an HSV-2-seropositive partner, females were significantly more likely to be HSV-2-seropositive than males (78% versus 50%, P<0.01). CONCLUSIONS: Treatable STIs were common among HIV-1-discordant couples and the majority of couples affected by an STI were discordant for the STI, with relatively high HSV-2 discordance. Awareness of STI correlates and treatment of both partners may reduce HIV-1 transmission.

More new HIV-1 infections occur within stable HIV-1-discordant couples than in any other group in Africa, and sexually transmitted infections (STIs) may increase transmission risk among discordant couples, accounting for a large proportion of new HIV-1 infections. Understanding correlates of STIs among discordant couples will aid in optimizing interventions to prevent HIV-1 transmission in these couples.

Sex Transm Infect. 2001 Aug;77(4):271-5.
Sexually transmitted infections and vaginal douching in a population of female sex workers in Nairobi, Kenya.
Fonck K, Kaul R, Keli F, Bwayo JJ, Ngugi EN, Moses S, Temmerman M.
Source
International Centre for Reproductive Health, Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium.
Abstract
OBJECTIVE:
To assess the association between vaginal douching and sexually transmitted infections (STI) among a group of female sex workers (FSWs) in Nairobi, Kenya.
METHODS:
This study was part of a randomised, placebo controlled trial of monthly prophylaxis with 1 g of azithromycin to prevent STIs and HIV infection in a cohort of Nairobi FSWs. Consenting women were administered a questionnaire and screened for STIs.
RESULTS:
The seroprevalence of HIV-1 among 543 FSWs screened was 30%. HIV infection was significantly associated with bacterial vaginosis (BV), trichomoniasis, gonorrhoea, and the presence of a genital ulcer. Regular douching was reported by 72% of the women, of whom the majority inserted fluids in the vagina, generally after each sexual intercourse. Water with soap was the fluid most often used (81%), followed by salty water (18%), water alone (9%), and a commercial antiseptic (5%). Douching in general and douching with soap and water were significantly associated with bacterial vaginosis (p = 0.05 and p = 0.04 respectively). There was a significant trend for increased frequency of douching and higher prevalence of BV. There was no direct relation observed between douching and risk for HIV infection or other STIs.
CONCLUSION:
The widespread habit of douching among African female sex workers was confirmed. The association between vaginal douching and BV is of concern, given the increased risk of HIV infection with BV, which has now been shown in several studies. It is unclear why we could not demonstrate a direct association between douching and HIV infection. Further research is required to better understand the complex relation between douching, risk for bacterial vaginosis, and risk for HIV and other STIs.
PMID:
11463927
[PubMed - indexed for MEDLINE]
PMCID:
PMC1744330
Free PMC Article

One of the critical issues for Community Development, Civil Society action and Governance anywhere and specifically in Africa is to create leaders at the fastest possible rate, at all levels of the society/ community. Such levels of leadership revolve round - skilled, ethical, effective and unifying leadership. Young people are most eager to play a leadership role in these efforts. The values/ benefits of the African young people involvement in Civil Society in the African states will bring energy, catalyze other group members to rethink their priorities, commitment and remove invisible barriers that have kept them from moving forward. Typically and traditionally in many cultures, young people have been excluded from efforts to rebuild their communities. This marginalization of our youth not only harms them and endangers our future, but it also cheats the world of a valuable resource. If we are to function effectively as local and even global communities then we must incorporate all significant voices. This paper argues that an enduring and positive community renewal is possible only if all members are involved and feel a sense of ownership. On the other hand, the spirit of volunteerism by young people helps to create a stable and cohesive society and as a result add value to the services that governments provide. Voluntary action creates bonds of trust and encourages cooperation; in other words it creates social capital. Volunteerism draws people of different ethnic origins, religion and economic status. This compositional aspect enhances social harmony. Voluntary participation in public affairs can also help to create a politically literate public, which is important for the preservation of democratic principles. Volunteer effort is essential to Civil Society action as a way that would enhance community policing and conflict resolution. Service For Peace (SFP) Kenya Chapter as an organization, through its young people empowerment program has the aim to integrate service learning and volunteerism in the processes of capacity development/ building, creating appropriate awareness, dissemination and networking of the youth in the sub-regional and region areas. The Kenyan Chapter serves as a knowledge resource base for periodic value-based training programs on volunteerism.

This book is an epic account of life, touching on diverse facets of existence with the Buddhist answers to the riddles of life and those provided by modern science towards the same or similar riddles. In this book, Ikeda catches and conveys to us the impression that living a fulfilling life is attainable, and that the splendour of living such a life has an immutable value that transcends the bounds of the physical death. Fleeting between the past, present and a possible future, the book wrestles with the giant headaches of humankind through a systematic explication of the nature of the cosmos and life, the Buddhist view of life, and the question of life and death. All this is done with the exactitude of a physician carrying out a heart surgery, and with the eloquence of a young man wooing a fair maid. On the whole, the book reduces the recurrent headaches of man to quite curable ailments, no more serious than the common cold or constipation. With respect to the nature of the cosmos and life, the author sinks his teeth into such concepts as the body and the spirit, man and nature, eyes that can see life, the riddle of time and the essence of the cosmos. On the body and the spirit, the author addresses first and foremost, the strange phenomenon of life as it manifests itself in empirical situations

Food security remains a key challenge to the development efforts of most poor nations. This study investigated the significance of gender (denoted by number of male, female and children in a household) and social amenities in the food security equation. Frequency of food-related illnesses in a household was used as proxy for food security situation, while the entitlement/food utilization side of the equation was represented by the number of male and female children in the household, main source of domestic water, distance to nearest health center, means of transport accessible, household sanitation and level of awareness on basic food preparation and handling methods. Both descriptive and econometric models were used for analysis of primary data from a random sample of 100 farm-households in Yala division, Siaya district of Kenya. This study was conducted in February 2004. Results of this study indicated that majority (74%) of the rural households were experiencing poor food utilization, and were thus generally food insecure. The study also revealed that gender and social amenities were significant in the food security equation. Specifically, there was high correlation between food-related illnesses and use of untapped water, more male children than females in a household, long distance to health centers, lack of quick means of transport, unsafe food disposal and poor food storage habits. In order to improve the food utilization and thereby security for the rural farm-households, the study recommends improvement in the provision of social amenities for both male and female household members equitably

Food security remains a key challenge to the development efforts of most poor nations. This study investigated the significance of gender (denoted by number of male, female and children in a household) and social amenities in the food security equation. Frequency of food-related illnesses in a household was used as proxy for food security situation, while the entitlement/food utilization side of the equation was represented by the number of male and female children in the household, main source of domestic water, distance to nearest health center, means of transport accessible, household sanitation and level of awareness on basic food preparation and handling methods. Both descriptive and econometric models were used for analysis of primary data from a random sample of 100 farm-households in Yala division, Siaya district of Kenya. This study was conducted in February 2004. Results of this study indicated that majority (74%) of the rural households were experiencing poor food utilization, and were thus generally food insecure. The study also revealed that gender and social amenities were significant in the food security equation. Specifically, there was high correlation between food-related illnesses and use of untapped water, more male children than females in a household, long distance to health centers, lack of quick means of transport, unsafe food disposal and poor food storage habits. In order to improve the food utilization and thereby security for the rural farm-households, the study recommends improvement in the provision of social amenities for both male and female household members equitably.

Food security remains a key challenge to the development efforts of most poor nations. This study investigated the significance of gender (denoted by number of male, female and children in a household) and social amenities in the food security equation. Frequency of food-related illnesses in a household was used as proxy for food security situation, while the entitlement/food utilization side of the equation was represented by the number of male and female children in the household, main source of domestic water, distance to nearest health center, means of transport accessible, household sanitation and level of awareness on basic food preparation and handling methods. Both descriptive and econometric models were used for analysis of primary data from a random sample of 100 farm-households in Yala division, Siaya district of Kenya. This study was conducted in February 2004. Results of this study indicated that majority (74%) of the rural households were experiencing poor food utilization, and were thus generally food insecure. The study also revealed that gender and social amenities were significant in the food security equation. Specifically, there was high correlation between food-related illnesses and use of untapped water, more male children than females in a household, long distance to health centers, lack of quick means of transport, unsafe food disposal and poor food storage habits. In order to improve the food utilization and thereby security for the rural farm-households, the study recommends improvement in the provision of social amenities for both male and female household members equitably.

It is now generally evident that the prevalence rates of various mental disorders in Africa are similar if not identical to those found in the West. Poverty and the relative deficiency of human resources are compounding factors that make it unlikely for replication of psychiatric and mental health services in the same quality and quantity as currently provided in resource-rich countries.This not withstanding, it is not necessary for such services to be imported wholesale into the peculiar socio-cultural Africa context, orfor quality and quantity to be measured in the same way as is done in the resource-rich countries.This means that Africa must find its own home-grown evidence-based policies and practices that allow for service to be available, accessible, affordable and appropriate within the socio-cultural and economic contexts prevailing in Africa.This can only be achieved through contextually designed operationalresearch to determine contextually appropriate solutions to the myriad of mental health issues and challenges facing Africa.

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

The Drylands of Eastern Africa have been home to many mobile/nomadic pastoral communities for centuries. These communities traversed large areas in search of pasture and water for their livestock. The objective of their livelihood system was subsistence based on milk. However, within the past one third of a century or so, there has been a sharp shift towards sedenta ry type of production and livelihood system. This shift has been caused by, inter alia , economic, political, demographic and environmental changes. Prolonged droughts, population growth, expanding crop agriculture, political insecurities including civil wars and et hnic conflicts, and conservation policies have all affected the ability of mobile pastoralists to keep their large herds, move freel y across the drylands and rely on mobile pastoralism as a livelihood system. As a consequence, crop agriculture is becoming increasingly common, and sometimes necessary subsistence strategy, albeit one that is considered a poor choice to animal husbandry particula rly since the drylands they occupy are uniquely suited to rearing of livestock. Still the majority of pastoral households in Easte rn Africa remain committed to raising livestock even as they adapt to a sedentary life and crop cultivation. Research on sedenterization of mobile pastoralists in this region has mainly been anthropological in nature. Published studies have addressed consequences an d impacts of sedenterization in terms of direct impact on immediate environment, human health and general welfare changes, social order within the household and community, and participation in the mainstream national economy. Hardly any research has been conducted to investigate the key parameters, characteristics and impacts of the crop-livestock production/livelihood system tha t emerges from mobile pastoralists who settle and take up crop agriculture in combination with livestock keeping, albeit at a red uced scale. This paper argues that crop-livestock systems by formerly mobile pastoralists in the drylands present issues and challe nges directly related to environmental quality, food security, natural resource management, human welfare and ultimately the Millenn ium Development Goals. This forms a priority research axis for Eastern Africa’s drylands

Global value chain and global production network analyses have largely focused on dominance of Northern retailers over suppliers in the global South. The expansion of retailers within the global South sourcing from and supplying consumer end-markets within their own geographic regions is reconfiguring value chain dynamics. This paper draws on GVC and GPN approaches and the concepts of multi-polar governance to analyse changing dynamics of global and regional retail supply networks. Drawing on a case study of supermarket expansion within South and East Africa, it analyses how ‘waves of diffusion’ by global and regional supermarkets provide new opportunities for ‘strategic diversification’ by some horticultural producers and workers. It examines the implications for economic and social upgrading and downgrading, finding mixed outcomes. Strategic diversification provides opportunities for economic and social upgrading by more capable suppliers and skilled workers, but economic downgrading pressures persist and some are excluded from both global and regional value chains.

Keywords Global value chains, global production networks, supermarkets, economic and social upgrading, horticulture, producers, workers

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

Bacillus thuringiensis (Bt) delta endotoxins represent the most successful use of biological control agents targeting crop pests to date. Studies have shown that Bt produces a wider range of toxins targeting a variety of unrelated pests than was initially documented. This further increases the prospects for its wider use as a microbial biopesticide. In this view the study sought to isolate and characterize native Bt from two different ecological regions; Kenya coastal intertidal brackish sediments and farmlands in Machakos district. Twenty eight Bt isolates were isolated and identified. Distinctions between the isolates were based on their morphological appearances, presence of parasporal inclusions and biochemical characteristics. Results for staining tests revealed that the isolates were Gram positive, rod shaped cells, with the spores terminally located. The cells from the two ecological regions did not have significant variation in average size. The rods had length ranging between 2.0 μm and 3.0 μm on average while the width was approximately 1 μm on average. Parasporal inclusions had varied shapes (i.e. bipyramidal, circular, squared, oval and rhomboid). Both biochemical tests (Proskauer (VP) test and catalase test) were positive. Average optimum temperature range for growth was between 28°C and 35°C while the optimal pH growth range was between 5.5 and 7.5. Both the morphological and biochemical results provided evidence that the isolates were different forms of Bacillus thuringiensis. Out of the fifty six soil and sediment samples, 28 samples (50%) yielded Bacillus thuringiensis. 53.6% of the isolates were recovered from samples from farms in Machakos district and 46.4% from the intertidal brackish sediments from the Gazi coastal mangroves of Kenya. This shows that Bt is also present in soils which are under constant cultivation and those lying fallow within the intertidal brackish sediments

Genetic polymorphisms of the Fc gamma receptors (FcγR) IIa and IIIa have been implicated in the rate of HIV-1 disease progression, but results are inconsistent. We aimed to determine the association between these polymorphisms and disease progression in a cohort of HIV-1 seroconverters from Mombasa, Kenya. Neither FcγRIIa nor FcγRIIIa genotypes were predictive of set point viral load, viral load increase, CD4 decline, or HIV-1 disease progression (time to CD4 count <200 cells/mm(3), death, or treatment initiation). Our results suggest that FcγR polymorphisms might not be an important indicator of viral control and disease progression in this population.

This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. METHODS: The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach. During restorations 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were used by the operators. The restorations were then followed for a period of 2 years. STATISTICS: SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used. RESULTS: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. CONCLUSION: Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. METHODS: The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach. During restorations 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were used by the operators. The restorations were then followed for a period of 2 years. STATISTICS: SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used. RESULTS: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. CONCLUSION: Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

Herpes simplex virus-2 (HSV-2) suppression with acyclovir or valacyclovir reduces HIV-1 viral RNA levels; one hypothesis is that HSV-2 suppression reduces immune activation. We measured T cell immune activation markers among women participating in a randomized placebo-controlled trial of valacyclovir to reduce HIV-1 RNA levels among pregnant women. Although valacyclovir was associated with lower HIV-1 RNA levels, the distribution of both CD4(+) and CD8(+) CD38(+)HLA-DR(+) T cells was not different among women taking valacyclovir when compared to women taking placebo. Further study is needed to understand the mechanism of HIV-1 RNA reduction following herpes suppression among those coinfected with HIV-1 and HSV-2.

Herpes simplex virus-2 (HSV-2) suppression with acyclovir or valacyclovir reduces HIV-1 viral RNA levels; one hypothesis is that HSV-2 suppression reduces immune activation. We measured T cell immune activation markers among women participating in a randomized placebo-controlled trial of valacyclovir to reduce HIV-1 RNA levels among pregnant women. Although valacyclovir was associated with lower HIV-1 RNA levels, the distribution of both CD4(+) and CD8(+) CD38(+)HLA-DR(+) T cells was not different among women taking valacyclovir when compared to women taking placebo. Further study is needed to understand the mechanism of HIV-1 RNA reduction following herpes suppression among those coinfected with HIV-1 and HSV-2.

A reliable rapid and inexpensive laboratory procedure is needed to screen native African forage grass species for forage quality. This study determined the potential of using a prepared cellulase solution to assess in vitro dry matter solubility of 22 native Kenyan forage grasses and 18 native warm season grasses from Missouri, USA. A prepared cellulase solution was used for screening the grass species for digestibility using two procedures. One procedure involved digesting grass samples in prepared cellulose solution without any pre-treatment (CSD), and the other procedure used an acid pepsin pretreatment prior to digestion in the prepared cellulose solution (APCS). The CSD procedures in comparison to APCS generally underestimated in vitro dry matter solubility by a rand of up to 23%. The variations were highly species dependent. Although the APCS procedure more time consuming, it made it possible to identify a group of species resolvable into high (42.6-61.4%), medium (36-40%) and low (29-34%) digestibility. With intensified efforts it is possible for one person to obtain in vitro dry matter solubility estimates on up to 200 samples in 30 days with minimal expense. Results of this investigation points to the end need for further research on the potential of the two digestibility procedures for rationalizing numbers in germplasm collection for initial screening.

Mycobacterium ulcerans infection is an emerging disease that causes indolent, necrotizing skin lesions known as Buruli ulcer (BU) and occasional contiguous or metastatic bone lesions. Buruli ulcer is named after Buruli County in Uganda (east Africa), where an epidemic occurred in the 1960s. Today, BU is most common in central and west Africa. We describe clinical and molecular evidence for a case of BU in Kenya.