OBJECTIVE: To determine the prevalence of bovine tuberculosis in urban dairy cattle and examine possible risk factors for human infection with bovine tuberculosis (BTB). DESIGN: Cross sectional study. SETTING: Urban and peri-urban dairy and non-dairy farming neighbour households. SUBJECTS: One hundred forty three dairy cattle and 299 and 149 dairy and non-dairy neighbour households respectively. RESULTS: Ten percent of the animals (15/143) were found to be reactors to the tuberculin test. The majority of the respondents 57% (168/295) and 72% (106/147) in dairy farming and non-farming households respectively, had limited knowledge of the disease in cattle thus making them unable to adopt any precautionary measures to protect themselves from contracting bovine tuberculosis. Distance from the main house and cattle shed, the time spent attending to the cattle, (on average 4.8 hours), and making of traditionally fermented milk were considered to be the major risk factors. CONCLUSION: Due to the presumed high background prevalence of human tuberculosis, the specificity of the test employed was unknown. Therefore no definite estimate of the prevalence of BTB was made. It is therefore necessary for further investigation involving culture, isolation and molecular typing from reactors to establish the prevalence of M. bovis in this setting.

OBJECTIVE: To determine the pattern and burden of injuries, their causes and action taken in a rural and urban community in Kenya. DESIGN: Household interview survey and focus group discussions. SETTING: Four rural villages and five urban clusters in Kiambu District, Kenya. SUBJECTS: A total of 1,980 members of 200 rural and 230 urban households. RESULTS: The number of reported injuries was 495, corresponding to 300,000 injuries per 100,000 people per year. Most common were cut or piercing (38.4%), followed by fall (16.2%), burn or scald (14.3%), animal bite or kick (10.1%), hit by moving object (5.9%) and road traffic accident (3.6%). Poisoning, sub-mersion/drowning and explosion were uncommon, each below three per cent. Of all reported injuries, 149 (30.1%) sought care from traditional healers, 91 (18.4%) were subject to self-care, 76 (15.4%) obtained service from drug shops, 22 (4.4%) were brought to a health facility for attention and 17 (3.4%) took no action at all. Additional information was obtained through focus group discussions with students, teachers and members of women groups. These generated detailed information about cases of sexual assault within and outside households which had not been captured during the previous household interviews. CONCLUSION: Injuries are very common but most of them are mild, prompting only home care or no action at all. Only one out of 25 injuries were brought to a health facility for attention. Some types of injury, such as domestic violence and sexual assault, are more likely to be captured through focus group discussions than during household interviews. A combination of methods is likely to best reflect the pattern of injury at community level.

Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya. skariuki@kemri.org BACKGROUND: In sub-Saharan Africa community-acquired non-typhoidal Salmonella (NTS) is a major cause of high morbidity and death among children under 5 years of age especially from resource poor settings. The emergence of multidrug resistance is a major challenge in treatment of life threatening invasive NTS infections in these settings. RESULTS: Overall 170 (51.2%) of children presented with bacteraemia alone, 28 (8.4%) with gastroenteritis and bacteraemia and 134 (40.4%) with gastroenteritis alone. NTS serotypes obtained from all the cases included S. Typhimurium (196; 59%), S. Enteritidis (94; 28.3%) and other serotypes in smaller numbers (42; 12.7%); distribution of these serotypes among cases with bacteremia or gastroenteritis was not significantly different. A significantly higher proportion of younger children (< 3 years of age) and those from the slums presented with invasive NTS compared to older children and those from upper socio-economic groups (p < 0.001). One hundred and forty-seven (44.3%) NTS were resistant to 3 or more antibiotics, and out of these 59% were resistant to ampicillin, chloramphenicol and tetracycline. There was no significant difference in antibiotic resistance between the two serotypes, S. Typhimurium and S. Enteritidis. Ceftriaxone and ciprofloxacin were the only antibiotics tested to which all the NTS were fully susceptible. Using Pulsed Field Gel Electrophoresis (PFGE) there were 3 main patterns of S. Typhimurium and 2 main patterns of S. Enteritidis among cases of bacteraemia and gastroenteritis. CONCLUSION: Serotype distribution, antibiotic susceptibility and PFGE patterns of NTS causing bacteraemia and gastroenteritis did not differ significantly. The high prevalence of NTS strains resistant to most of the commonly used antimicrobials is of major public health concern.

SETTING: A rural district, Machakos, in Kenya, facing decreasing national resources for health and an increasing tuberculosis (TB) caseload fuelled by the human immunodeficiency virus (HIV). OBJECTIVE: To evaluate the impact on district TB programme performance of decentralising TB treatment by providing ambulatory care in the hospital and peripheral health units and in the community. METHODS: A comparative study of district TB programme performance before and after the decentralisation of TB services at the end of 1997. To facilitate ambulatory care, ethambutol replaced streptomycin in the new treatment regimen. FINDINGS: The number of patients registered in the control period (1996) was 1141, of whom almost 100% were admitted during the intensive phase of TB treatment, and in the intervention period (1998 and 1999), it was 3244, of whom only 153 (4.7%) required admission in the intensive phase. Of 3244 TB patients (all forms) registered in the intervention period, the number (%) choosing the different options for directly observed treatment (DOT) supervision were: hospital clinic 1618 (49.9%), peripheral health unit 904 (27.9%), community volunteer 569 (17.5%) and hospitalisation 153 (4.7%). The options were found to be acceptable to patients, their families and health staff. The treatment outcomes among new sputum smear-positive pulmonary TB patients were similar in the intervention and control cohorts, with treatment success rates of 88% vs. 85% and death rates of 4% vs. 6%, respectively. Treatment completion was significantly higher among new sputum smear-negative and extra-pulmonary TB patients in the intervention than in the control cohort (79% vs. 48%, respectively). CONCLUSION: The decentralisation of the intensive phase of TB treatment resulted in maintenance of good TB programme performance, while Machakos hospital closed its TB wards. A separate paper describes the cost-effectiveness of this approach. The National Tuberculosis Control Programme plans to adopt this approach as national policy.

An ecosystem approach was applied to study the links between malaria and agriculture in Mwea Division, Kenya. The study was organized into five phases. Phase I had two components including a stakeholder workshop conducted with community representatives and other key stakeholders, and the collation of data on common diseases from outpatient service records at the local hospital. Phase I aimed at an a priori needs-assessment in order to focus the research agenda. Workshop participants directly contributed to the selection of two villages with rice irrigation and two non-irrigated villages for detailed health studies. In Phase II, various Participatory Rural Appraisal (PRA) tools were used to gather more detailed qualitative information from the study villages. The qualitative results indicated that Mwea residents considered malaria and lack of clean drinking water to be their most important health problems, and this was corroborated by local hospital records. Phase III consisted of a comprehensive household survey developed with inputs from Phases I and II. Phase IV involved a comparative evaluation of entomological and parasitological aspects of malaria in the villages with and without rice irrigation. The malaria parasitological survey found an average Plasmodium falciparum parasite rate of 23.5% among children up to 9 years of age. Results of the entomological evaluation showed a 30-300-fold increase in the number of the local malaria vector, Anopheles arabiensis, in villages with rice irrigation compared to those without irrigation yet malaria prevalence was significantly lower in these villages (0-9% versus 17-54%). The most likely explanation of this 'paddies paradox' in Mwea appeared to be the tendency for A. arabiensis in irrigated villages to feed overwhelmingly on cattle. The results suggested that zooprophylaxis was potentially a practical option for long-term malaria control in the rice irrigated areas, in spite of the large number of A. arabiensis. Phase V consisted of end-of-project workshops for the dissemination of research results and participatory decision-making regarding follow-up actions. Owing to the utilization of a transdisciplinary and participatory approach to research, it was possible to identify opportunities for maintaining zooprophylaxis for malaria in Mwea, through the integration of agroecosystem practices aimed at sustaining livestock systems within a broader strategy for rural development.

45 Kenyan traditional healers were interviewed with respect to the diagnosis and treatment of eye diseases. Traditional management of eye diseases is based on the healers' concept of the disease causation as well as their knowledge of the herbal, animal and chemical substances that possess (or are reported to possess) remedial effect on the disease. While many of the healers interviewed failed to give a clear distinction between the various eye conditions, diseases such as cataract, foreign bodies and injuries were recognized easily. In almost all cases the medicinal substances were first diluted in water before they were applied to the eyes. Human milk, blood and the white of the egg were the animal substances listed as medicinal to various eye conditions. A solution of sugar was one of the chemical substances used in the treatment of specific eye conditions. Given correct information, some of these healers could f

OBJECTIVE: To explore the knowledge, attitudes and practices of dairy and non-dairy farming households in Dagoretti in regard to the risk posed by bovine brucellosis and determine the prevalence of the disease in urban dairy cattle. DESIGN: A cross sectional study. SETTING: Urban and Peri-urban dairy farming and non dairy farming households in Dagoretti division, Nairobi. SUBJECTS: Two hundred ninety nine dairy farming and 149 non dairy farming households. INTERVENTION: Segregated focus group discussions, administration of a household questionnaire and collection of unboiled milk from dairy and non dairy farming households were the instruments used to gather data on the practices, attitudes, perceptions and prevalence of bovine brucellosis. RESULTS: Three hundred and ninety three milk samples were collected and analysed for the presence of antibodies to Brucella abortus in an indirect ELISA. The apparent prevalence of bovine brucellosis from milk was estimated at 1% for the samples collected while in dairy farming households the prevalence was 1.1% [0.2, 3.4%] and 0.7% [0.4%] in non dairy farming households.. Thirty percent (90/296) of dairy respondents and 22% (32/147) of non-dairy respondents knew of the existence of brucellosis. Risk of contracting brucellosis was very low considering that milk is boiled together with other ingredients used in making tea and porridge. However, 31% (93/296) and 22% (31/143) of dairy and non dairy farming households respectively made traditionally fermented milk without first boiling the milk. This practice may predispose this group to brucellosis. CONCLUSION: The low prevalence of bovine brucellosis requires constant surveillance in case the prevalence rates do change. Education of dairy farming households who are more at risk of contracting brucellosis on the transmission pathways and risk factors is required in order to lower further the prevalence of bovine brucellosis in Dagoretti.

NTRODUCTION: Family Health International developed a simple checklist to help family planning providers apply the new medical eligibility criteria (MEC) of the World Health Organization (WHO) for the use of the intrauterine device (IUD) contraceptive method. METHODS: One hundred thirty-five providers in four countries participated in focus groups to field test the checklist. Before participating in a discussion about the checklist, each provider was given a copy of the checklist, its instructions and hypothetical client scenarios. Providers used the checklist to answer questions about the client scenarios in order to determine if they understood the checklist and if they would correctly determine IUD eligibility for women in updated categories of eligibility on the basis of the checklist. RESULTS: Providers found the checklist easy to use and thought that it would enhance identification of eligible IUD users. Nevertheless, many providers relied on prior knowledge of IUD eligibility rather than the checklist recommendations. Providers only correctly determined eligibility for new categories of IUD use 69% of the time. CONCLUSIONS: The IUD checklist is a useful job tool for providers, but training and effective dissemination of the WHO MEC should precede its introduction to ensure that it is correctly used.

A study conducted in a rural agricultural community (Githunguri location) in Kenya between 1987 and 1990 investigated the extent of use of agrochemicals, especially pesticides, by the farmers; their level of awareness of the dangers posed by these chemicals and their attitudes towards agricultural chemicals in general. The findings showed that more than 95% of the farmers used pesticides extensively. More women than men were found to be at risk of agrochemicals exposure, while babies and children were at more risk of agrochemicals exposure than the women. In this community, knowledge and awareness regarding safety in handling and storage of agrochemicals was to some extent limited. For instance, many had no knowledge of an antidote in case of accidental poisoning. Additionally, suicidal attempts by ingestion of agrochemicals was prevalent. Improper handling of the agrochemicals by the community members was implicated to have adverse health effects. These health effects were reported in form of complaints. They ranged from acute to chronic conditions. Consequently, an intervention programme was launched with the women as the key players. It is envisaged that community participation in the on going intervention programme is saving babies, children, women and the community at large from agrochemicals hazards.

BACKGROUND: Pregnancy among adolescents is unplanned in many instances. Although some pregnant adolescents carry the pregnancy to term, abortion, in many instances unsafely induced, is a commonly sought solution in Kenya. OBJECTIVE: To determine adolescents' perceptions of induced abortion. DESIGN: A cross-sectional descriptive study carried out between July 1995 and June 1996. SETTING: An urban and a rural district in Kenya. PARTICIPANTS: Adolescents aged 10-19 years in schools in Nairobi and Kiambu districts, and a group of immediate post-abortion adolescent girls in some health facilities in Nairobi. MAIN OUTCOME MEASURES: The number of health programmes formulated and put into use, which are adolescent-friendly and providing information, education and communication on abortion issues. DATA COLLECTION: One thousand eight hundred and twenty adolescents were subjected to a self-administered questionnaire that collected demographic and health data as well as perceptions of induced abortion. Focus group discussions on perceptions of abortion were held with 12 groups of adolescents in schools and the information obtained recorded on paper and in a tape-recorder. RESULTS: One thousand nine hundred and fifty two adolescents, comprising of 1048 school girls (SG), 580 boys (SB), 192 post-abortion girls (PA) and 132 adolescents in the focus group discussions, formed the study sample. More than 90% were aware of induced abortion (IA). Knowledge of IA correlated positively with level of education (P < 0.01). Seventy one per cent of SG, 84% of PA and 40% of SB were aware of abortion-related complications, the most common being infections, death and infertility. Eighty three per cent of PA felt that complications were preventable by seeking care from a qualified doctor compared to one quarter each for the SB and SG. 56% PA, 69% SB and 72% SG felt that abortions were preventable. However, less than 40% proposed abstinence as a primary strategy. The most important source of information on abortion was the media followed by friends and teachers. CONCLUSION: Adolescents are aware of abortion and the related complications, but there is more variability in their knowledge and preventive measures.

OBJECTIVE: To explore the knowledge, attitudes and practices of dairy and non-dairy farming households in Dagoretti in regard to the risk posed by bovine brucellosis and determine the prevalence of the disease in urban dairy cattle. DESIGN: A cross sectional study. SETTING: Urban and Peri-urban dairy farming and non dairy farming households in Dagoretti division, Nairobi. SUBJECTS: Two hundred ninety nine dairy farming and 149 non dairy farming households. INTERVENTION: Segregated focus group discussions, administration of a household questionnaire and collection of unboiled milk from dairy and non dairy farming households were the instruments used to gather data on the practices, attitudes, perceptions and prevalence of bovine brucellosis. RESULTS: Three hundred and ninety three milk samples were collected and analysed for the presence of antibodies to Brucella abortus in an indirect ELISA. The apparent prevalence of bovine brucellosis from milk was estimated at 1% for the samples collected while in dairy farming households the prevalence was 1.1% [0.2, 3.4%] and 0.7% [0.4%] in non dairy farming households.. Thirty percent (90/296) of dairy respondents and 22% (32/147) of non-dairy respondents knew of the existence of brucellosis. Risk of contracting brucellosis was very low considering that milk is boiled together with other ingredients used in making tea and porridge. However, 31% (93/296) and 22% (31/143) of dairy and non dairy farming households respectively made traditionally fermented milk without first boiling the milk. This practice may predispose this group to brucellosis. CONCLUSION: The low prevalence of bovine brucellosis requires constant surveillance in case the prevalence rates do change. Education of dairy farming households who are more at risk of contracting brucellosis on the transmission pathways and risk factors is required in order to lower further the prevalence of bovine brucellosis in Dagoretti.

BACKGROUND: Pregnancy among adolescents is unplanned in many instances. Although some pregnant adolescents carry the pregnancy to term, abortion, in many instances unsafely induced, is a commonly sought solution in Kenya. OBJECTIVE: To determine adolescents' perceptions of induced abortion. DESIGN: A cross-sectional descriptive study carried out between July 1995 and June 1996. SETTING: An urban and a rural district in Kenya. PARTICIPANTS: Adolescents aged 10-19 years in schools in Nairobi and Kiambu districts, and a group of immediate post-abortion adolescent girls in some health facilities in Nairobi. MAIN OUTCOME MEASURES: The number of health programmes formulated and put into use, which are adolescent-friendly and providing information, education and communication on abortion issues. DATA COLLECTION: One thousand eight hundred and twenty adolescents were subjected to a self-administered questionnaire that collected demographic and health data as well as perceptions of induced abortion. Focus group discussions on perceptions of abortion were held with 12 groups of adolescents in schools and the information obtained recorded on paper and in a tape-recorder. RESULTS: One thousand nine hundred and fifty two adolescents, comprising of 1048 school girls (SG), 580 boys (SB), 192 post-abortion girls (PA) and 132 adolescents in the focus group discussions, formed the study sample. More than 90% were aware of induced abortion (IA). Knowledge of IA correlated positively with level of education (P < 0.01). Seventy one per cent of SG, 84% of PA and 40% of SB were aware of abortion-related complications, the most common being infections, death and infertility. Eighty three per cent of PA felt that complications were preventable by seeking care from a qualified doctor compared to one quarter each for the SB and SG. 56% PA, 69% SB and 72% SG felt that abortions were preventable. However, less than 40% proposed abstinence as a primary strategy. The most important source of information on abortion was the media followed by friends and teachers. CONCLUSION: Adolescents are aware of abortion and the related complications, but there is more variability in their knowledge and preventive measures.

Centre for Microbiology Research, Kenya Medical Research Institute, PO Box 43640, Nairobi, Kenya. skariuki@kemri.org In Africa, multidrug-resistant non-typhoidal salmonellae (NTS) are one of the leading causes of morbidity and high mortality in children under 5 years of age, second in importance only to pneumococcal disease. The authors studied NTS isolates from paediatric admissions at two hospitals in Nairobi, Kenya, and followed the index cases to their homes, where rectal swabs and stools from parents and siblings, and from animals in close contact, were obtained. The majority of NTS obtained from cases were Salmonella enterica serotype Typhimurium (106 out of 193; 54.9%) and Salmonella enterica serotype Enteritidis (64; 33.2%), a significant proportion (34.2%) of which were multiply resistant to three or more antibiotics, including ampicillin, tetracycline, cotrimoxazole and chloramphenicol. Only 23.4% of NTS were fully susceptible to all 10 antibiotics tested. Of the 32 NTS obtained from contacts (nine adults and 23 children) at the homes of index cases, 21 (65.6%) isolates were similar by antibiotic-susceptibility profiles and plasmid content, and their XbaI- and SpeI-digested chromosomal DNA patterns were indistinguishable from those of the corresponding index cases. Only three out of 180 (1.7%) samples from environmental sources, including animals, soil, sewers and food, contained NTS matching those from corresponding index cases. The carriage of NTS in an asymptomatic population was represented by 6.9% of human contacts from 27 out of 127 homes sampled. This population of carriers may represent an important reservoir of NTS that would play a significant role in the epidemiology of community-acquired NTS bacteraemia in children.

OBJECTIVES: To determine the socio-cultural, economic and environmental factors that encourage urban dairy production and the factors which may predispose the producer, consumer and other handlers to risks associated with dairy farming. To assess the knowledge, attitudes and behaviour of men and women towards health risks and benefits associated with urban dairy farming in smallholder dairy farming and their immediate non-dairy farming neighbour households. DESIGN: A cross sectional study and participatory urban appraisal (PUA. SETTING: Urban and peri-urban households in Dagoretti Division, Nairobi. SUBJECTS: Three hundred dairy farming households, and 150 non-dairy farming neighbour households and six participatory urban appraisals, 58 males and 45 females. RESULTS: There were more females than males dairy farmers. Both women and men had equal access to resources and benefits obtained from dairy farming but the men had the greater control over the resources. Low levels of knowledge on the specific health risks related to urban dairy farming were observed. Less than half of the respondents believed they were at risk of being exposed to the health hazards, while 63% sensed they could protect themselves from the health risks. There was an association between knowledge levels, perceptions and behaviour of men and women toward risks associated with dairy farming. CONCLUSIONS: Apart from giving treatment to animals most men did less dairy farming activities. Women rated men lower in all dairy activities but when the men did the scoring for the same activities they rated themselves higher, arguing that their participation was indirect such as providing cash to buy the feed supplements and veterinary services. There were gender differences in all important tasks associated with dairy keeping. Farmers stated that older children, when not in school sometimes assisted but in general children did not show much enthusiasm in dairy work.

SETTING: A rural district, Machakos, in Kenya, facing decreasing national resources for health and an increasing tuberculosis (TB) caseload fuelled by the human immunodeficiency virus (HIV). OBJECTIVE: To evaluate the impact on district TB programme performance of decentralising TB treatment by providing ambulatory care in the hospital and peripheral health units and in the community. METHODS: A comparative study of district TB programme performance before and after the decentralisation of TB services at the end of 1997. To facilitate ambulatory care, ethambutol replaced streptomycin in the new treatment regimen. FINDINGS: The number of patients registered in the control period (1996) was 1141, of whom almost 100% were admitted during the intensive phase of TB treatment, and in the intervention period (1998 and 1999), it was 3244, of whom only 153 (4.7%) required admission in the intensive phase. Of 3244 TB patients (all forms) registered in the intervention period, the number (%) choosing the different options for directly observed treatment (DOT) supervision were: hospital clinic 1618 (49.9%), peripheral health unit 904 (27.9%), community volunteer 569 (17.5%) and hospitalisation 153 (4.7%). The options were found to be acceptable to patients, their families and health staff. The treatment outcomes among new sputum smear-positive pulmonary TB patients were similar in the intervention and control cohorts, with treatment success rates of 88% vs. 85% and death rates of 4% vs. 6%, respectively. Treatment completion was significantly higher among new sputum smear-negative and extra-pulmonary TB patients in the intervention than in the control cohort (79% vs. 48%, respectively). CONCLUSION: The decentralisation of the intensive phase of TB treatment resulted in maintenance of good TB programme performance, while Machakos hospital closed its TB wards. A separate paper describes the cost-effectiveness of this approach. The National Tuberculosis Control Programme plans to adopt this approach as national policy.

SETTING: A rural district, Machakos, in Kenya, facing decreasing national resources for health and an increasing tuberculosis (TB) caseload fuelled by the human immunodeficiency virus (HIV). OBJECTIVE: To evaluate the impact on district TB programme performance of decentralising TB treatment by providing ambulatory care in the hospital and peripheral health units and in the community. METHODS: A comparative study of district TB programme performance before and after the decentralisation of TB services at the end of 1997. To facilitate ambulatory care, ethambutol replaced streptomycin in the new treatment regimen. FINDINGS: The number of patients registered in the control period (1996) was 1141, of whom almost 100% were admitted during the intensive phase of TB treatment, and in the intervention period (1998 and 1999), it was 3244, of whom only 153 (4.7%) required admission in the intensive phase. Of 3244 TB patients (all forms) registered in the intervention period, the number (%) choosing the different options for directly observed treatment (DOT) supervision were: hospital clinic 1618 (49.9%), peripheral health unit 904 (27.9%), community volunteer 569 (17.5%) and hospitalisation 153 (4.7%). The options were found to be acceptable to patients, their families and health staff. The treatment outcomes among new sputum smear-positive pulmonary TB patients were similar in the intervention and control cohorts, with treatment success rates of 88% vs. 85% and death rates of 4% vs. 6%, respectively. Treatment completion was significantly higher among new sputum smear-negative and extra-pulmonary TB patients in the intervention than in the control cohort (79% vs. 48%, respectively). CONCLUSION: The decentralisation of the intensive phase of TB treatment resulted in maintenance of good TB programme performance, while Machakos hospital closed its TB wards. A separate paper describes the cost-effectiveness of this approach. The National Tuberculosis Control Programme plans to adopt this approach as national policy.

45 Kenyan traditional healers were interviewed with respect to the diagnosis and treatment of eye diseases. Traditional management of eye diseases is based on the healers' concept of the disease causation as well as their knowledge of the herbal, animal and chemical substances that possess (or are reported to possess) remedial effect on the disease. While many of the healers interviewed failed to give a clear distinction between the various eye conditions, diseases such as cataract, foreign bodies and injuries were recognized easily. In almost all cases the medicinal substances were first diluted in water before they were applied to the eyes. Human milk, blood and the white of the egg were the animal substances listed as medicinal to various eye conditions. A solution of sugar was one of the chemical substances used in the treatment of specific eye conditions. Given correct information, some of these healers could f

An ecosystem approach was applied to study the links between malaria and agriculture in Mwea Division, Kenya. The study was organized into five phases. Phase I had two components including a stakeholder workshop conducted with community representatives and other key stakeholders, and the collation of data on common diseases from outpatient service records at the local hospital. Phase I aimed at an a priori needs-assessment in order to focus the research agenda. Workshop participants directly contributed to the selection of two villages with rice irrigation and two non-irrigated villages for detailed health studies. In Phase II, various Participatory Rural Appraisal (PRA) tools were used to gather more detailed qualitative information from the study villages. The qualitative results indicated that Mwea residents considered malaria and lack of clean drinking water to be their most important health problems, and this was corroborated by local hospital records. Phase III consisted of a comprehensive household survey developed with inputs from Phases I and II. Phase IV involved a comparative evaluation of entomological and parasitological aspects of malaria in the villages with and without rice irrigation. The malaria parasitological survey found an average Plasmodium falciparum parasite rate of 23.5% among children up to 9 years of age. Results of the entomological evaluation showed a 30-300-fold increase in the number of the local malaria vector, Anopheles arabiensis, in villages with rice irrigation compared to those without irrigation yet malaria prevalence was significantly lower in these villages (0-9% versus 17-54%). The most likely explanation of this 'paddies paradox' in Mwea appeared to be the tendency for A. arabiensis in irrigated villages to feed overwhelmingly on cattle. The results suggested that zooprophylaxis was potentially a practical option for long-term malaria control in the rice irrigated areas, in spite of the large number of A. arabiensis. Phase V consisted of end-of-project workshops for the dissemination of research results and participatory decision-making regarding follow-up actions. Owing to the utilization of a transdisciplinary and participatory approach to research, it was possible to identify opportunities for maintaining zooprophylaxis for malaria in Mwea, through the integration of agroecosystem practices aimed at sustaining livestock systems within a broader strategy for rural development.

The Consortium for Emergency Contraception introduced Postinor-2, a progestin-only EC product, into Kenya as part of its work to expand access to EC in developing countries. Introduction activities included registering Postinor-2, training providers, and developing provider and client materials. We surveyed family planning clients and providers to assess the impact of these activities. Knowledge of EC among clients and providers improved between the baseline and evaluation surveys. More women and providers had heard of EC and more providers were distributing it. Support for access to EC in Kenya also improved. The results indicate, though, that further information is needed. Only one-fifth of women at the evaluation had heard of EC and almost half of the women expressed concerns about EC at baseline and evaluation. More research and experience using novel ways of informing women about EC in Africa is needed, and information needs to address women's concerns.

45 Kenyan traditional healers were interviewed with respect to the diagnosis and treatment of eye diseases. Traditional management of eye diseases is based on the healers' concept of the disease causation as well as their knowledge of the herbal, animal and chemical substances that possess (or are reported to possess) remedial effect on the disease. While many of the healers interviewed failed to give a clear distinction between the various eye conditions, diseases such as cataract, foreign bodies and injuries were recognized easily. In almost all cases the medicinal substances were first diluted in water before they were applied to the eyes. Human milk, blood and the white of the egg were the animal substances listed as medicinal to various eye conditions. A solution of sugar was one of the chemical substances used in the treatment of specific eye conditions. Given correct information, some of these healers could f

Background: Human parainfluenza viruses (HPIVs) belong to the paramyxoviridae family. HPIV is the major cause of croup in which type 1 is most frequent cause, followed by type 3 and type 2 respectively. Surveillance has shown that Human Parainfluenza viruse are a major cause of respiratory infections in Kenya. In January 2013 through an existing influenza surveillance network at the Kenyan National Influenza center, we screened for parainfluenza and other non-influenza respiratory viruses. This was done within the designated Influenza network made up of eight sentinel sites. Objective: The objective of this study was to monitor and document circulation of Human parainfluenza viruses in Kenya in the period January–September 2013. Materials and Methods: Specimens were collected from the nasopharynx using a flocked swab from consenting patients meeting the WHO influenza-like-illness (ILI) case definition. Specimens were transported to the NIC while observing the cold chain and inoculated into LLCMK2 cell line. After incubation and observation for cytopathic effect, all samples were screened by direct immunofluorescence assay (IFA) using the Respiratory Panel I Viral Screening and Identification kit (Chemicon International, Inc).Results and Discussion: A total of 972 nasopharyngeal swab specimens were collected between January – September 2013. HPIVs were detected in 108 (11%) cases. Out of these, there were 36 co-infections of the parainfluenza viruses. In general, Their seasonality patterns shows two peaks; one severe one occurring in April with 40.6% and the second milder peak occurring in June with 23.1% of all the cases. There was co-circulation of HPIV sub-types throughout the year. The three subtypes circulated between January to May with a peak in April with type 1 dominating in the month of April. They formed a second peak in June with type three dominating and type three lagging behind and appearing a month later. From our analysis we found that the conditions that trigger their occurrence are the same since their peaks are synchronized.Conclusion: This study shows that parainfluenza viruses are the major contributor of influenza in Kenya.

OBJECTIVE: To explore the knowledge, attitudes and practices of dairy and non-dairy farming households in Dagoretti in regard to the risk posed by bovine brucellosis and determine the prevalence of the disease in urban dairy cattle. DESIGN: A cross sectional study. SETTING: Urban and Peri-urban dairy farming and non dairy farming households in Dagoretti division, Nairobi. SUBJECTS: Two hundred ninety nine dairy farming and 149 non dairy farming households. INTERVENTION: Segregated focus group discussions, administration of a household questionnaire and collection of unboiled milk from dairy and non dairy farming households were the instruments used to gather data on the practices, attitudes, perceptions and prevalence of bovine brucellosis. RESULTS: Three hundred and ninety three milk samples were collected and analysed for the presence of antibodies to Brucella abortus in an indirect ELISA. The apparent prevalence of bovine brucellosis from milk was estimated at 1% for the samples collected while in dairy farming households the prevalence was 1.1% [0.2, 3.4%] and 0.7% [0.4%] in non dairy farming households.. Thirty percent (90/296) of dairy respondents and 22% (32/147) of non-dairy respondents knew of the existence of brucellosis. Risk of contracting brucellosis was very low considering that milk is boiled together with other ingredients used in making tea and porridge. However, 31% (93/296) and 22% (31/143) of dairy and non dairy farming households respectively made traditionally fermented milk without first boiling the milk. This practice may predispose this group to brucellosis. CONCLUSION: The low prevalence of bovine brucellosis requires constant surveillance in case the prevalence rates do change. Education of dairy farming households who are more at risk of contracting brucellosis on the transmission pathways and risk factors is required in order to lower further the prevalence of bovine brucellosis in Dagoretti.

BACKGROUND: Pregnancy among adolescents is unplanned in many instances. Although some pregnant adolescents carry the pregnancy to term, abortion, in many instances unsafely induced, is a commonly sought solution in Kenya. OBJECTIVE: To determine adolescents' perceptions of induced abortion. DESIGN: A cross-sectional descriptive study carried out between July 1995 and June 1996. SETTING: An urban and a rural district in Kenya. PARTICIPANTS: Adolescents aged 10-19 years in schools in Nairobi and Kiambu districts, and a group of immediate post-abortion adolescent girls in some health facilities in Nairobi. MAIN OUTCOME MEASURES: The number of health programmes formulated and put into use, which are adolescent-friendly and providing information, education and communication on abortion issues. DATA COLLECTION: One thousand eight hundred and twenty adolescents were subjected to a self-administered questionnaire that collected demographic and health data as well as perceptions of induced abortion. Focus group discussions on perceptions of abortion were held with 12 groups of adolescents in schools and the information obtained recorded on paper and in a tape-recorder. RESULTS: One thousand nine hundred and fifty two adolescents, comprising of 1048 school girls (SG), 580 boys (SB), 192 post-abortion girls (PA) and 132 adolescents in the focus group discussions, formed the study sample. More than 90% were aware of induced abortion (IA). Knowledge of IA correlated positively with level of education (P < 0.01). Seventy one per cent of SG, 84% of PA and 40% of SB were aware of abortion-related complications, the most common being infections, death and infertility. Eighty three per cent of PA felt that complications were preventable by seeking care from a qualified doctor compared to one quarter each for the SB and SG. 56% PA, 69% SB and 72% SG felt that abortions were preventable. However, less than 40% proposed abstinence as a primary strategy. The most important source of information on abortion was the media followed by friends and teachers. CONCLUSION: Adolescents are aware of abortion and the related complications, but there is more variability in their knowledge and preventive measures.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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

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There is a strong need for research capacity strengthening in developing countries. In this paper we present achievements and lessons learnt from a South-North collaboration. The collaboration is situated within the Kenyan-Danish Health Research Project (KEDAHR) which started in 1994 and lasted till 2004. A total of
41students (27 Kenyans and 14 Danish) undertaking studies at post-graduate and doctoral levels were involved over this period and more than 37 articles published in peer-reviewed journals and in edited books. In addition, there are other intangible benefits that have accrued over time.We conclude that the collaboration between the five institutions involved has been very productive. The focus on capacity development has led to a large pool of well trained anthropologists who are now forming a critical mass of expertise within which we expect future collaborations to be based.

Background: The national epidemiological characteristics of retinoblastoma in Kenya have not been determined. The diagnosis of this cancer is mainly clinical; histology determines tumour extent. Late diagnosis of this otherwise curable malignancy is associated with high mortality.
Aim: To determine the incidence and pattern of presentation of retinoblastoma in Kenya.
Design: A retrospective case series
Setting: All 75 eye care centres in the 8 provinces of Kenya as registered in the Ministry of health eye information system.
Methods: With permission, clinical registers at eye care centers were reviewed to identify cases of retinoblastoma that presented from 1sr January 2006 to 31st December 2007. Only centers that reported cases were visited to record patient's clinical and demographic data in a questionnaire. Cross-referred cases were analysed once to avoid double-counting.
Results: A total of 206 suspected cases presented to 46 eye care facilities but 58 cases (28.2%) were lost
after referral. Of 148 traced cases, 28.4% were self referrals and of the referred cases, most (21.6%) were
from central province. Only 63.5% of cases were finally treated at 2 teaching and referral hospitals.After
excluding 3 missing files and 13 cases that were ruled out on histology, 132 confirmed cases(166 eyes) were
subsequently analysed. The mean delay in first presentation was 6.75 months and delay after referral was
1.69 months. Leukocoria was the most common presenting complaint (91.7% cases) and sign (71.1 % eyes).
There were 25.8% bilateral cases and 78.2% unilateral cases with mean ages of 26 and 35.9 months
respectively. The male to female ratio was 1.49:1. Only 4.5% had a positive family history. Most (32.6%)
cases resided in the Rift valley province. There was no association between ethnicity and bilaterality. The annual incidence of retinoblastoma in 2007 was 1:17,030 live births.
Conclusions: A significant proportion of cases were lost after referral. The late presentation was associated with advanced disease. Leukocoria was the most common finding. Most cases resided in the Rift valley province. The incidence of retinoblastoma was similar to most countries but may be an underestimate.
Recommendations: Public education ancl screening with the red reflex test by primary health care workers would ensure early detection. Quality control measures in record keeping would ensure accuracy. A retinoblastoma registry would provide accurate estimates through register-based studies. Further research is necessary to investigate the lost cases after referral, delays in presentation and barriers to uptake of services.

To determine the incidence and distribution of retinoblastoma in Kenya we performed a retrospective study
of patients seen from 1st January 2006 to 31st December 2007. Of 206 suspected cases of retinoblastoma
identified, 58 (28.2%) referred cases were not found at any treatment center and 148 (71.8%) were
successfully traced to facilities where they were treated, of which 16 cases were excluded (3 missing files
and 13 cases ruled out on histology). The remaining 132 confirmed cases comprised of 79 (59.8%) males and
53 (40.2%) females (p=0.016), 34 (25.8%) bilateral and 98 (74.2%) unilateral cases. The overall mean age at
presentation was 33.5 months (SD 20.8); the difference between the mean age of the bilateral cases (25.4
months, SD 16.8) and unilateral cases (36.3 months, SD 20.8) was statistically significant (p=0.008). Only 6
(4.5%) confirmed cases reported a positive family history. The calculated incidence for 2007 was 1 in 17,030
live births. In the first study of its kind in Kenya, we show the incidence of retinoblastoma is similar to that
reported globally, with no ethnic or regional variation in its distribution. Similar to other resource-poor
settings, children with retinoblastoma in Kenya presented late, even those with positive family history.
Many cases were lost after referral. We recommend that in addition to increasing public awareness, better
documentation in a retinoblastoma register is likely to improve patient follow-up after referral, leading to
timely treatment of affected children.
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A retrospective study of poisoned patients admitted at Kenyatta National Hospital (KNH) over the period January 2002 to June 2003 was carried out. KNH is a national referral and university teaching hospital and patients are admitted from all parts of Kenya. The results of the study are therefore expected to mirror closely the situation in the rest of the country. Data analysis showed that 58.9% of poisoned patients were males. Pesticides and household/industrial chemicals, the two most important poisoning agents, accounted for 43% and 24% of poisoning, respectively. Organophosphates and rodenticides were the two most common pesticides accounting for 57.4% and 31% of poisoning, respectively. Kerosene accounted for 66% of poisoning with household agents. Self-poisoning was prevalent in the age bracket 21-30 years (70.7%)while accidental poisoning, mostly with kerosene,was prevalent in the age group 0-5 years (83.9%). The overall mortality rate from poisoning was 7.0%.

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Background: Local anticoagulation services are inadequate and substantially underutilized despite compelling evidence showing that their appropriate use significantly reduces the risk of thromboembolic complications.
Objectives: To determine the predictors of adequate ambulatory anticoagulation services in Kenyatta National Hospital.
Methodology: A cross sectional study between December 2014 and April 2015 among 102 adult outpatients on anticoagulation using consecutive sampling was done. Information abstracted into a predesigned data collection tool included participants’ sociodemographic characteristics, regular sources of supply of anticoagulant, clinic pre-appointment reminders, indications of treatment and international normalized ratio tests. Data were analyzed using IBM Statistical Package for Social Sciences version 21.0 and logistic regression was used to determine independent predictors of adequate anticoagulation, which was defined as international normalized ratio ranging 2 - 3.
Results: Females were majority (76.5 %) and only 27.5 % of patients had adequate anticoagulation control. The indication of warfarin for heart valve surgery (p=0.014) and deep venous thrombosis (p=0.021) were associated with adequate anticoagulation. Age above 60 years was associated with poor anticoagulation (p=0.006). Logistic regression revealed that the independent predictor of adequate anticoagulation was warfarin use due to heart valve surgery (OR=3.1; 95% CI: 1.2 – 7.9, p=0.017).
Conclusions: Ambulatory anticoagulation control in the hospital is poor. Further investigation is required to find out the reasons behind adequate anticoagulation in heart valve surgery patients.
Key Words: Ambulatory anticoagulation, anticoagulant, outpatient, international normalized ratio tests.

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.

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A retrospective study of poisoned patients admitted at Kenyatta National Hospital (KNH) over the period January 2002 to June 2003 was carried out. KNH is a national referral and university teaching hospital and patients are admitted from all parts of Kenya. The results of the study are therefore expected to mirror closely the situation in the rest of the country. Data analysis showed that 58.9% of poisoned patients were males. Pesticides and household/industrial chemicals, the two most important poisoning agents, accounted for 43% and 24% of poisoning, respectively. Organophosphates and rodenticides were the two most common pesticides accounting for 57.4% and 31% of poisoning, respectively. Kerosene accounted for 66% of poisoning with household agents. Self-poisoning was prevalent in the age bracket 21-30 years (70.7%)while accidental poisoning, mostly with kerosene,was prevalent in the age group 0-5 years (83.9%). The overall mortality rate from poisoning was 7.0%.

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Abstract
Extreme unpredicted momentum in global indices and security prices associated with uncertainty and
unexplained stock price movements have made life difficult for a rational investor who relies on market
fundamentals to make investment decisions. This study attempted to determine the contribution of
investor behavior in influencing investor portfolio performance at the Nairobi Securities Exchange using
a sample of 385 individual stock investors. The relationship between investor behavior and portfolio
performance was tested using multiple regression. The overall model was statistically significant
indicating that investor behavior influences portfolio performance with herding and disposition effect
having a positive effect on portfolio performance while overconfidence has a negative effect on
performance. The findings provide an eye-opener and basis of appreciation of the effect of behavioral
biases on the results of trading activities. Stock market players can use these findings to understand the
market dynamics and incorporate behavioral factors in analysing capital markets performance.
Keywords: Investor behavior, herding, overconfidence, disposition effect and portfolio performance

The investors must trade to make a return and the choice of where to invest and how many times to trade
lies with the investor. This study sought to determine whether the investment styles adopted by the
investors on the Nairobi Securities Exchange have an effect on their portfolio performance. The
relationship was tested using multiple regression analysis on a sample of 385 individual retail investors.
The overall model was statistically significant indicating that investment style influences portfolio performance. Passive investment style and Growth oriented investment style have a significant
relationship with portfolio performance with growth having a negative effect while passive style has a
positive effect. The implication here is that investors who actively trade should cautiously evaluate the
implication on their portfolio to avoid the negative effects.
Keywords: Investment style, passive, active, value, growth, portfolio performance

The investors must trade to make a return and the choice of where to invest and how many times to trade
lies with the investor. This study sought to determine whether the investment styles adopted by the
investors on the Nairobi Securities Exchange have an effect on their portfolio performance. The
relationship was tested using multiple regression analysis on a sample of 385 individual retail investors.
The overall model was statistically significant indicating that investment style influences portfolio performance. Passive investment style and Growth oriented investment style have a significant
relationship with portfolio performance with growth having a negative effect while passive style has a
positive effect. The implication here is that investors who actively trade should cautiously evaluate the
implication on their portfolio to avoid the negative effects.
Keywords: Investment style, passive, active, value, growth, portfolio performance

Abstract
Extreme unpredicted momentum in global indices and security prices associated with uncertainty and
unexplained stock price movements have made life difficult for a rational investor who relies on market
fundamentals to make investment decisions. This study attempted to determine the contribution of
investor behavior in influencing investor portfolio performance at the Nairobi Securities Exchange using
a sample of 385 individual stock investors. The relationship between investor behavior and portfolio
performance was tested using multiple regression. The overall model was statistically significant
indicating that investor behavior influences portfolio performance with herding and disposition effect
having a positive effect on portfolio performance while overconfidence has a negative effect on
performance. The findings provide an eye-opener and basis of appreciation of the effect of behavioral
biases on the results of trading activities. Stock market players can use these findings to understand the
market dynamics and incorporate behavioral factors in analysing capital markets performance.
Keywords: Investor behavior, herding, overconfidence, disposition effect and portfolio performance

Corporate Social Responsibility (CSR) is increasingly being embraced by organizations worldwide. This study aims to investigate the relationship between CSR and financial performance for the banks listed on the Nairobi Securities Exchange (NSE). The study analyzed ten of the eleven banks listed on the NSE for the period 2008 to 2012 using data obtained from audited annual reports and other publications by the banks including information from their websites. The analysis was done using multiple regression analysis and the correlation coefficient (r) was calculated together with the coefficient of determination (r2) to further determine the relationship between the variables. The research found that there was an insignificant positive relationship between CSR and financial performance in the Kenyan banking industry with CSR having a very minimal effect on financial performance. The model shows that, for every one unit increase in CSR, the firm’s financial performance increases by 0.00002 units. The study further concluded that in the Kenyan banking industry, CSR activities are not undertaken for the purpose of improving the banks financial performance but are undertaken for other reasons such as building brand image and building customer loyalty.
Key Words: Corporate Social Responsibility (CSR), Financial Performance, Nairobi Securities Exchange (NSE), Kenyan banking Industry.

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Alcohol based hand sanitizers are currently recommended for routine use in curbing the spread of the COVID-19 global pandemic. The present survey examined hand sanitizers marketed in Nairobi County with regards to product appearance, packaging, labelling and declared composition. Seventy-six samples were collected from five sites within the Nairobi metropolis - Central Business District, Kibera, Kilimani/Karen, Ngong and Thika. A wide range of non-conformities were observed for the criteria applied. Many samples had incomplete or missing label information, ingredient lists, cautionary warnings, Kenya Bureau of Standards (KEBS) standardization marks and permit numbers. Glycerin, fragrances and carbomers were the most common added ingredients. Poor formulation indicators such as haziness and phase separation were encountered in some products. The median price of the products was KES 250 (USD 2.36) per 100 ml although there was considerable variation in pricing of samples. None of the samples evaluated fully met all the standards for the parameters evaluated. Strict adherence to regulatory standards by producers of hand sanitizers is required to ensure that only compliant products are available on the market.

A recently published FDA guidance on chewable tablets has addressed the quality attributes of this class of dosage forms. This study evaluated disintegration as a quality attribute for a number of commercially available chewable antacid tablets. Additionally, acid-neutralizing-capacity values were evaluated. A number of the products exhibited prolonged disintegration times—which were far longer than those of conventional immediate-release tablets. The mean disintegration times ranged from 6 to more than 60 min in distilled water and from 9 to over 60 min in 0.1 N HCl. The products with longer disintegration times had higher breaking force and tensile strength values. Despite the range in disintegration times, all products met the criteria for acid-neutralizing capacity. These results indicate a need for patients to be aware of the need to thoroughly chew antacid tablets upon administration. Given these considerations, disintegration testing would be a useful quality control test in evaluating these dosage forms as the implicit assumption by the manufacturer that patients will chew the product sufficiently may not be met in every case.

Background: Alcohol-based hand sanitizers (ABHS) have become widely used products since the advent of the SARS-CoV-2 coronavirus based COVID-19 pandemic. In addition to ethanol or isopropanol (the active ingredients of ABHS) and water, these products are formulated with a number of ingredients to optimize delivery, efficacy and safety as well as to provide consumer appeal. Despite the widespread use of ABHS, there is very limited information in the literature on the non-alcohol ingredients used in these products.
Objectives: The aim of this work was to determine the inactive ingredients used in ABHS marketed in metropolitan Nairobi.
Methodology: ABHS products were randomly obtained from several locations at retail outlets within the Nairobi metropolitan region. The ingredients used in each ABHS were obtained from the product labels.
Results: The most common inactive ingredients based on percentage frequency of listing on product labels were glycerin (50%), fragrances (36%), carbomer (26%), triethanolamine (18%) and propylene glycol (17%). It was observed that some products incorporated additional antimicrobial agents and preservatives in the formulation. The fragrances and some of the preservatives used in the ABHS products are potential allergens. Incomplete or inadequate ingredient naming was noted for several products.
Conclusions: There is a need for ABHS manufacturers to fully disclose all raw materials used in ABHS products using standardized ingredient nomenclature. ABHS users need to be aware of potential allergens present in respective marketed products.

Fetal cocaine exposure is a major problem resulting from the illicit use of cocaine by pregnant women. Studies examining the prevalence of cocaine use during pregnancy estimate usage ranges from 5-17% (I). Although no definitive syndrome has been defined, prenatal cocaine exposure is associated with decreased birth weight and size, brain injury and congenital anomalies (2).

Purpose – This paper investigated the relationship between the stock market performance and the
economic growth in the East African Community. The stock market variables considered in the
study were stock market capitalization, market liquidity and share price volatility. The GDP
growth was a used a measure for economic growth.
Methodology – The quantitative research methods were employed to define the nature of
relationship between the variables. The population of the study was the All-Share index in the 4
stock markets in the member countries. To fulfill the purposes under the research, the stock market
performance of the EAC member countries was collected from the Capital markets, EASRA and
the respective Stock Exchanges. Data for GDP growth was collected from the World Bank website.
The study employed the Vector Autoregressive (VAR) model as well as the Granger test for
causality to estimate as well as provide evidence regarding the nature and direction of relationship
of the variables.
Findings - The study established an existence of long term relationship between the stock market
performance variables (market capitalization and liquidity) and economic growth in the East
African community. The study established that there was no relationship between the share price
volatility of the stock market and economic growth

BACKGROUND: Influenza viruses evolve rapidly and cause regular seasonal epidemics in humans challenging effective vaccination. The virus surface HA glycoprotein is the primary target for the host immune response. Here, we investigated the vaccine efficacy and evolution patterns of human influenza A/H3N2 viruses that circulated in Kenyan in the period before and after the 2009 A/H1N1 pandemic, targeting the HA1 domain. MATERIALS AND METHODS: A hundred and fifteen HA sequences of Kenyan virus viruses were analyzed relative to the corresponding WHO vaccine reference strains using bioinformatics approaches. RESULTS: Our analyses revealed varied amino acid substitutions at all the five antigenic sites (A-E) of the HA1 domain, with a majority the changes occurring at sites A and B. The Kenyan A/H3N2 viruses isolated during 2007/2008 seasons belonged to A/Brisbane/10/2007-like viruses lineage, while those circulating in 2009-2012 belonged to the lineage of A/Victoria/361/2011-like viruses. The 2013 viruses clustered in clade 3C.3 of the A/Samara/73/2013-like viruses. The mean evolutionary rate of the A/H3N2 viruses analyzed in the study was at 4.17$\times$10-3 (95% HPD=3.09$\times$10-3-5.31$\times$10-3) nucleotide substitutions per site per year, whereas the TMRCA was estimated at 11.18 (95% HPD=9.00-14.12) years ago from 2013. The prediction of vaccine efficacy revealed modest vaccine efficaciousness during 2008, and 2010 influenza seasons, whilst sub-optimal effectiveness was registered in 2007, 2009, 2012 and 2013. Further, the overall selective pressure acting on the HA1 domain was estimated at 0.56 ($ømega$<1), suggesting that a majority of codon sites in the HA1 epitopes were evolving under purifying selection. CONCLUSIONS: Generally, our results highlight the genetic plasticity of A/H3N2 viruses and reveal considerable disparity in vaccine efficaciousness against the A/H3N2 viruses that circulated in Kenya, specifically during 2007, 2009, 2012, and 2013 influenza seasons. Our findings underscore the importance and need for consistent surveillance and molecular characterization of influenza viruses, to inform decision making and enhance early of detection of strains with epidemic/pandemic potential as well as benefit in guiding decisions regarding the appropriate annual influenza vaccine formulations.

BACKGROUND: Influenza viruses evolve rapidly and cause regular seasonal epidemics in humans challenging effective vaccination. The virus surface HA glycoprotein is the primary target for the host immune response. Here, we investigated the vaccine efficacy and evolution patterns of human influenza A/H3N2 viruses that circulated in Kenyan in the period before and after the 2009 A/H1N1 pandemic, targeting the HA1 domain. MATERIALS AND METHODS: A hundred and fifteen HA sequences of Kenyan virus viruses were analyzed relative to the corresponding WHO vaccine reference strains using bioinformatics approaches. RESULTS: Our analyses revealed varied amino acid substitutions at all the five antigenic sites (A-E) of the HA1 domain, with a majority the changes occurring at sites A and B. The Kenyan A/H3N2 viruses isolated during 2007/2008 seasons belonged to A/Brisbane/10/2007- like viruses lineage, while those circulating in 2009 to 2012 belonged to the lineage of A/Victoria/361/2011-like viruses. The 2013 viruses clustered in clade 3C.3 of the A/Samara/73/2013-like viruses. The mean evolutionary rate of the A/H3N2 viruses analyzed in the study was at 4.17×10(-3) (95% HPD=3.09×10(-3) to 5.31×10(-3)) nucleotide substitutions per site per year, whereas the TMRCA was estimated at 11.18 (95% HPD=9.00-14.12) years ago from 2013. The Prediction of vaccine efficacy revealed modest vaccine efficaciousness during 2008, and 2010 influenza seasons, whilst sub-optimal effectiveness was registered in 2007,2009, 2012 and 2013. Further, the overall selective pressure acting on the HA1 domain was estimated at 0.56 (ω<1), suggesting that a majority of codon sites in the HA1 epitopes were evolving under purifying selection. CONCLUSIONS: Generally, our results highlight the genetic plasticity of A/H3N2 viruses and reveal considerable disparity in vaccine efficaciousness against the A/H3N2 viruses that circulated in Kenya, specifically during 2007,2009, 2012, and 2013 influenza seasons. Our findings underscore the importance and need for consistent surveillance and molecular characterization of influenza viruses, to inform decision making and enhance early of detection of strains with epidemic/pandemic potential as well as benefit in guiding decisions regarding the appropriate annual influenza vaccine formulations.

Fuelwood accounts for most of the domestic energy use in the Third World. In East Africa the use of charcoal especially in urban centres has continued though threatened by social factors such as deforestation. The typical East African metal charcoal stove has been studied with emphasis on its efficiency and pollutant emission. The study has brought to better focus the very low performance figures and the dangerously high pollutant emissions by the stove. The study consisted of: i. Continuous flue gas monitoring which was achieved by positioning the stove in a specially constructed enclosure allowing sampling of the flue gases before dillution with the surrounding air. ii. Temperature monitoring of various .. posi tions both on and off the stove to assess the heat energy distribution. Following lighting up concentrations of over 3% CO and 8% CO were recorded each time. These concentrations reduced to about half the above values within 10 minutes though for up to 30 minutes the concentrations were still1\3 times above the.:poisonous ., threshold limit based on normal air. changes -wi thin an occupied room

Abstract
Aluminium induced crystallization (AIC) was used to crystallize sputtered amorphous silicon thin films on aluminium-coated glass at annealing temperatures ranging from 250-520°C in vacuum. Crystalline volume fractions were measured by Raman spectrometry as a function of annealing temperature. It was shown that the crystallized films had large grains as the Raman peaks were centred at about 520 cm-1 at and over annealing temperatures of 420°C. The three-layer sample crystallization resulted in crystallization of the films at lower temperatures compared to the two-layer sample crystallizations which implied a reduction in the
cost of production of the seedlayer and resulting products. Hall mobilities and hole densities ranging from 17.0-22.8 cm2V-1s-1and (4.7-9.2) x 1018 cm-3 respectively were measured. Low hole charge densities for films of the same thickness were achieved at high annealing temperatures which was an indication of less aluminium in seed layers prepared at those temperatures. Having seed layers with sufficiently low hole
charge densities is desirable for application of the seed layer in photovoltaic applications.

Key Words: microcrystalline, silicon, annealed, raman, crystallinity, hall-effect

Tungiasis or jigger infestation is a parasitic disease caused by the female sand flea Tunga penetrans. Secondary infection of the lesions caused by this flea is common in endemic communities. This study sought to shed light on the bacterial pathogens causing secondary infections in tungiasis lesions and their susceptibility profiles to commonly prescribed antibiotics. Participants were recruited with the help of Community Health Workers. Swabs were taken from lesions which showed signs of secondary infection. Identification of suspected bacteria colonies was done by colony morphology, Gram staining, and biochemical tests. The Kirby Bauer disc diffusion test was used to determine the drug susceptibility profiles. Out of 37 participants, from whom swabs were collected, specimen were positive in 29 and 8 had no growth. From these, 10 different strains of bacteria were isolated. Two were Gram positive bacteria and they were, Staphylococcus epidermidis (38.3%) and Staphylococcus aureus (21.3%). Eight were Gram negative namely Enterobacter cloacae (8.5%), Proteus species (8.5%), Klebsiellla species (6.4%), Aeromonas sobria (4.3%), Citrobacter species (4.3%), Proteus mirabillis(4.3%), Enterobacter amnigenus (2.1%) and Klebsiella pneumoniae (2.1%). The methicillin resistant S. aureus (MRSA) isolated were also resistant to clindamycin, kanamycin, erythromycin, nalidixic acid, trimethorprim sulfamethoxazole and tetracycline. All the Gram negative and Gram positive bacteria isolates were sensitive to gentamicin and norfloxacin drugs. Results from this study confirms the presence of resistant bacteria in tungiasis lesions hence highlighting the significance of secondary infection of the lesions in endemic communties. This therefore suggests that antimicrobial susceptibility testing may be considered to guide in identification of appropriate antibiotics and treatment therapy among tungiasis patients.

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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.

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.

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Identification of plant resources that persist under grazing pressure, support desirable levels of production and at the same time protect the grazing environment is central to sustainable livestock production. This study assessed the infiltration capacity and soil loss associated with perennial swards subjected to different levels of utilization using simulated rainfall. The hypothesis was tested that grazed perennial swards have similar hydrologic properties and threshold removal levels below which runoff increases markedly. Infiltration capacity for the perennial swards increased with increasing stubble height before leveling off towards the highest stubble height. A 50% removal of current growth was the upper limit above which runoffs from the swards increased rapidly. Aggregate stability, organic carbon and percent ground plant cover were the most significant attributes that influenced infiltration capacity. Panicum maximum and Enteropogon macrostachyus were the most suitable perennial swards with favourable soil physical properties and infiltration capacities in the study area. The results support the existence of a threshold level of sward stubble height for minimizing runoff.

Key words: Perennial swards, water infiltration capacity, runoff thresholds.

Occurrence of equilibrium and non equilibrium system dynamics in semiarid environments present serious management challenges. In these areas, resource management strategies are increasingly based on equilibrium rather than non equilibrium dynamics that assume simple system dynamics and strong coupling of animal-plant responses. This management approach underlies increasing trends of range degradation and low livestock productivity in these environments. To reverse these trends dictates greater understanding and alignment of grazing resource extraction strategies in space and time to prevailing system dynamics behaviour. In this study, range use patterns by free ranging herds under agropastoral herding were studied in two cycles of four consecutive grazing periods, in semiarid southeastern Kenya. The bites count and herd locations per area methods were used. While grazing thresholds in the system were derived from biweekly sward biomass measured by the quadrant technique in the growing period and stocking rates applied to a growth-consumption rate model. The analysis tested the responsiveness of the agropastoral herding strategies to the predominant system dynamics in the area. In this environment, high rainfall variability ranging from 71 to 98% is experienced across years and seasons, pointing to non-equilibrium dynamics in the system. The agropastoralists practiced seasonal range use and tracking strategies. During the dry season, areas of concentrated drainage; river valleys, bottomlands and ephemeral drainage ways absorbed a greater grazing load, taking 57.1 to 60% of the grazing time by the animals. In contrast, areas of limited moisture concentration, the open sandy/clay plains, were mainly exploited in the wet season and accounted for 52.6 to 55.6% of the grazing time. The agropastoralists tracked forage availability through use of multispecies livestock (cattle, goats and sheep) that exploited different grazing resources in space and time. These range use patterns and strategies tend to stabilize nutrient and energy flow to livestock and thus productivity throughout the seasons. Based on the growth-consumption rate model, grazing thresholds in the system are achieved at 13800, 13000, 4000 and 12300, 4600 and 12000, and 5600 and 11000 kgha-1 of grass biomass at, 2.5, 5, 7, 8 and 10 TLUha-1, respectively. 7 TLUha-1 represent the upper stocking rate limit in the system during the growing period. In this system, resource use strategies are in line with the predominantly non-equilibrium system behaviour. However, sedentary land use interventions and limiting farm sizes that restrict livestock mobility and negatively affect grazing resource diversity will undermine system stability and sustainable livestock production in the area.

Key words: Agropastoralists, range use, system dynamics.

Kenya’s agricultural sector has undergone various changes emanating from policy reforms over the years. These reforms, which occurred from the late 1980s to the early 1990s, were aimed at reducing government involvement in economic activity and allowing the economy to move towards a free market. Policy reforms covered monetary, fiscal and trade aspects and liberalization of the agricultural sector. This study analyses the impact of specific reforms on agricultural production, performance and trade, and therefore food security. The study uses secondary data from the Central Bureau of Statistics and the Ministry of Agriculture. Welfare Monitoring Surveys of 1982, 1992 and 1997 were used as sources of regional cross-sectional household data. Trends in production and trade are analysed, the impact of policy instruments such as prices and market access explained, household incomes and expenditures estimated, and food security trends are analysed using various indicators for both the pre- and post-reforms periods. The analysis indicates that agricultural prices and production have generally declined. The performance of the agricultural sector in the 1990s was dismal, with annual growth in agricultural GDP averaging 2% compared with 4% in the 1980s. Agricultural export growth after the reforms has shown mixed trends due to market access limitations for Kenyan exports. Market access for imports into the Kenyan market has improved since the reforms, occasioning tremendous import growth. However, the capacity to import food has declined, making the country more food insecure. The balance of trade between Kenya and the rest of the world has worsened against Kenya. After the reforms the country moved from broad self-sufficiency in production of most food staples to a net importer. The sources of food security for rural people are subsistence food production and purchases using farm or off-farm income, with a third of households receiving remittances. The linkage between the performance of the agricultural sector and household incomes indicates that when the performance of the sector is poor, household incomes are low. In the light of these challenges, the country needs to reconsider increasing the use of domestic support measures allowed within the World Trade Organization (WTO) agreement on agriculture to allow adequate development of the sector. However, implementation of liberalized policies should be harmonized and coordinated to avoid adverse effects on the sector.

primary energy extraction patterns by livestock under agropastoralism anci ranching were investigated by the bite count method in semiarid south-eastern Kenya. Sward biomass for optimal energy intake by cattle was derived using intake-digestibility constraint curves and realized livestock productivity from the systems compared. Cattle and sheep, and goats primarily consumed herbaceous and woody plants, respectively. Enteropogon macrostachyus and Panicum maximum, E. macrostachyus and Blepharis integrifolia, and Combretum exalatum and Duosperma kilimandscharica accounted for 33.5% and 9.9%, 16.6% and 10'3%, and 11.7"k and 10.7% ot cattle, sheep and goats total energy intake, respectively. cattle optimised energy intake at 370-6'1ogma of sward biomass and 55.5-64.3% organic matter digestibility. Panicum maximum yielded the highest optimal sward biomass. The energy expenditure of the animals was generally lower under agropastoralism across seasons. During the dry season, more animals (33-50%) lost weight under ranching. Agropastoralism was an efficient system as animals were moved across quality grazing microenvironments that minimised feeding costs and enhanced energy intake. Therefore, mobile grazing strategies, plant diversity and complementary trophic interactions stabilise energy extraction patterns and enhance Iivestock productivity under agropastoralism. However, human activities that affect plant diversity and mobility will undermine sustainable livestock production in such environments.

Habitat utilization patterns and feeding interaction of free ranging agropastoral herds
were investigated in two cycles of four consecutive grazing periods, in a semiarid environment,
southeastern Kenya. The bites count and herd locations per area methods were used. During the dry
season, areas of concentrated drainage; river valleys, bottomlands and ephemeral drainage ways
absorbed a greater feeding load, taking 57.1 to 60% of the grazing time by the animals. In contrast,
areas of limited moisture concentration, the open sandy/clay plains, were mainly exploited in the wet
season and accounted for 52.6 to 55.6% of the grazing time. The trophic interaction patterns indicated
that goats and cattle had a seasonal mean diet overlap index of less than 0.5 for all forage classes.
Sheep and cattle, and sheep and goats had a seasonal mean diet overlap index of greater than 0.5 on
grass and forbs, and browse and forbs, respectively. This indicated that during periods of resource
scarcity, sheep and cattle or sheep and goats could become competitive feeders for same feed resources.
Grazing management strategies aimed at even distribution of grazing pressure and enhancing
complementary trophic interactions could be central to sustainable livestock production in such
environments.
KEYWORDS
Agropastoralists. Range Use. Animal Trophic Interactions

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