objective
To assess the availability of resources that support the provision of basic neonatal care in eight first referral level (district) hospitals in Kenya.
methods
We selected two hospitals each from four of Kenya’s eight provinces with the aim of representing the diversity of this part of the health system in Kenya. We created a checklist of 53 indicator items necessary for providing essential basic care to newborns and assessed their availability at each of the eight hospitals by direct observation, and then compared our observations with the opinions of health workers providing care to newborns on recent availability for some items, using a self administered structured questionnaire.
results
The hospitals surveyed were often unable to maintain a safe hygienic environment for patients and health care workers; staffing was insufficient and sometimes poorly organised to support the provision of care; some key equipment, laboratory tests, drugs and consumables were not available while patient management guidelines were missing in all sites.
conclusion
Hospitals appear relatively poorly prepared to fill their proposed role in ensuring newborn survival. More effective interventions are needed to improve them to meet the special needs of this at-risk group.

To assess the availability of resources that support the provision of basic neonatal care in eight first-referral level (district) hospitals in Kenya.

Mobile telephony has diffused more rapidly than any Indian technology in recent memory, yet systematic studies of its impact are rare, focusing on technological rather than social change. We employ network surveys of separate groups of Kerala residents in 2002 and again in 2007 to examine recent shifts in mobile usage patterns and social relationships. Results show (1) near saturation of mobiles among both the professionals and nonprofessionals sampled, (2) a decrease in the number of social linkages across tie types and physical locations, and (3) a shift towards friends and family but away from work relationships in the core networks of Malayalis. We interpret these findings as support for the bounded solidarity thesis of remote communication that emphasizes social insulation and network closure as mobiles shield individuals from their wider surroundings.

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The NH(2)-terminal end of a protein, named SMCp, which contains an ARID (A/T rich interaction domain) DNA binding domain and is similar to the mammalian SMCY/SMCX proteins and retinoblastoma binding protein 2, was shown to bind the African swine fever virus encoded ubiquitin conjugating enzyme (UBCv1) using the yeast two hybrid system and in in vitro binding assays. Antisera raised against the SMCp protein were used to show that the protein is present in the cell nucleus. Immunofluorescence showed that although UBCv1 is present in the nucleus in most cells, in some cells it is in the cytoplasm, suggesting that it shuttles between the nucleus and cytoplasm. The interaction and co-localisation of UBCv1 with SMCp suggest that SMCp may be a substrate in vivo for the enzyme.

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Eleven female rabbits, mainly of the NZW breed, aged between 1 and 3.5 years, were examined post mortem. All had originated over the years 1982 to 1987 from the same rabbitry where they had been fed on pellets from the same manufacturer. Apart from one rabbit, all had a history of progressive loss of bodily condition and six of them had also been infertile. Grossly, most of them were emaciated and their arteries were hardened. In some, hepatopathy, nephropathy and pulmonary emphysema were evident. In one case, mummified foetuses were recovered from the abdominal cavity. Microscopically, degenerative changes and calcification were found in the walls of arteries, kidneys, lungs, hearts and ovaries.

A cross sectional study of 115 patients admitted at the Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya was carried out to determine the prevalence and antibiotic susceptibility of Staphylococcus aureus isolated from infected wounds. The prevalence of Staphylococcus aureus was 33.0 %. The drugs tested and their corresponding sensitivity was amoxycillin (13.2 %), co-amoxyclav (39.5 %), oxacillin (55.3 %), erythromycin (44.7 %), gentamicin (60.5 %), ciprofloxacin (62.2 %), minocycline (86.8 %), cefuroxime (57.9 %), and clidamycin (84.2 %). These results show the sensitivity profile of Staphylococcus aureus and can be used to choose suitable drugs in the management of wounds for hospitalized patients.

Developmental defects of Enamel (DDE) are common dental problems that are commonly encountered by the dentist during routine dental practice. DDE result from the effects of genetic, environmental and nutritional factors that affects the enamel during its formation or development period. The effects may be on the laying of the enamel matrix or on the maturation of the enamel. The total result is an effect on on the patient of either the function, aesthetics or both. Many dentists experience difficulties in distinguishing one type of DDE from the other, hence the importance of writing this book. In this book, four types of DDE have been described and a suggestion made on the management regimes of each condition. It is hoped that the book will help many of these dentist to adequately understand and deal with DDE when they encounter them during their routine practice. Show More Show Less

Dental caries has been on the increase in many developing nations and even in the poor communities in the developed nations# Dental restorations have been used to manage dental caries, especially, in their early cavitation stages of its development# Atraumatic restorative treatment #ART# has been used as an alternative treatment approach for dental caries in areas where traditional dental treatment is lacking as a result of economic difficulties# Restorations placed in single-surface dental cavities using this ART approach, have been found to have good survival rates in the short to medium term# However, the survival of restorations placed in multi-surface cavities using the same method has been poor# It is important to establish the factors behind the poor survival of these multi-surface restorations, and to use the results of such findings to improve on their survival# This monograph discusses some of the factors influencing the survival rate of proximal ART restorations #example of multi-surface restorations# placed in primary molars# Show More Show Less

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Different types of breeding services are available to the Kenyan smallholder farmers. An important question is whether farmers choose the service, or they are constrained in their choice. Assessing the demand for breeding services is crucial for planning purposes since it will help in identifying the constraints faced by smallholders in the aftermath of agricultural liberalisation policies of the 1990’s. Household and community surveys were conducted in March and April 2004 in three different farming systems of the Kenyan Highlands. The study of 300 smallholder cattlekeepers found that while 54% prefer artificial insemination (AI) to natural (bull) service, 81% actually use natural service, suggesting a sharp contrast between actual use and expressed preferences. Even in intensive dairy systems (represented by Ndia division in Kirinyaga district), the majority of smallholders use natural service. Farmers prefer AI service in view of its ability to maintain and/or upgrade their dairy herd but main constraints to use of AI services are low availability and perceived high costs. This study shows that the observed high use of natural service over AI recorded in previous studies may not reflect farmers’ choice but the unavailability of the Demand for breeding services by smallholders alternative service types, cost considerations, information gaps and misinformation amongst farmers, historical reasons among other constraining factors. Some recommendations for breeding policy reform are made.

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The effect of experimentally induced Pasteurella haemolytica pneumonia on the pharmacokinetics of doxycycline (Doxycen Retard) administered intramuscularly was studied in seven East African dwarf goats. The study was conducted in two consecutive phases, separated by a washout ~eriod of four weeks. The experimental infection, induced by intratracheal administration of 5 ml of 10 to 109 cfu/ml of Pasteurella haemolytica, produced a temperature rise, depression and laboured breathing within 6-12 days after inoculation. The concentrations of doxycycline in the serum were determined by a quantitative microbiological assay using an agar-gel diffusion method employing Bacillus cereus var mycoides (ATCC 11778) as the test organism, with a level of detectability of approximately 0.05 ug/ml. The concentration-time curve of doxycycline in the serum after intramuscular injection of 20 mg/kg bodyweight of the long-acting formulation before and after experimental infection was adequately described by a one-compartment open model. The maximum serum concentrations (CmaJ of doxycycline were lower in pneumonic goats than in healthy goats (3.87±0.52 and 5.56±0.213 ug/ml, respectively), suggesting an increased distribution volume in the peripheral compartment. The mean ± SEM absorption rate (ka) before infection (1.13 ± 0.02 h-l) was smaller than that after infection (8.23 ± 3.81 h-l), but the difference was not significant. The apparent elimination half-life (tI/2~) (24.51 ±0.02 h) after infection was significantly increased (p < 0.05), while the corresponding rate constant (p) was decreased (p < 0.01). The absorption half-life (t1/2J (0.137±0.03 h) was significantly decreased (p<0.01) after infection. The distribution volume (Vd(~) was significantly increased after infection (p < 0.05). It is concluded that, although experimental infection had an effect on the disposition kinetics of doxycycline, this was not sufficiently pronounced to require alteration of the dosage during disease

Recurrent outbreaks of Aflatoxin (AF) poisoning in maize continue to exacerbate the food security crisis in Sub-Saharan Africa. This study determined the distribution and contamination levels of Aspergillus spp. and Aflatoxin B1 (AFB1) in soil, maize and maize-based products. Maize grain samples (n=256), semi-processed grain (n=56), flour (n=52), hammer mill dust (n=11), and soil (n=117) were collected during the 2008 and 2009 growing seasons. Aspergillus spp. was isolated and AFB1 was determined by Enzyme-Linked Immunosorbent Assay (ELISA). Aspergillus flavus was frequently isolated in maize samples from the semi-arid regions. The frequency of A. flavus was higher in semi-processed grain than in whole grain and packed flour samples. AFB1 was not detected in samples from the humid regions. AFB1 was detected at levels exceeding the Kenyan legal limit of 10 μg/kg in 20% of the samples, at maximum of 136 μg/kg for semi-processed maize,77 μg/kg for whole grain and 41 μg/kg for flour sold in open bags. The high temperature and periodic drought prevalent in the semi-arid regions could explain the higher levels of A. flavus and AFB1 contamination in that climate. In addition, unfavourable drying and storage practices may aggravate the problem. Therefore, it is recommended that the careful monitoring of AF be continued.

This paper presents data on an assessment of community attitudes toward HIV/AIDS and home based care. The findings indicate that due to inadequate information about the disease and care expectations, people were ambivalent toward the sick and in some instances out-right rejection prevailed. This formed the basis for their preference for institutional based care as opposed to home based care. This was further compounded by the economic status of the household/family. Sheer poverty militates against providing adequate home care in as much as families may be willing to do so. It also confirms that one may perhaps be too taken in by the romanticized idea of unswerving community support. This may further relegate the burden to the primary unit, the family and especially the women who ultimately carry the load with limited resources. This emphasizes the need to initially share the issue with the community in order to work out the mechanisms that will lessen the burden of, and facilitate home care. Training in the care of AIDS patients is crucial yet lacking at the family and community level. Whereas care, counseling and social support are particularly important prerequisites for home-based care, these were conspicuously lacking. Very few caregivers had appropriate training and were worried about their lack of knowledge and yet they had to care for patients. It was evident that they lacked a framework that would provide the capacity to facilitate home care. Such a framework would bridge the gap between the noble concept of home-based care and the realities of home based care.

Kenya's Rift Valley has been undergoing rapid land cover change for the past two decades, which has resulted in ecological and hydrological changes. An effort is under way to quantify the timing and rate of these changes in and around the River Njoro watershed located near the towns of Njoro and Nakuru using remote sensing and geographic information system (GIS) methods. Three Landsat TM images, representing a 17-year period from 1986 to Z003 in which the area underwent a significant land cover transition, were classified and compared with one another. Vegetation diversity and temporal variability, common to tropical and sub-tropical areas, posed several challenges in disaggregating classified data into sub-classes. An iterative approach for the resolving challenges is presented that incorporates unsupervised and supervised classification routines in coordination with knowledge- based spatial analyses. Changes are analysed at three spatial scales ranging from the highly impacted and deforested uplands to the watershed and landscape scales. Land cover transitions primarily occurred after 1995, and included large forest losses coupled with increases in mixed small-scale agriculture and managed pastures and degraded areas. These changes in cover type are highly spatially variable and are theorized to have significant impacts on ecological and hydrologic systems-with implications for environmental sustainability.

Keywords: accuracy assessment. deforestation, Landsat, scale

The Kakamega Forest is the only remaining tropical rainforest fragment in Western Kenya and hosts large numbers of endemic animal and plant species. Protected areas were established decades ago in order to preserve the forest's unique biodiversity from being converted into agricultural land by the regions large number of small-scale farmers. Nonetheless, recent research shows that degradation continues at alarming rates. In this paper we address an important challenge faced by protected area management, namely, the design of a cost-effective incentive scheme that balances local demand for subsistence non-timber forest products against conservation interests. Using primary data collected from 369 randomly selected farm-households we combine a farm-household classification with mathematical programming in order to estimate the opportunity costs of conserving the Kakamega Forest and restricting access to non-timber forest product resources. We validate our model and analyze the impact of changes in major economic frame conditions on our results before we derive recommendations for an improved protected area management in the study region. Our findings suggest that a more flexible approach to determining the price of recently established forest product extraction permits would greatly enhance management efficiency without significantly compromising local wellbeing.

Over the last four decades smallholder agriculture in the Amazon region continuously adapted to changing economic conditions. This had environmental implications on a local and global scale. In order to reduce pressure on the environment as well as poverty through sustainable production, technological innovations need to be ecologically sound, economically viable, and socially acceptable at the same time. Various research activities currently conducted in the Amazon region investigate the potential of alternative technologies for smallholder agriculture. The session presents selected findings of a research project carried out by the Center for Development Research (ZEF), University of Bonn, and its Brazilian partners (Embrapa Amazˆonia Oriental and Federal University of Par´a — NAEA, Bel´em) during the past twelve years. The project developed, tested, and economically evaluated fire-free alternatives to slash-and-burn practices in the eastern Amazon region. The fire-free technologies aim at maintaining the existing fallow system while integrating “modern”, productivity increasing inputs like fertiliser and mechanisation. Fallowing provides important economic and ecological services, such as temporary carbon sequestration and biodiversity conservation, which most technologies for continuous cropping do not accomplish. The presentations first introduce various technologies for smallholders that are currently under investigation. Secondly, a cost-benefit analysis of on-farm trial data highlights the private and social determinants of technology profitability. Moreover, results of a profit function analysis based on representative farm household data reveal the quantitative importance of fallow as a production factor and the role of fertiliser and product prices in production decisions. Finally, the impact of technology adoption on land use and household welfare is assessed in a set of technology and policy simulations using a bio-economic farm-household model including uncertainty. The results indicate that the economic impact of environmental degradation is still too low for many farmers to switch from traditional technologies to more sustainable — but cost and / or labour intensive — technologies without substantial government support. Moreover, institutional frame conditions and infrastructure at the municipal level favour technological innovation in some districts, while holding it back in others. Especially, in the latter areas, cash and liquidity constraints represent the main obstacle to technological innovation among smallholders. Concluding remarks reflect on: 1. the research design and the methodological approaches employed in the project, 2. interdisciplinary research that combines ecological as well as socio-economic aspects, 3. and the need to adopt a broader perspective including technological and institutional innovations to stimulate farmers’ adoption behaviour. Finally, a discussion of implications for policy action that arise from the project findings will open the session to a broader debate.

Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making.

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Transportation infrastructure, such as railways, roads and power lines, contribute to national and regional economic, social and cultural growth and integration. Kenya, with support from the Chinese government, is currently constructing a standard gauge railway (SGR) to support the country’s Vision 2030 development agenda. Although the actual land area affected by the SGR covers only a small proportion along the SGR corridor, a significant proportion of the area supports a wide range of ecologically fragile and important ecosystems in the country, with potential wider impacts. This study used a qualitative content analysis approach to gain an understanding and perceptions of stakeholders on the potential ecological impacts of the interactions between the SGR and the traversed ecological systems in Kenya. Three dominant themes emerged: 1) ecosystem degradation; 2) ecosystem fragmentation; and 3) ecosystem destruction. Ecosystem degradation was the most commonly cited impact at while ecosystem destruction was of the least concern and largely restricted to the physical SGR construction whereas the degradation and fragmentation have a much wider footprint. The construction and operation of the SGR degraded, fragmented and destroyed key ecosystems in the country including water towers, protected areas, community conservancies and wildlife dispersal areas. Therefore, we recommend that project proponents develop sustainable and ecologically sensitive measures to mitigate the key ecosystem impacts.

The main objective of this study was to assess the past and potential future environmental changes, and their impact on the hydrology of the Nzoia catchment. More specifically, the study has analyzed the historical climatic (1962-2004) and land cover changes (1973-2001) that have taken place in the Nzoia River catchment in Kenya, and the effect these have had on the hydrology of the catchment. It has also made use of land cover and climate change scenarios for the future to determine the potential effects these will have on the catchment. The Soil and Water Assessment Tool (SWAT) model was used to investigate the impact of land cover and climatic change on streamflow of the study area. The model was set up using readily available spatial and temporal data, and calibrated against measured daily discharge. The land cover changes within the watershed were examined through classification of satellite images and a land cover change model generated the land cover change scenarios for the year 2020. Climate change scenarios were obtained from general circulation models (GCMs) for the period 2010-2039 (ie 2020s) and 2040-2069 (ie 2050s). The climate change IPCC SRES scenarios A2 and B2 were selected. To this purpose, rainfall and temperature scenarios based on the GCMs CCSR, CSIRO, ECHAM4, GFDL and HADCM3 were superimposed on the calibrated SWAT model.

Mau water catchment and its environs is a very fragile ecosystem whose dynamics exhibits oscillations in magnitude caused mainly by human impacts and other climatic factors. The most recent oscillation was accompanied by excision of the forested catchment by the communities living around, leading to additional decrease in vegetative cover. The main purpose of this study was to determine the relationship between discharge and normalized difference vegetative index over the catchment of interest. Monthly Normalized Difference Vegetative Index (NDVI), discharge and rainfall datasets for the period 1982 and 2000 were used in this study.
Time series of the NDVI, discharge and rainfall were then obtained. In order to determine the relationship between NDVI and discharge correlation analysis was done between the two variables. The relationship between NDVI and rainfall was also determined through correlation analysis.
From the results obtained it was evident that discharge has been relatively constant over time except for a marked increase between 1996 and 1999. NDVI and rainfall had a constant trend throughout the study period. From correlation analysis it is evident that there is no statistically significant relationship between discharge and rainfall. This is explained by the fact that the clearance of vegetation has been compensated by growth of other vegetation types. NDVI only reflects the vigor of vegetation but does not distinguish between vegetation types e.g. tea from forest. NDVI and rainfall only shows a slight relationship when lagged. This is explained by the fact that the NDVI at a region only affects the rainfall forming processes later in the season, though on a very slight scale.
In conclusion, the variability in discharge is thought to be dependent on other catchment parameters e.g. vegetation type, soil type and slope .Rainfall is completely dependent on other synoptic scale parameters e.g. air masses and other mesoscale forcings e.g. Lake Victoria circulation. It should be noted that a statistically significant relationship could be attained only with the use of very high resolution NDVI.

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The objective of the study was assessment and mapping of the community villages in order to rank degree of vulnerabilities to climate change. On sensitivity to vulnerability, the majority of the respondents indicated that it was high (59.6%), medium (16.3%) and low (20.8%).of which on response to exposure to vulnerability, the respondents who indicated high (61.7%), medium (24.2% and low (11.3%).On vulnerabilities in response to adaptive capacity to vulnerability, was high (3.3%), medium (12.5%) and low (81.3%). This study demonstrated that participatory approach of addressing vulnerability to climate change which involved all stakeholders is effective in this dry forested pastoral ecosystem.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

Abstract in Bellamy, M. and B. Greenshields (eds), Issues in Agricultural Development: Sustainability and Cooperation. IAAE Occasional Paper No. 6. Dartmouth Publishing Co. Ltd, Aldershot.

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In this study, we assessed the feasibility of collecting standardized nasal and salivary samples at centers in Nairobi (Kenya), Kigali (Rwanda) and London (UK) using different collection devices and media (Synthetic absorptive matrices versus flocked swabs, and Salimetrics Oral swabs versus whole oral fluid collection). We detected anti Gag (p24) and envelope (gp140) antibodies in both nasal fluid and salivary collections from all HIV-infected individuals, and cross-reactive anti-p24 antibodies were detected in 10% of HIV-uninfected individuals enrolled at one site. Collections from the nasal turbinates were comparable to samples collected deeper in the nasopharyngeal tract, and the yield of anti-p24 IgA in the whole oral fluid samples was higher than in samples collected from the parotid gland. We noted a trend toward reduced levels of anti-HIV antibody in the volunteers receiving anti-retroviral therapy (ART). Levels of antibodies were stable over multiple collection visits. Overall, this study shows that nasal and salivary samples can be collected in a standardized manner over repeated visits in both low and high resource settings. These methods may be used in support of future HIV vaccine clinical trials.

Diabetes mellitus is a predominant public health concern, causing substantial morbidity, mortality, and long-term complications. Many of the conventional drugs used for the management of this disease are not only expensive but also have numerous side effects. Herbal medications are cheaper and locally available. Many plants have been traditionally used to manage diabetes without authentication on their antidiabetic properties and assessment of their safety. In this study aqueous stem bark extract of Ficus sycomorus was assessed for its antidiabetic potential along with evaluation its preliminary in vivo toxicity in alloxan-induced diabetic mice. Results show that the plant harbours remarkable antidiabetic potential. It safely lowered blood glucose level to levels below what insulin, the model drug, lowers, in a dose-dependent manner.

The improvement in income in developing countries has led to emergence of middle and high income consumers in urban centers. Improvement in income usually causes the shift to consumption of non-staples including leafy vegetables. Thus in major developing country urban centers there has been rapid expansion of the grocery sections featuring leafy vegetables in leading retail stores. Specialty stores have also emerged featuring broad range vegetables. Many middle and high income consumers shop these stores. This study examines the willing of the middle and high income consumers who shop specialized stores to pay for quality of leafy vegetables and drivers of willingness to pay for quality. The study uses contingent valuation and the payment card method in eliciting consumers’ WTP. It considers a broad range of quality attributes including safety, nutrition, environmental friendliness, hygiene in handling. The study finds that mean willingness to pay for quality is higher among high income consumers (>60%). It also finds that income, age of children the consumer has, access to information of food safety are among the significant drivers of kale consumers’ willingness to pay for quality of kales. The study concludes that there is demand for quality of leafy vegetables and discusses policy implications.

The improvement in income in developing countries has led to emergence of middle and high income consumers in urban centers. Improvement in income usually causes the shift to consumption of non-staples including leafy vegetables. Thus in major developing country urban centers there has been rapid expansion of the grocery sections featuring leafy vegetables in leading retail stores. Specialty stores have also emerged featuring broad range vegetables. Many middle and high income consumers shop these stores. This study examines the willing of the middle and high income consumers who shop specialized stores to pay for quality of leafy vegetables and drivers of willingness to pay for quality. The study uses contingent valuation and the payment card method in eliciting consumers’ WTP. It considers a broad range of quality attributes including safety, nutrition, environmental friendliness, hygiene in handling. The study finds that mean willingness to pay for quality is higher among high income consumers (>60%). It also finds that income, age of children the consumer has, access to information of food safety are among the significant drivers of kale consumers’ willingness to pay for quality of kales. The study concludes that there is demand for quality of leafy vegetables and discusses policy implications.

The Upper Athi River sub-catchment area has experienced exponential growth of human population since the turn of the century. This has led to establishment of satellite towns such as Ngong, Kiserian, Ongata Rongai, Mlolongo, Kitengela and Ruai. These towns have either no or inadequate supply of water from the local governments, that is, Kajiado, Machakos and Nairobi. Communities in this area of study have therefore resorted to obtaining ground water through drilling boreholes and digging shallow wells for their domestic needs. This is done without proper information on whether the water meets quality standards set out by Kenya Bureau of Standards (KEBS). This study therefore sought to assess the water quality in this area to determine whether ground water meets these standards. It also compared these levels of dissolved ions and coliforms to those of river water in the recharge area of the Upper Athi sub-catchment area. Twenty one water samples comprising of eleven boreholes, five shallow wells and five river water samples were collected from the Upper Athi sub-catchment area in the months of December 2011 which was a dry month and in May 2012 which was a wet month. The samples were analysed for dissolved ions and microbial coliforms. The metal ions analysed included Ca, Cd, Cr, Cu, Fe, Mg, Mn, Na, Pb and Zn while anions included Cl-, CO32-/HCO3-, F-, NO2-/NO3- and SO42- as well as faecal coliforms. Physical parameters analysed included pH, electrical conductivity (EC) turbidity, total dissolved solids and colour. The analysis of cations was carried out using atomic absorption spectrophotometry while chlorides and total alkalinity were analysed using titrimetric method. Levels of fluoride and nitrate were analysed using ion selective electrodes, sulphate using gravimetric method and microbial coliforms using lactose broth methods. The results showed that levels of dissolved ions in ground water were higher than in surface water while surface water had higher number of faecal coliforms. The high levels of dissolved ions in ground water was attributed to the geology of area while high levels of iron and faecal coliforms in river water samples was attributed to anthropogenic activities The results from the samples analyzed show that pH of boreholes and shallow wells (ground water) water was higher than that of river water (surface water). pH levels ranged from 7.16±0.003 - 9.34±0.004 for ground water and 7.24±0.002-8.00±0.003 for surface water. Electrical conductivity was also higher in ground water ranging from 669±0.002μS/cm-1568±0.004μS/cm while that of surface water ranged from 382±0.003μS/cm-1202±0.002μS/cm at Magadi road. Turbidity was vi higher for surface water than that of ground water ranging from 74.3±0.004 NTU- 95.4±0.003 NTU and below detection limits (BDL) levels for ground water with the exception being borehole at Athi Primary school which had turbidity of 18.6±0.03 NTU. Colour was high for surface water ranging from 159±0.002 c.u to 343±.004 c.u while that of ground water ranged from 1.5±0.003 51.2±0.004 c.u in borehole 5 located at Athi Primary School. Total Dissolved Solids were higher in ground water ranging from 231.68.00±0.003mg/l - 1003.52±0.004mg/l in shallow well located at near Brookshine School, Kangundo road while that of surface water ranged from 244.48±0.002mg/l-769.28±0.003mg/l. From the chemical parameters analysis, fluorides were significantly higher in ground water ranging from 0.37±0.003 to 9.36±0.002 ppm at Mlolongo which exceeded the KEBS limits for drinking water of 1.5ppm. Iron levels were higher in river water samples ranging from 2.11±0.002 to 18.401±0.003 ppm at Kangundo Road Bridge. Even though ground water had lower levels of iron that river water, it ranged from <0.001ppm to 1.93ppm against the 0.3ppm recommended by KEBS. Lead levels in ground water ranged from <0.001ppm to 2.64ppm at borehole BH4 located at Brookshine School. This was way above the recommended levels of 0.03ppm by KEBS. The levels of microbial coliforms were higher in river water ranging from 140-294 c.f.u/100ml during the dry month of December 2011 and 156-309 c.f.u/100ml during the wet month of May 2012. Ground water recorded coliforms ranging from zero to 40 c.f.u/100ml. Within the ground water system shallow wells had a higher count of coliforms than in boreholes. The high levels of fluorides have led to increased cases of dental fluorosis especially among young children in the area of study. Adults are at risk on increased bone fractures in their lifetime. High levels of lead in some ground water could lead to mental retardation since lead is a very toxic metal even at very low levels. There is therefore need to develop a long-term plan of providing safe drinking water by the county governments. There is also the need to establish regulations that require private water vendors and water companies to invest in water treatment plants that reduce levels of dissolved ions in ground water before distributing the water to local communities

Description
The Upper Athi River sub-catchment area has experienced exponential growth of human population since the turn of the century. This has led to establishment of satellite towns such as Ngong, Kiserian, Ongata Rongai, Mlolongo, Kitengela and Ruai. These towns have either no or inadequate supply of water from the local governments, that is, Kajiado, Machakos and Nairobi. Communities in this area of study have therefore resorted to obtaining ground water through drilling boreholes and digging shallow wells for their domestic needs. This is done without proper information on whether the water meets quality standards set out by Kenya Bureau of Standards (KEBS). This study therefore sought to assess the water quality in this area to determine whether ground water meets these standards. It also compared these levels of dissolved ions and coliforms to those of river water in the recharge area of the Upper Athi sub-catchment area. Twenty one water samples comprising of eleven boreholes, five shallow wells and five river water samples were collected from the Upper Athi sub-catchment area in the months of December 2011 which was a dry month and in May 2012 which was a wet month. The samples were analysed for dissolved ions and microbial coliforms. The metal ions analysed included Ca, Cd, Cr, Cu, Fe, Mg, Mn, Na, Pb and Zn while anions included Cl-, CO32-/HCO3-, F-, NO2-/NO3- and SO42- as well as faecal coliforms. Physical parameters analysed included pH, electrical conductivity (EC) turbidity, total dissolved solids and colour. The analysis of cations was carried out using atomic absorption spectrophotometry while chlorides …

Thirty percent of residents in Nairobi practise urban agriculture (UA) with a majority of the farmers using untreated sewage to irrigate crop and fodder. Due to the environmental and health risks associated with wastewater irrigation, a study was carried out in partnership with farmers in Kibera and Maili Saba which are informal settlements along the Ngong River, a tributary of the Nairobi River Basin. Soil, water, crops and human faecal samples from the farming and non-farming households were analysed to elucidate sources, types and level of heavy metal pollutants in the wastewater and the pathogen loads in humans and vegetable crops. Heavy metal accumulation in soils collected from Kibera and Maili Saba were Cd (14.3 mg kg-1), Cr (9.7 mg kg-1) and Pb (1.7 mg kg-1) and Cd (98.7 mg kg-1), Cr (4.0 mg kg-1) and Pb (74.3 mg kg-1), respectively. This led to high phytoaccumulation of Cd, Cr and Pb in the crops that exceeded the maximum permissible limits. No parasitic eggs were detected in the vegetables but coliform count in the wastewater was 4.8 x108±2.2 x1011/100ml. Soils irrigated with this water had parasitic eggs and non-parasitic larvae counts of 54.62 and 27.5/kg respectively. Faecal coliform and parasitic eggs of common intestinal parasites increased in leafy vegetable sampled from the informal markets along the value chain.

The study was carried out to assess how farmers in Kyuso District have adapted to the effects of climate change. Survey data was collected from 246 farmers from six locations that were sampled out through a multistage and simple random sampling procedure. The probit regression model was fitted into the data in order to assess factors influencing farmers’ adaptation to the effects of climate change. The analysis revealed that 85% of the farmers had adapted in various ways to the effects of climate change. In this regard, the age of the farmer, gender, education, farming experience, farm income, access to climate information, household size, local agro-ecology, distance to input/output market, access to credit, access to water for irrigation, precipitation and temperature were found to have significant influence on the probability of farmers to adapt to climate change. The study suggests that more policy efforts should thus be geared towards helping all the farmers in the district to adapt to climate change.

ABSTRACT
Background: An accurate estimation of renal function in children is important in optimising the dose of many drugs used in paediatric oncology for allows clinical monitoring of the nephrotoxic effects of cytotoxic agents such as cisplatin. The glomerular filtration rate (GFR) is widely accepted as the best index of renal function in patients. Chemotherapy is the mainstay of treatment in the paediatric oncology unit at the Kenyatta National Hospital.
Objectives: To determine the glomerular filtration rate profiles of paediatric oncology patients and to assess changes that had occured over a period of at least six months of continuing cancer chemotherapy.
Design: Cross-sectional hospital based survey.
Setting: General Paediatric wards, including Paediatric Oncology and Paediatric Ophthalmology ward. Kenyatta National Hospital, Nairobi, Kenya.
Subjects: Paediatric patients who had an established diagnosis of cancer and had been on chemotherapy for at least six months.
Results: Out of the 115 children enrolled in the study 43 had abnormal kidney function. This gave a prevalence of 37% (95%CI 28-46).The other 72 children had normal kidney function. Patients aged less than five years and those with solid tumors had a higher likelihood of having an abnormal GFR compared to their older counterparts and those with lymphomas and leukemias
Conclusions: Monitoring of GFR should be done regularly as decline occurs as one continues on chemotherapy especially for the ones below 5yrs and those with solid malignancies.

An evaluation of the performance of Napier grass (Pennisetum purpureum) cultivars Kakamega-I (ILRI accession No. 16971), Kakamega-II (ILRI accession No. 16978) and Muguga Bana was carried out in the Lower Highland Zone 3 (LH3) at KARI-Muguga South, Central Kenya. Kakamega-I has been shown to be resistant to Napier grass head smut disease while Muguga Bana is susceptible but popular in Central Kenya. The varieties were planted in a Complete Randomised Design (CRD) without application of manure or fertiliser. Dry matter yields (DM), leaf to stem ratio and tiller numbers were recorded for six consecutive harvests. Growth rates were measured during the fourth, fifth and sixth ratoon (regrowths). The varieties produced similar (P > 0.05) number of tillers but differed in the tiller heights and subsequent growth rates. Kakamega-I produced significantly the tallest tillers and had the highest growth rate followed by Kakamega-II and Muguga Bana respectively. Cumulative DM yields (t/ha) for six harvests was highest for Kakamega-I (68.3 t/ha). Leaf to stem ratio was higher for Muguga Bana (4.98) than both Kakamega-I and Kakamega-II, which were similar in this aspect (2.49 and 3.32). The higher dry matter yields in Kakamega-I was attributed to the faster growth rate than the other varieties.

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The aim of this study was to assess and validate the herbal anthelmintic remedies used by farmers in
Kirinyaga county, Kenya for the treatment of their cattle against gastrointestinal nematodes. The herbs
used were identified via questionnaire surveys through focused group discussions. The aqueous
extracts of plants used: Aspillia pluriseta, Vernonia lasiopus, Entada leptostachya and Erythrina
abyssinica were prepared and using dosage between 10 and 30%, the viability of infective strongyle
larvae were assessed for a period of 48 h. The results of the in vitro antihelmintic study indicated a high
to moderate anthelmintic activity for the tested extracts. E. leptostachya exhibited the highest in vitro
anthelmintic activity, while E. abyssinica had the lowest activity. The anthelmintic activity may have
been due to the presence of saponins in the herbal remedies. There was a positive correlation between
the saponin concentration and the anthelmintic activity of the extracts. In general, the in vitro
anthelmintic activity increased with the extract concentration for the medicinal plants examined.

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There are four hypotheses which have been advanced to explain the pathophysiology of severe and complicated malaria such as cerebral malaria. However, none of them adequately explains all the features of cerebral malaria in man. One such hypotheses is Disseminated Intravascular Coagulation (DIC). To determine whether this condition occurs in patients with uncomplicated malaria, the authors conducted a study on fibrinogen and its degradation products, euglobulin lysis time and parasite counts in 30 cases of uncomplicated malaria. By spectrophotometric method, plasma fibrinogen in patients with uncomplicated malaria was found to be normal as compared to normal healthy adults. There were no fibrinogen degradation production (FDP) detected in either patients or healthy controls, using latex agglutination tests at a dilution of 1:5. This method for FDP estimation is significant in that a serum agglutination with 1:5 dilution indicates a concentration of FDP in the original serum in excess of 10g/ml, designated as positive results of experiment. High values of euglobulin lysis time (ELT) were noted in patients with low parasitaemia. Analysis of these results showed that disseminated intravascular coagulation did not occur in uncomplicated cases of malaria. In this study on cases of uncomplicated malaria and low parasitaemia the biochemical parameters relating to to DIC have been essentially normal, although DIC is thought to be a primary stage in the development of cerebral malaria. According to Reid, DIC is an important intermediate mechanism in the pathophysiology of severe and complicated malaria such as cerebral malaria.

Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi. Four hundred and thirty six pupils in two primary schools in Kibwezi, Kenya aged between seven and sixteen years and positive for S. mansoni were treated as follows: 320 pupils with a single dose of praziquantel at 40 mg/kg body weight and 116 controls with a placebo. Immediate and delayed side effects of praziquantel were observed. The main side-effects were abdominal pain (36.3%), headache (35.3%) and nausea (13.1%). There was correlation between frequencies of these side-effects and intensity of infection measured as eggs per gram of faeces. Other side-effects included dizziness (9.7%), fever (7.8%), urticaria and bloody diarrhoea. Overall, the side-effects of praziquantel were mild and transient, and did not require any intervention. For ethical reasons, all pupils who served as controls were treated with praziquantel after the study. PMID: 8898462 [PubMed - indexed for MEDLINE]

Abstract
INTRODUCTION:
Competence in neonatal resuscitation, which represents the most urgent pediatric clinical situation, is critical in delivery rooms to ensure safety and health of newly born infants. The challenges experienced by health care providers during this procedure are unique due to different causes of cardio respiratory arrest. This study aimed at assessing the knowledge of health providers on neonatal resuscitation.
METHODS:
Data were gathered among 192 health providers drawn from all counties of Kenya. The clinicians were asked to complete questionnaires which were in two parts as; demographic information and assessment of their knowledge by different scenarios which were formatted in the multiple choice questions. Data were analyzed using SPSS version 15.0 for windows. The results are presented using tables.
RESULTS:
All the participants were aged 23 years and above with at least a certificate training. Most medical providers had heard of neonatal resuscitation (85.4%) with only 23 receiving formal training. The average duration of neonatal training was 3 hours with 50% having missed out on practical exposure. When asked on steps of resuscitation, only 68 (35.4%) of the participants scored above 85%. More than 70% of them considered their knowledge about neonatal resuscitation inadequate and blamed it on inadequate medical training programs.
CONCLUSION:
Health providers, as the key personnel in the management of neonatal resuscitation, in this survey seem to have inadequate training and knowledge on this subject. Increasing the duration and quality of formal training should be considered during the pre-service medical education to ensure acceptable neonatal outcome.

Competence in neonatal resuscitation, which represents the most urgent pediatric clinical situation, is critical in delivery rooms to ensure safety and health of newly born infants. The challenges experienced by health care providers during this procedure are unique due to different causes of cardio respiratory arrest. This study aimed at assessing the knowledge of health providers on neonatal resuscitation.

The main concern of this paper is to assess the marketing of horticultural produce in Kenya. In 1950 the Horticultural Cooperative Union (HCU) was organized to help mostly European farmers to market fruit and vegetables. The HCU has been faced with some financial problems, mainly due to loss in customers and inactive members. The HCU shares about 15 to 20 % of the total Kenya exports. There are some producers-exporters specialized in exporting flowers and some commodities like French beans, pineapples and capsicum. The climatical conditions and ecological zones are good, enabling many fruit and vegetables to be produced in Kenya. The major export products are flowers, pineapples, French beans, capsicum and fresh fruits. The trade channels are mainly directed to the British market, which is dominant with a share of 50.64 % in 1982 and European markets (mainly West Germany, having a market share of 15.5 % in 1982 and France with a market share of 12.20 % for the same year 1982). In 1974 the main export to West Germany was pineapple which amounted to 24.9 % of all fresh produce imported from Kenya, second was capsicums with 10.8 %. Kenya fresh fruit and vegetables show a high demand on European markets. This market is a very competitive one. The countries in the Mediterranean region and in the tropical equatorial part of the African Continent pose a challenging position to this market. There is free entry and free exit to this market. When Kenya wants to have a sizable share of this market also in the future, it has to maintain a high quality at a reasonable price. This means that quality control, proper packaging and efficient transportation to the market have to be improved. The smallholders need to be supported when entering the market and need close advisory in order to supply high quality produce. Kenya should be willing to invest in areas like market research, market intelligence and export promotion. In addition the local consumption of fruit and vegetables should be encouraged as a part of the National Food Policy Program.

A double antibody enzyme linked immunosorbent assay for identification of thermostable muscle antigens of autoclaved meat samples is described. The assay differentiates heterologous thermostable muscle antigens from homologous at P 0.001. In model meat mixtures, the assay detects adulterants at the level of 1% at p0.001 even in phylogenetically related species such as buffalo and cattle.

Scenarios of past, present and intermediate future climates for Sondu River basin were analysed in this study to evaluate the potential changes in hydrologically relevant rainfall statistics that are likely to be observed by the middle of this century as a result of climate change. These climate scenarios were developed by applying dynamical downscaling of the relatively course resolution climate scenarios simulated by the fourth generation coupled Ocean-Atmosphere European Community Hamburg Model (ECHAM4) using the Providing Regional Climates for Impacts Studies (PRECIS) modelling system. The regional climate scenarios, which were available at a daily time-step and a spatial grid resolution of 0.5˚ over the Eastern Africa region, were matched to the Sondu river basin in the western region of Kenya. The possible hydrological impacts of climate change were assessed by applying the scenarios in a daily time-step hydrological model. The analysis of hydrologically relevant rainfall statistics focussed on determining changes in rainfall patterns and the likely hydrological implications to the basin. The results indicated that more rainfall is projected for the region in the immediate and intermediate future in form of increased seasonal rainfall during the December-January-February (DJF), March-April-May (MAM) and September-October-November (SON) seasons resulting from increased number of days of rainfall and higher probabilities of a wet day following a dry day in a month. Based on these scenarios, the combination of the wetter antecedent conditions and the more rain days in a month will result in more surface runoff being generated which will not only have implications on the water balance but also the water quality in the basin.

Key Words: climate change, climate scenarios, climate modelling, climate downscaling, Sondu Basin, Kenya

Scenarios of past, present and intermediate future climates for Sondu River basin were analysed in this study to evaluate the potential changes in hydrologically relevant rainfall statistics that are likely to be observed by the middle of this century as a result of climate change. These climate scenarios were developed by applying dynamical downscaling of the relatively course resolution climate scenarios simulated by the fourth generation coupled Ocean-Atmosphere European Community Hamburg Model (ECHAM4) using the Providing Regional Climates for Impacts Studies (PRECIS) modelling system. The regional climate scenarios, which were available at a daily time-step and a spatial grid resolution of 0.5 over the Eastern Africa region, were matched to the Sondu river basin in the western region of Kenya. The possible hydrological impacts of climate change were assessed by applying the scenarios in a daily time-step hydrological model. The analysis of hydrologically relevant rainfall statistics focussed on determining changes in rainfall patterns and the likely hydrological implications to the basin. The results indicated that more rainfall is projected for the region in the immediate and intermediate future in form of increased seasonal rainfall during the December-January-February (DJF), March-April-May (MAM) and September-October-November (SON) seasons resulting from increased number of days of rainfall and higher probabilities of a wet day following a dry day in a month.

Abstract
Scenarios of past, present and intermediate future climates for Sondu River basin were analysed in this study to evaluate the potential changes in hydrologically relevant rainfall statistics that are likely to be observed by the middle of this century as a result of climate change. These climate scenarios were developed by applying dynamical downscaling of the relatively course resolution climate scenarios simulated by the fourth generation coupled Ocean-Atmosphere European Community Hamburg Model (ECHAM4) using the Providing Regional Climates for Impacts Studies (PRECIS) modelling system. The regional climate scenarios, which were available at a daily time-step and a spatial grid resolution of 0.5˚ over the Eastern Africa region, were matched to the Sondu river basin in the western region of Kenya. The possible hydrological impacts of climate change were assessed by applying the scenarios in a daily time-step hydrological model. The analysis of hydrologically relevant rainfall statistics focussed on determining changes in rainfall patterns and the likely hydrological implications to the basin. The results indicated that more rainfall is projected for the region in the immediate and intermediate future in form of increased seasonal rainfall during the December-January-February (DJF), March-April-May (MAM) and September-October-November (SON) seasons resulting from increased number of days of rainfall and higher probabilities of a wet day following a dry day in a month. Based on these scenarios, the combination of the wetter antecedent conditions and the more rain days in a month will result in more surface runoff being generated which will not only have implications on the water balance but also the water quality in the basin.
Key Words: climate change, climate scenarios, climate modelling, climate downscaling, Sondu Basin, Kenya

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The microbiological quality of ground water (boreholes) and domestic tanks in five locations of Kikuyu Division, Kiambu District, was determined. Two boreholes and twelve domestic tanks were sampled from each location. Seven (70%) out of 10 boreholes were contaminated with faecal coliforms. Total bacterial counts ranged from 1 to 6280 per ml of water while the coliform counts ranged from 0 to 161. Out of 70 water samples screened for faecal coliforms, 63 (90%) were positive. Faecal Streptococci were isolated in 71% of the samples.

The microbiological quality of ground water (boreholes) and domestic tanks in five locations of Kikuyu Division, Kiambu District, was determined. Two boreholes and twelve domestic tanks were sampled from each location. Seven (70%) out of 10 boreholes were contaminated with faecal coliforms. Total bacterial counts ranged from 1 to 6280 per ml of water while the coliform counts ranged from 0 to 161. Out of 70 water samples screened for faecal coliforms, 63 (90%) were positive. Faecal Streptococci were isolated in 71% of the samples.

The microbiological quality of ground water (boreholes) and domestic tanks in five locations of Kikuyu Division, Kiambu District, was determined. Two boreholes and twelve domestic tanks were sampled from each location. Seven (70%) out of 10 boreholes were contaminated with faecal coliforms. Total bacterial counts ranged from 1 to 6280 per ml of water while the coliform counts ranged from 0 to 161. Out of 70 water samples screened for faecal coliforms, 63 (90%) were positive. Faecal Streptococci were isolated in 71% of the samples.

The microbiological quality of ground water (boreholes) and domestic tanks in five locations of Kikuyu Division, Kiambu District, was determined. Two boreholes and twelve domestic tanks were sampled from each location. Seven (70%) out of 10 boreholes were contaminated with faecal coliforms. Total bacterial counts ranged from 1 to 6280 per ml of water while the coliform counts ranged from 0 to 161. Out of 70 water samples screened for faecal coliforms, 63 (90%) were positive. Faecal Streptococci were isolated in 71% of the samples.

The microbiological quality of ground water (boreholes) and domestic tanks in five locations of Kikuyu Division, Kiambu District, was determined. Two boreholes and twelve domestic tanks were sampled from each location. Seven (70%) out of 10 boreholes were contaminated with faecal coliforms. Total bacterial counts ranged from 1 to 6280 per ml of water while the coliform counts ranged from 0 to 161. Out of 70 water samples screened for faecal coliforms, 63 (90%) were positive. Faecal Streptococci were isolated in 71% of the samples.

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BACKGROUND: Diabetes Mellitus is a common and demanding health related problem that has a wide effect on every day’s life of the patients. It can have a profound effect on quality of life in terms of social and psychological well-being as well as physical ill-health. It is one of the most psychologically demanding of the chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment.
OBJECTIVE: To Assess the perceived Health-related quality of life of diabetic patients not on insulin therapy using the WHOQoL-Bref (World Health Organization Quality of Life – Brief).
STUDY DESIGN: This was a cross-sectional study.
STUDY SITE: The study was conducted on patients attending the Diabetic clinic at Kenyatta National Hospital.
RESULTS: Study recruited 139 patients with type2 diabetes not on insulin therapy. The study population was predominantly female (61%) , majority were 40-60yrs, having had diabetes for less than 5yrs, 75% having more than one complication. Most (75%) of the study participants were poorly controlled with HbA1C mean score of 8.04% .Majority of the study participants( 84%) achieved a good score on the HRQoL scale using the WHOQoL-Bref tool. The determinants of HRQoL in our study were: age of study participants, duration of diabetes, presence of complications and income related factors. Age of the study subjects had significant association only in the social domain of HRQoL with a p-value of 0.037. Level of income had a significant association with overall HRQoL score (p-value of 0.029), psychological domain (p value of 0.023) and in the social domain (p-value of 0.029). Health care financing was significantly associated with psychological domain (p-value 0.006) and environmental domain (p-value 0f 0.04) and overall score (p-value 0.011). There was an association between employment status and HRQoL. Having a job improved the scores in physical domain (p-value of 0.013) and social domain (p value of 0.020). Duration with diabetes had significant association with physical domain where the p value was 0.007. The HRQoL of the study subjects was associated significantly with the number of complications. Indeed the association of complications with the HRQoL involved physical domain (p-value of <0.0001) and psychological domain (p-value of 0.041) which directly impacted on the overall total score (p value of 0.041).
CONCLUSION: The results of this study show that diabetes affected HRQoL of our study participants. There is a need for interventions programs to improve glycemic control and inclusion of HRQoL assessment as part of patients on follow up. Age and duration of disease are not modifiable but complications can be reduced by better health care initiaves. Income-related factors can be modifiable through poverty alleviation and pooled health care financing.

BACKGROUND: Diabetes Mellitus is a common and demanding health related problem that has a wide effect on every day’s life of the patients. It can have a profound effect on quality of life in terms of social and psychological well-being as well as physical ill-health. It is one of the most psychologically demanding of the chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment.
OBJECTIVE: To Assess the perceived Health-related quality of life of diabetic patients not on insulin therapy using the WHOQoL-Bref (World Health Organization Quality of Life – Brief).
STUDY DESIGN: This was a cross-sectional study.
STUDY SITE: The study was conducted on patients attending the Diabetic clinic at Kenyatta National Hospital.
RESULTS: Study recruited 139 patients with type2 diabetes not on insulin therapy. The study population was predominantly female (61%) , majority were 40-60yrs, having had diabetes for less than 5yrs, 75% having more than one complication. Most (75%) of the study participants were poorly controlled with HbA1C mean score of 8.04% .Majority of the study participants( 84%) achieved a good score on the HRQoL scale using the WHOQoL-Bref tool. The determinants of HRQoL in our study were: age of study participants, duration of diabetes, presence of complications and income related factors. Age of the study subjects had significant association only in the social domain of HRQoL with a p-value of 0.037. Level of income had a significant association with overall HRQoL score (p-value of 0.029), psychological domain (p value of 0.023) and in the social domain (p-value of 0.029). Health care financing was significantly associated with psychological domain (p-value 0.006) and environmental domain (p-value 0f 0.04) and overall score (p-value 0.011). There was an association between employment status and HRQoL. Having a job improved the scores in physical domain (p-value of 0.013) and social domain (p value of 0.020). Duration with diabetes had significant association with physical domain where the p value was 0.007. The HRQoL of the study subjects was associated significantly with the number of complications. Indeed the association of complications with the HRQoL involved physical domain (p-value of <0.0001) and psychological domain (p-value of 0.041) which directly impacted on the overall total score (p value of 0.041).
CONCLUSION: The results of this study show that diabetes affected HRQoL of our study participants. There is a need for interventions programs to improve glycemic control and inclusion of HRQoL assessment as part of patients on follow up. Age and duration of disease are not modifiable but complications can be reduced by better health care initiaves. Income-related factors can be modifiable through poverty alleviation and pooled health care financing.

BACKGROUND: Diabetes Mellitus is a common and demanding health related problem that has a wide effect on every day’s life of the patients. It can have a profound effect on quality of life in terms of social and psychological well-being as well as physical ill-health. It is one of the most psychologically demanding of the chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment.
OBJECTIVE: To Assess the perceived Health-related quality of life of diabetic patients not on insulin therapy using the WHOQoL-Bref (World Health Organization Quality of Life – Brief).
STUDY DESIGN: This was a cross-sectional study.
STUDY SITE: The study was conducted on patients attending the Diabetic clinic at Kenyatta National Hospital.
RESULTS: Study recruited 139 patients with type2 diabetes not on insulin therapy. The study population was predominantly female (61%) , majority were 40-60yrs, having had diabetes for less than 5yrs, 75% having more than one complication. Most (75%) of the study participants were poorly controlled with HbA1C mean score of 8.04% .Majority of the study participants( 84%) achieved a good score on the HRQoL scale using the WHOQoL-Bref tool. The determinants of HRQoL in our study were: age of study participants, duration of diabetes, presence of complications and income related factors. Age of the study subjects had significant association only in the social domain of HRQoL with a p-value of 0.037. Level of income had a significant association with overall HRQoL score (p-value of 0.029), psychological domain (p value of 0.023) and in the social domain (p-value of 0.029). Health care financing was significantly associated with psychological domain (p-value 0.006) and environmental domain (p-value 0f 0.04) and overall score (p-value 0.011). There was an association between employment status and HRQoL. Having a job improved the scores in physical domain (p-value of 0.013) and social domain (p value of 0.020). Duration with diabetes had significant association with physical domain where the p value was 0.007. The HRQoL of the study subjects was associated significantly with the number of complications. Indeed the association of complications with the HRQoL involved physical domain (p-value of <0.0001) and psychological domain (p-value of 0.041) which directly impacted on the overall total score (p value of 0.041).
CONCLUSION: The results of this study show that diabetes affected HRQoL of our study participants. There is a need for interventions programs to improve glycemic control and inclusion of HRQoL assessment as part of patients on follow up. Age and duration of disease are not modifiable but complications can be reduced by better health care initiaves. Income-related factors can be modifiable through poverty alleviation and pooled health care financing.

One of the sources of feacal contamination of rainwater harvested from roofs is wind-blown dust containing particulate matter from animal faeces, or through direct defecation. Since the primary habitat for Escherichia coli (E.coli) is the gastro-intestinal tract of mammals and birds (Atlas 1984), it\'s a good indictor of feacal contamination (Hazen, 1988). This study aimed to investigate the presence of E.coli. In rainwater samples collected from roofs in some areas around Nairobi, which have different levels of livestock density. Forty four of the 89 samples collected tested positive for the presence of E.coli from Ngong Division, which had a cattle density of 1446 per square Kilometre was, 55%, but it was not significantly different from both Kikuyu Division: cattle density of 166; both of which had 34% of the samples testing positive to E.coli (p=0.3094). It was concluded that rain water harvested from roofs for human consumption in the study area should be treated before use.

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A prophylactic HIV-1 vaccine is a global health priority.

Description
The monitoring of water quality for both domestic and commercial use is absolutely essential for policy formulation that affects both public and environmental health. This study investigates the quality of water of river Molo system which lies in the Kenyan Rift Valley. The river is considered a vital source of water for the residents and industrial activities in Nakuru and Baringo Counties. Six water samples were collected during the dry season of December 2017. Various physicochemical parameters were determined in situ by use of a portable pH meter. These parameters included pH, temperature, electrical conductivity and total dissolved solids (TDS). Anions such as fluorides, sulfates, phosphates, nitrates, chlorides, carbonates and bicarbonates were determined using conventional methods such as titrimetry and (ultra-violet visible) UV–Vis techniques. The cations including sodium, potassium, calcium and …
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The objective of this study was to apply Data Mining in the analysis of imports of pharmaceutical products in Kenya with the aim of discovering patterns of association and correlation among the various product groups. The RapidMiner Data Mining was used to analyze data obtained from the Pharmacy and Poison Board, the regulator of pharmaceutical products in the country, covering the period 2008 to 2010. The CRISP method was used to get a business understanding of the Board, understand the nature of the data held, prepare the data for analyze and actual analysis of the data. The results of the study discovered various patterns through correlation and association analysis of various product groups. The results were presented through various graphs and discussed with the domain experts.These patterns are similar to prescription patterns from studies in Ethiopia, Nigeria and India. The research will provide regulators of pharmaceutical products, not only in Kenya but other African countries, a better insight into the patterns of imports and exports of pharmaceutical products. This would result into better controls, not only in import and exports of the products, but also enforcement on their usage in order to avert negative effects to the citizens.

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Few studies have examined the association between self-reported sexual risk behaviors and biologic outcomes in human immunodeficiency virus (HIV)-1-seropositive African adults.

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

Vaginal washing has been associated with reductions in cultivable and an increased risk of both bacterial vaginosis (BV) and HIV infection. The effect of vaginal washing on the quantity of individual species is not well characterised. This analysis tested the hypothesis that vaginal washing would be associated with a lower likelihood of spp. detected by both culture and quantitative PCR (qPCR).

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Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and neurosurgical management of VEDH.

Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.

Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression.Methods. HIV-1-seropositive women were enrolled during pregnancy and received short-course zidovudine. HIV-1 RNA levels and CD4 cell counts were determined at baseline and at months 1, 3, 6, 12, 18, and 24 postpartum and were compared between breast-feeding and formula-feeding mothers.Results. Of 296 women, 98 formula fed and 198 breast-fed. At baseline, formula-feeding women had a higher education level and prevalence of HIV-1-related illness than did breast-feeding women; however, the groups did not differ with respect to CD4 cell counts and HIV-1 RNA levels. Between months 1 and 24 postpartum, CD4 cell counts decreased 3.9 cells/ mu L/month (P<.001), HIV-1 RNA levels increased 0.005 log(10) copies/mL/month (P=.03), and body mass index (BMI) decreased 0.03 kg/m(2)/month (P<.001). The rate of CD4 cell count decline was higher in breast-feeding mothers (7.2 cells/ mu L/month) than in mothers who never breast-fed (4.0 cells/ mu L/month) (P=.01). BMI decreased more rapidly in breast-feeding women (P=.04), whereas HIV-1 RNA levels and mortality did not differ significantly between breast-feeding and formula-feeding women.Conclusions. Breast-feeding was associated with significant decreases in CD4 cell counts and BMI. HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection.

Bacterial vaginosis (BV) is highly prevalent among African women and has been associated with adverse pregnancy outcomes, sexually transmitted diseases, and HIV-1.

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