To adapt a validated instrument that quantitatively measures stigma among English/Swahili speaking TB (tuberculosis) patients in Kenya, a high burden TB country.

The aim of this study was to determine suitability zones of future banana growth under a changing climate to guide the design of future adaptation options in the banana sub-sector of Uganda. The study used high resolution (~1 km) data on combined bioclimatic variables (rainfall and temperature) to map suitability zones of the banana crop while the Providing Regional Climate for Impacts Studies (PRECIS) regional climate model temperature simulations were used to estimate the effect of rising temperature on banana growth assuming other factors constant. The downscaled future climate projections were based on the Intergovernmental Panel on Climate Change (IPCC) Representative Concentration Pathways (RCPs, 2.6, 4.5, 6.0 and 8.5) and Special Report on Emission Scenarios (SRES, A1B and A2) across the period 2011–2090. The methodology involved identification of banana-climate growth thresholds and developing suitability indices for banana production under the high mitigation (RCP 2.6, less adaptation), medium mitigation (RCP 4.5 and RCP 6.0, medium adaptation), no mitigation (RCP 8.5, very high adaptation) scenarios, SRES A1B and A2 scenarios. The FAO ECO-Crop tool was used to determine and map future suitability of banana growth. Banana production indices were determined using a suitability model in the Geographical Information System (GIS) spatial analyst tool. The non-linear banana-temperature regression model was used to assess the impact of future changes in temperature on banana growth. The results revealed unique and distinct banana production suitability and growth patterns for each climate scenario in the sub-periods. RCPs 2.6 and 6.5 are likely to be associated with higher levels of banana production than RCPs 4.5 and 8.5. The results further showed that projected temperature increase under SRES A1B will promote banana growth. In contrast, expected increases in temperatures under SRES A2 are likely to retard banana growth due to high moisture deficits. There is need to develop adaptation option for farming communities to maximize their agricultural production and incomes. The effectiveness of adaptation options needed to combat the impacts will be influenced by the magnitude of the expected climatic changes associated with each scenario, the timing of expected climate change extremes and sensitivity of the crop to climate. This study has provided critical information that will be useful for planning integrated adaptation practices in the banana farming subsector to promote productivity.

The aim of this study was to determine suitability zones of future banana growth under a changing climate to guide the design of future adaptation options in the banana sub-sector of Uganda. The study used high resolution (~ 1km) data on combined bioclimatic variables (rainfall and temperature) to map suitability zones of the banana crop while the Providing Regional Climate for Impacts Studies (PRECIS) regional climate model temperature simulations were used to estimate the effect of rising temperature on banana growth assuming other factors constant. The downscaled future climate projections were based on the Intergovernmental Panel on Climate Change (IPCC) Representative Concentration Pathways (RCPs, 2.6, 4.5, 6.0 and 8.5) and Special Report on Emission Scenarios (SRES, A1B and A2) across the period 2011-2090. The methodology involved identification of banana-climate growth thresholds and developing suitability indices for banana production under the high mitigation (RCP 2.6, less adaptation), medium mitigation (RCP 4.5 and RCP 6.0, medium adaptation), no mitigation (RCP 8.5, very high adaptation) scenarios, SRES A1B and A2 scenarios. The FAO ECO-Crop tool was used to determine and map future suitability of banana growth. Banana production indices were determined using a suitability model in the Geographical Information System (GIS) spatial analyst tool. The non-linear banana-temperature regression model was used to assess the impact of future changes in temperature on banana growth.

The use of clinical practice guidelines envisages augmenting quality and best practice in clinical outcomes. Generic guidelines that are not adapted for local use often fail to produce these outcomes. Adaptation is a systematic and rigorous process that should maintain the quality and validity of the guideline, while making it more usable by the targeted users. Diverse skills are required for the task of adaptation. Although adapting a guideline is not a guarantee that it will be implemented, adaptation may improve acceptance and adherence to its recommendations.

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Background: Cardioplegia is the gold standard for providing ideal operating conditions while effecting myocardial protection. Some studies suggest that adding blood to St Thomas cardioplegia solution improves efficacy; this is generally accepted as true. However, the few meta-analyses conducted on children have pooled heterogeneous populations; this raises concern about the validity of their conclusions. Methods: PUBMED, the Cochrane Library and Google Scholar were searched systematically until March 2019 using the search terms “cardioplegia”; “myocardial protection”; “pediatric” “pediatric”; “children”; “infants”; “neonates”. Full text articles were examined if abstracts revealed that the studies possibly contained a blood cardioplegia arm and a crystalloid cardioplegia arm. Studies were included in the meta-analysis if they had a 4:1 blood cardioplegia arm and a St Thomas solution arm. Meta-analysis was performed using Meta-Mar software. Results: The search retrieved 423 articles; 5 were included in the meta-analysis, representing 324 patients. The risk ratio for operative mortality was 0.77(95% CI 0.24–2.5; p=0.66). Little evidence was seen of heterogeneity of the pooled patients. Conclusion: Adding blood to St Thomas cardioplegia solution did not improve in-hospital operative mortality; this may have implications for blood cardioplegia use.

Objective: To determine the pattern of breast disease at Kenyatta National Hospital (KNH) Study design:    Retrospective descriptive study Study setting:    Kenyatta National Hospital, a University teaching and National Referral Hospital Patients: Records of 1172 patients were reviewed. Results: An average 469 new patients per year or 11 new patients per clinic visit were seen at the clinic over a two and a half year period. Females predominated (98.9%) in this series. The mean age was 34.71 years (range 1 to 96 years). The average age at menarche was 14.49 years and the mean duration of symptoms was 6.86 months. Only 2.6% of 843 patients had a positive family history of breast disease. Fibroadenoma was the commonest diagnosis made (33.2%) followed by ductal carcinoma (19.7%). Gynaecomastia was the most common lesion seen in males. Two thirds of patients presenting with tumors had masses measuring more than 5cm.  Overall five conditions (fibroadenoma, ductal carcinoma, breast abscesses, fibrocystic disease and mastalgia) accounted for over 85% of all breast ailments. Surgery formed the main stay of care in over 80% of patients. Conclusions: The pattern of breast diseases at KNH closely mirrors those reported in other studies in the region and beyond. This study indicates that a large proportion of patients presenting with breast disease are treated initially by surgery. It may be wise to consider other alternative forms of therapy where appropriate. The Annals of African Surgery: 2008 June; Vol 2, pg 97-101.

PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.

PIP: The efficacy and complication rate of menstrual regulation with the hand-held Karman cannula was tested on 223 women with amenorrhea up to 56 days in the Dept. of Obstetrics and Gynecology, University of Nairobi, Kenya from October 1982-January 1983. 195 women had positive pregnancy tests, while menstrual regulation was done on the others because of concern over late menses. the procedures were done without anesthesia with a 50 ml vacuum syringe fitted with a self-locking plunger, a rubber adaptor and stop cock, 5-8 mm flexible plastic Karman cannula and a toothless volsellum, using hibitane solution and savlon antiseptic. The average procedure time was 7 minutes. Bleeding lasted over 1 week in 4%, total blood loss was over 50 ml in 3.1%, and immediate side effects were syncope in 1.3%, nausea and vomiting in 1.8% and pain in 5.4%. There were 2 (0.8%) cases of endometritis. In Kenya where 60% of all gynecological hospital admissions are for septic abortions, it is essential to provide safe termination as a backup for family planning method failures.

The ternary systems, Pt-Al-V at the Pt-rich corner and Pt-Cr-V were investigated. Phase equilibria data were obtained using scanning electron microscopy with energy dispersive X-ray spectroscopy and X-ray diffraction analyses. The alloys were studied in the as-cast condition, as well as after annealing at 1000°C for 1500 h. Solidification projections were constructed and liquidus surface projections derived for the two systems. Isothermal sections at 1000°C were also determined for the two systems. Two ternary phases were found in the Pt-Al-V system and one in the Pt-Cr-V system. It was concluded that all the phase regions were identified correctly since the results were self-consistent. Four invariant reactions were identified in the Pt-Cr-V system. Four Pt-Al-Cr-Ru-V and two Pt-Al-Cr-Ru-V-Nb alloys were also investigated and data obtained using scanning electron microscopy with energy dispersive X-ray spectroscopy and X-ray diffraction analyses. The alloys were studied in the as-cast condition, as well as after annealing at 1000°C for 1500 h. The compositions of the alloys were based on a quaternary alloy, Pt82:Al12:Cr4:Ru2, which had been identified as one of the alloys having optimum properties in an earlier investigation. Four of the as-cast alloys had a two-phase structure of ~Pt3Al and (Pt), while two had a single phase, ~Pt3Al. Vanadium partitioned more to ~Pt3Al compared to (Pt). There was an improvement in hardness compared to the quaternary alloys which had been identified as having optimum properties. About 64% of as-cast Pt-Al-V alloys had Vickers hardnesses higher than 500 HV0.3 while ~70% of the annealed alloys had hardness higher than 500 HV0.3. More than 60% of both as-cast and annealed Pt-Cr-V alloys had hardness values higher than 600 HV0.3. There was a general increase in hardness after annealing Pt-Cr-V alloys. Hardness increased with V content in the higher order alloys, and also the annealed alloys had higher hardness compared to the as-cast ones.

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Abstract

Rising demand for energy is one of the major challenges facing the world today and charcoal is a principal fuel in Kenya. Faced with energy poverty many poor households turn to briquette making. This study assessed the additional cooking fuel obtained from recycling charcoal dust into charcoal briquettes. It applied Life Cycle Assessment (LCA) to assess the global warming potential (GWP) from use of charcoal and production of briquettes from charcoal dust and cooking a traditional meal for a standard household of five people. Native vegetation of Acacia drepanolobium and a low efficiency kiln were considered the common practice, while an Acacia mearnsii plantation and a high efficiency kiln was used as an alternative scenario. Charcoal and kerosene were considered as reference fuels. Recovering charcoal dust for charcoal briquettes supplied an additional 16% cooking fuel. Wood carbonization and cooking caused the highest GWP, so there is a need for technologies to improve the efficiency at these two stages of charcoal briquettes and charcoal supply chain. Supplying energy and cooking a traditional meal in a combined system using charcoal and recovering charcoal dust for charcoal briquettes and charcoal alone accounted for 5.3–4.12 and 6.4–4.94 kg CO2 eq. per meal, respectively, assuming trees were not replanted. These amounts declined three times when the carbon dioxide from the carbonization and cooking stages was assumed to be taken up by growing biomass. This requires replanting of trees cut down for charcoal if the neutral impact of biomass energy on GWP is to be maintained.

BACKGROUND: Malaria control in Africa relies primarily on early effective treatment for clinical disease, but most early treatments for fever occur through self-medication with shop-bought drugs. Lack of information to community members on over-the-counter drug use has led to widespread ineffective treatment of fevers, increased risks of drug toxicity and accelerating drug resistance. We examined the feasibility and measured the likely impact of training shop keepers in rural Africa on community drug use. METHODS: In a rural area of coastal Kenya, we implemented a shop keeper training programme in 23 shops serving a population of approximately 3500, based on formative research within the community. We evaluated the training by measuring changes in the proportions of drug sales where an adequate amount of chloroquine was purchased and in the percentage of home-treated childhood fevers given an adequate amount of chloroquine. The programme was assessed qualitatively in the community following the shop keeper training. RESULTS: The percentage of drug sales for children with fever which included an antimalarial drug rose from 34.3% (95% CI 28.9%-40.1%) before the training to a minimum of 79.3% (95% CI 71.8%-85.3%) after the training. The percentage of antimalarial drug sales where an adequate amount of drug was purchased rose from 31.8% (95% CI 26.6%-37.6%) to a minimum of 82.9% (95% CI 76.3%-87.3%). The percentage of childhood fevers where an adequate dose of chloroquine was given to the child rose from 3.7% (95% CI 1.2%-9.7%) before the training to a minimum of 65.2% (95% CI 57.7%-72.0%) afterwards, which represents an increase in the appropriate use of over-the-counter chloroquine by at least 62% (95% CI 53.7%-69.3%). Shop keepers and community members were strongly supportive of the aims and outcome of the programme. CONCLUSIONS: The large shifts in behaviour observed indicate that the approach of training shop keepers as a channel for information to the community is both feasible and likely to have a significant impact. Whilst some of the impact seen may be attributable to research effects in a relatively small scale pilot study, the magnitude of the changes support further investigation into this approach as a potentially important new strategy in malaria control.

Summing multipliers is an important class of operators in the geometric theory of general Banach spaces. They are particularly useful in the study of the structure of the classical spaces. The work done by Grothendieck and Pietsch provides a good basis for the study of this class of operators. The topic of this study is Aspects on (p,q)-summing multipliers. (p,q)-summing multipliers are sequences of bounded linear operators mapping weakly p-summable sequences into strongly q-summable sequences. This study is concerned with using the concepts of absolute and p-summing multipliers to characterize the space of all (p,q)-summing multipliers. In particular we show that the space of all (p, q)-summing multipliers is complete. This is accomplished through a detailed study of the concepts of the summing operators and absolute and p-summing multipliers

Mefloquine pharmacokinetics were studied in Kenyan African normal volunteers and in patients with severe acute attack of Plasmodium falciparum malaria. Peak concentrations were achieved in both groups at 20-24 hours. The mean half-life of elimination was 385 +/- 150 hours (mean +/- SD) in normal subjects while in severe malaria it was 493 +/- 215 hours which was significantly longer (P less than or equal to 0.001). The volume of distribution was significantly smaller in severe malaria where it was 30.76 +/- 10.50 l/kg (mean +/- SD) while in the normal subjects it was 40.90 +/- 20.70 l/kg (mean +/- SD) (P less than or equal to 0.001). The total body clearance in severe malaria was 3.75 +/- 1.51 l/h (mean +/- SD). This was significantly lower than in the normal subjects where it was 5.15 +/- 1.50 l/h (mean +/- SD) (P less than or equal to 0.001).

Department of Pharmacology and Toxicology, College of Pharmacy, University of Texas, Austin 78712.

Primary cultures of spontaneously beating myocardial cells isolated from neonatal rat hearts were used to screen the cardiotoxic effects of Jamesoni's mamba (Dendroaspis jamesoni) venom and components isolated from the venom by gel filtration and ion exchange chromatography. Cardiotoxicity was evaluated on the basis of leakage of lactate dehydrogenase (LDH), changes in morphology, cell membrane lysis, cellular viability, and alterations in spontaneous beating activity. The whole venom caused dose- and time-dependent leakage of LDH, disruption of the cell monolayer, decreases in viability, and inhibition of beating activity. Gel filtration of the venom yielded eight fractions (DjI to DjVIII). DjI (30 micrograms/ml), DjII (20 micrograms/ml), and DjV (20 micrograms/ml) caused significant (P less than 0.001) leakage of LDH, extensive morphologic damage, and decreases in viability. At lower concentrations DjI to DjVIII caused progressive inhibition of spontaneous beating activity. The main fraction (DjV), which was the most toxic, was further separated into 14 polypeptides (Dj1 to Dj14) by ion-exchange chromatography using Bio-Rex 70. Based on the ability to induce LDH leakage, produce morphologic damage, lyse cell membranes, and arrest beating activity, four categories of polypeptides were identified: cardiotoxins, Dj1 and Dj2; cardiotoxinlike polypeptides, Dj3 to Dj8; less active membrane lytic polypeptides, Dj9 to Dj13; and membrane lytic polypeptide, Dj14.

PMID: 3410805 [PubMed - indexed for MEDLINE]

PIP: Of 110 males selected for review with possible chancroid, 96 were clinically diagnosed as having chancroid, 7 as having herpetic lesions, and 7 as having syphilis. Of the 96 patients diagnosed clinically as chancroid, 76 (79.2%) were culture positive for H. ducreyi. 9 (9.4%) of these 96 patients yielded Herpes Simplex Virus (HSV). Both HSV and H. ducreyi were isolated from 5 of the patients, and from 4 of the patients HSV alone was isolated. 7 patients (6.4%) were clinically diagnosed as having herpetic ulcers. 5 of these grew HSV. Overall, 14 of the 110 patients (12.7%) yielded HSV. 1 patient, who presented with small vesicular lesions characteristic of HSV, yielded the virus on culture. The vesicles were initially negative for H. ducreyi, but 6 days later he had developed deep purulent ulcers in the same sites as the vesicular lesions and became culture positive for H. ducreyi snd HSV-negative. The possible association between HSV and chancroid is discussed in the light of these findings and comparisons made between the results of the present study and earlier findings made in Kenya and elsewhere, with suggestions being given as to the reasons for the apparent differences. The HSV isolation techniques used in this study may be less sensitive than those used in other studies, but it is highly unlikely that this possibility alone accounts for all of the observed differences. Patients with hepetic ulcers may be less likely to present early in the course of the disease, if at all, believing the infection to be minor and one that will heal on its own. It is also possible that HSV infection is less common in Kenya, either alone or as an initiator of chancroid, than in the US or Europe, becuase of a higher rate of childhood HSV infections in Kenya, which may confer a degree of immunity against genital HSV infection in this population. The lower prevalence of HSV in association with H. ducreyi reported may be at least partly the result of a much higher incidence in Kenya of chancroid which is not initiated by HSV. A higher incidence of HSV genital infection in Europe and America would also make it more likely that HSV would fortuitously be isolated more frequently from H. ducreyi positive lesions.

BACKGROUND: The khat habit is a widespread phenomenon which has in the past two decades spread to parts of Western Europe and North America from Eastern Africa and the Arabian Peninsula. Although khat has been identified as one of the most commonly abused substances in Kenya, restrictions on cultivation, trade and usage have been non-existent since its legalisation in 1977. OBJECTIVE: To describe the socio-economic effects of khat chewing in Ijara District in the North Eastern Province of Kenya. DESIGN: Cross sectional study. SETTING: Ijara District, North Eastern Kenya. SUBJECTS: Fifty respondents were interviewed. RESULTS: Eighty eight percent of the respondents were khat chewers, and the majority (80%) had family members who engaged in the khat habit. There was a general lack of education on the negative effects of khat chewing. Due to reported mood changes and withdrawal symptoms when not chewing khat, many respondents used more than half of their domestic budgets on khat, but few (28%) perceived this as a waste of resources. Fifty four percent of khat chewers typically started the habit during the day, implying a waste of time for productive work. However, only 40% of the persons interviewed admitted that the drug affected work performance negatively. The khat habit was associated with strain on family relationships, anti-social behaviour and health effects such as insomnia. CONCLUSION: In spite of the negative socio-economic impact of khat in Ijara District, khat consumption remains a widespread habit.

Changes in plasma purine nucleoside level, autonomic activity and hemodynamic reactions were studied in pentobarbital anesthetized rabbits during hemorrhagic shock. Shock was elicited by bleeding the animals to a mean blood pressure of 40 mmHg and maintained until 60% of the maximum bleeding volume in the reservoir had been taken up spontaneously. The remaining shed blood was reinfused thereafter. Norepinephrine (NE), epinephrine (E), adenosine (AD) and uric acid were measured by HPLC with electrochemical detection, fluorometry or UV absorbance. The results showed hemorrhagic shock caused a significant rise in plasma NE, E, AD, and uric acid levels, but the magnitudes and time profiles were different among them. Plasma NE and E increased during the shock compensatory period then declined in the decompensation period whereas adenosine and its metabolite uric acid were elevated persistently during both periods. It is concluded that a balance between autonomic activity and tissue metabolism is important in the maintenance of hemodynamics during shock.

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Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London, UK. Previous attempts to determine the interactions between filariasis transmission intensity, infection and chronic disease have been limited by a lack of a theoretical framework that allows the explicit examination of mechanisms that may link these variables at the community level. Here, we show how deterministic mathematical models, in conjunction with analyses of standardized field data from communities with varying parasite transmission intensities, can provide a particularly powerful framework for investigating this topic. These models were based on adult worm population dynamics, worm initiated chronic disease and two major forms of acquired immunity (larval- versus adult-worm generated) explicitly linked to community transmission intensity as measured by the Annual Transmission Potential (ATP). They were then fitted to data from low, moderate and moderately high transmission communities from East Africa to determine the mechanistic relationships between transmission, infection and observed filarial morbidity. The results indicate a profound effect of transmission intensity on patent infection and chronic disease, and on the generation and impact of immunity on these variables. For infection, the analysis indicates that in areas of higher parasite transmission, community-specific microfilarial rates may increase proportionately with transmission intensity until moderated by the generation of herd immunity. This supports recent suggestions that acquired immunity in filariasis is transmission driven and may be significant only in areas of high transmission. In East Africa, this transmission threshold is likely to be higher than an ATP of at least 100. A new finding from the analysis of the disease data is that per capita worm pathogenicity could increase with transmission intensity such that the prevalences of both hydrocele and lymphoedema, even without immunopathological involvement, may increase disproportionately with transmission intensity. For lymphoedema, this rise may be further accelerated with the onset of immunopathology. An intriguing finding is that there may be at least two types of immunity operating in filariasis: one implicated in anti-infection immunity and generated by past experience of adult worms, the other involved in immune-mediated pathology and based on cumulative experience of infective larvae. If confirmed, these findings have important implications for the new global initiative to achieve control of this disease.

All over the world and specifically sub-Saharan Africa, there is massive scaling up of availability and accessibility to highly active antiretroviral therapy. (HAART) which resulted in improved survival and reduced incidence of opportunistic infections among people living with HIV & AIDS. Nonetheless, whereas efforts to increase access to HIV & AIDS treatment have achieved the desired effects with respect to improvement in the quality of life, other issues such as adherence, sustainability and effectiveness of treatment have emerged.
The goal to sustain a near optimal adherence for successful antiretroviral treatment is undoubtedly a major concern in the management of HIV & AIDS. Among adolescents, the challenge assumes greater proportions given the unique circumstances the group is exposed to. For instance, emotional, neurocognitive and physical development changes are some of the challenges. The transition from paediatric to adult state coupled with the knowledge about their HIV status that prompts them to initiate treatment on their own is to say the least, monumental challenges for adolescents. Moreover, adolescents are generally in school where they are subjected to stigma, discrimination and unfavourable school schedules that do not permit them time to access treatment and medication. Several studies have concluded that a high level of adherence to HAART at 95% or higher is necessary in order to avoid treatment failure and emergence of resistant strains.
Consequently, patients with 95% or higher adherence are known to have a superior virological outcome, an increase in CD4 lymphocyte count, and a lower rate of hospitalization compared with patients with lower levels of adherence.
As cited earlier, a near optimal adherence is a challenge for all patients, and non-adherent behavior is a big problem during adolescent period.
The aim of the study was therefore to determine adherence levels to antiretroviral drugs among adolescents and also establish levels of appointment keeping to clinic visits and pharmacy drug refi 11.

Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) contributes to over 90% of the paediatric HIV infections. The national PMTCT guidelines make recommendations for specific interventions to reduce perinatal transmission. Data on adherence to the guidelines by caregivers and quality of PMTCT care is however limited.
OBJECTIVE:

To evaluate the extent to which PMTCT care offered to HIV positive women admitted for delivery at Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH) adheres to National Guidelines in order to reduce vertical transmission of HIV during labour and delivery.
DESIGN:

A cross-sectional study.
SETTING:

Kenyatta National Hospital and Pumwani Maternity Hospital from January to April 2009.
SUBJECTS:

All consenting HIV positive women admitted to the labour wards at the two facilities and planned for delivery.
RESULTS:

A total of 370 women were enrolled, 266 at Pumwani Maternity Hospital and 104 at Kenyatta National Hospital. Among the enrolled women 357 (96.4%) had been counselled on vertical transmission and 205 (55.4%) had HIV disease staging by CD4 cell count. There were no significant differences between the two study sites in the proportion of women counselled on MTCT (p = 0.398) and receiving HIV disease staging by CD4 testing (p = 0.28). Three hundred and forty nine (94.3%) women were offered varied ARV regimens for PMTCT. 101(27.3%) received HAART, 94 (26.9%) were given single dose nevirapine and 130 (37%) received AZT+NVP combination prophylaxis. Twenty one women received no ARV prophylaxis. Overall, 268 women (72.5%) had spontaneous vertex delivery. An episiotomy rate of 7% was observed and no vacuum delivery was recorded. A Caesarean section rate of 27.5% was recorded with PMTCT as an indication in almost half of the cases. Women delivered at KNH were more likely to receive HAART (p < 0.001) and to be delivered by elective caesarean (p < 0.001).
CONCLUSION:

A great majority of HIV positive women admitted for delivery received counseling on vertical transmission and were offered ARVs for PMTCT. Many women did not get CD4 measurement and clinical staging as recommended in the National guidelines.

Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) contributes to over 90% of the paediatric HIV infections. The national PMTCT guidelines make recommendations for specific interventions to reduce perinatal transmission. Data on adherence to the guidelines by caregivers and quality of PMTCT care is however limited.

Abstract
OBJECTIVE:

To determine adherence to oral rehydration solution (ORS) among in-patients aged 1-59 months suffering from gastroenteritis and having some dehydration (SD) or no dehydration (ND) in two rural hospitals in Kenya.
METHODS:

Children aged 1-59 months suffering from acute gastroenteritis with (SD) or (ND) were enrolled into the study, examined and medical records reviewed. On the second and third day of follow up, children were re-examined to ascertain hydration status and care-takers interviewed.
RESULTS:

Ninety-nine children were enrolled. Forty-five (75%) of the 60 children with SD received a correct prescription for ORS but only 12 (20%) received the correct amount. Among the 39 children with ND, 23 (59%) received a correct prescription for ORS, however only 16 (41%) received the correct amount. On the 3rd day, 9 (15%) of the 60 children with SD at baseline and 2 (5%) of the 39 with ND were classified as having SD.
CONCLUSION:

Four in five children with SD and 6 in 10 children with ND fail to receive the correct amounts of ORS.

Clinical Practice Guidelines for childhood illnesses including pneumonia in Kenya are contained in the Ministry of Health Basic Paediatric Protocols. In the presence of a cough and/ or difficulty in breathing and increased respiratory rate for age, pneumonia is diagnosed. In addition to these the presence of lower chest wall indrawing denotes severe pneumonia; The presence of cyanosis, inability to drink/ breastfeed, grunting, level of consciousness using the AVPU scale less than A in addition to the aforementioned is classified as very severe pneumonia. Recommended management is intravascular Crystalline penicillin, gentamycin and oxygen for severe pneumonia, intravascular crystalline penicillin for severe pneumonia and oral amoxyl or cotrimaxole for pneumonia. These guidelines have been disseminated through the Emergency Triage And Treatment Plus (ETAT +) coursesheld since 2007. Implementation of guidelines into care has been shown to reduce case fatality from pneumonia by 36%.

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The Road to Democarcy, ESAURP, Dar es Salaam

Two male patients with diabetes mellitus and alcohol dependence syndrome are presented. Both were married and in middle age. MI stayed alone in the city while his spouse and two children lived in the rural home. He showed no obvious underlying psychiatric morbidity. FWK was living with his family in the city. He was an alcoholic receiving psychiatric care for alcoholism. They both presented separately at different hospitals with decompensated diabetes following heavy alcohol consumption. The history and clinico-laboratory picture of both patients are presented and brief management programme and outcome are also given. Review of literature on alcoholism and its potential impact on the course and management of diabetes is presented.

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Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

No abstract available.

Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London, UK. Previous attempts to determine the interactions between filariasis transmission intensity, infection and chronic disease have been limited by a lack of a theoretical framework that allows the explicit examination of mechanisms that may link these variables at the community level. Here, we show how deterministic mathematical models, in conjunction with analyses of standardized field data from communities with varying parasite transmission intensities, can provide a particularly powerful framework for investigating this topic. These models were based on adult worm population dynamics, worm initiated chronic disease and two major forms of acquired immunity (larval- versus adult-worm generated) explicitly linked to community transmission intensity as measured by the Annual Transmission Potential (ATP). They were then fitted to data from low, moderate and moderately high transmission communities from East Africa to determine the mechanistic relationships between transmission, infection and observed filarial morbidity. The results indicate a profound effect of transmission intensity on patent infection and chronic disease, and on the generation and impact of immunity on these variables. For infection, the analysis indicates that in areas of higher parasite transmission, community-specific microfilarial rates may increase proportionately with transmission intensity until moderated by the generation of herd immunity. This supports recent suggestions that acquired immunity in filariasis is transmission driven and may be significant only in areas of high transmission. In East Africa, this transmission threshold is likely to be higher than an ATP of at least 100. A new finding from the analysis of the disease data is that per capita worm pathogenicity could increase with transmission intensity such that the prevalences of both hydrocele and lymphoedema, even without immunopathological involvement, may increase disproportionately with transmission intensity. For lymphoedema, this rise may be further accelerated with the onset of immunopathology. An intriguing finding is that there may be at least two types of immunity operating in filariasis: one implicated in anti-infection immunity and generated by past experience of adult worms, the other involved in immune-mediated pathology and based on cumulative experience of infective larvae. If confirmed, these findings have important implications for the new global initiative to achieve control of this disease.

Burning refuse, especially plastics and other hazardous waste that affect air quality has been a common practice. Authorities point to a well balanced environmental past. During those good old days, people used to be able to throw garbage away. And garbage actually went "away." As they pose, Where is "away" now? "Away" is here. "Away" is someone's back yard. There is no place to go from here. We now see that we inhabit a smaller and smaller planet. "Away" has become very close indeed. Based on preliminary findings of a continuing research, and having used case study approaches to isolate pertinent issues, secondary data obtained through stratified random sampling points to unsustainable livelihoods. This papers objective was to highlight this problem from an eco-ethical perspective. The effect of lack of eco-ethics is numerous. From the very cradle of evolution, nature has been propagating to man in subtle ways the message 'use but don't abuse'. The ancient Bible has a message: After God created the Garden of Eden, Adam and Eve, He took the two of them around and told them 'See the world I created, it is all for you, don't spoil it because no one will be there to restore it', (Genesis 2:15). This is probably the first and strongest statement, based upon which Humankind later developed ideas of nature and ecological ethics. Data reveals that humanity and designers, the case of this study, has ignored their responsibility to nurture their environment. This paper concludes that mankind has got a responsibility to future generations in the process of their current development endeavours.

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This paper develops an improved real and reactive power control technique using linear programming (LP) for an integrated power system. The problem is decomposed into two subproblems comprising real (P) and reactive power (Q) modules, and, using a unified approach, the real power generation, voltage magnitude, and transformer tap settings are optimized. The objective function is the fuel cost which is minimized in both the P and Q modules, subject to the operating constraints. The P-Q decomposition combined with the LP formulation improve the computation speed. The paper has another advantage of using the same cost objective function for both modules, unlike other conventional methods which use the power loss function for the Q module. The LP formulation is used for both the P and Q optimization modules, utilizing the revised simplex method which is normally available in a mainframe computer.

Objective In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent. Design and setting We used data collected on a consistent panel of indicators during four separate cross sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002–2012). Main outcome measures Basic resource availability,use of diagnostics and uptake of recommended practices. Results There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines. Conclusions Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low income settings and to those developing novel therapeutic or diagnostic interventions.

Objective In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent.
Design and setting We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002–2012).
Main outcome measures Basic resource availability, use of diagnostics and uptake of recommended practices. Results There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines.
Conclusions Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions.

Purpose
The study aims to estimate the rates of exposure to, and adoption of, rural bank credit programs by smallholder farmers in rural Ghana and the factors responsible for those rates.

Design/methodology/approach
The study used a random sample of 300 smallholder farmers in the Fanteakwa District of Ghana, obtained through the multistage sampling technique. The study also employed the average treatment effects approach to estimate the average treatment effect of farmers’ exposure to rural bank credit programs, on their adoption of such programs.

Findings
The actual adoption rate is approximately 41%, and the potential, conditional on the whole population being aware of rural bank credit programs, is approximately 61%. Accordingly, there is a gap of about 20% in the adoption of rural bank credit programs, and is due to the incomplete exposure of smallholder farmers to the rural bank credit programs. Age of the household head, access to extension services, membership in farmer-based organizations and active savings accounts with a rural bank are the major contributors to smallholder farmer exposure to and the adoption of rural bank credit programs.

Originality/value
The current study is the first of its kind to be conducted in Ghana on rural bank credit programs. It takes into account the extent to which smallholder farmers are exposed to such credit programs and how it influences their decisions to access or adopt.

Developing an effective human resource system that is compatible with organizational strategy is critical for the functioning and success of an organization in the competitive business arena. The main objectives of the study were to establish the extent of adoption of strategic human resource management practices among commercial banks in Kenya; and to determine the factors that influence adoption of strategic human resource management practices by commercial banks in Kenya. The research questions were systematically generated from the objectives. In the data analysis, descriptive statistics and factor analysis were used to help draw comparisons and conclusions based on the results. It was assumed in the data analysis that the results obtained were quite representative for the general population considering the sampled size.
The conclusions of the study are based on the research questions leading to the main purpose of the study. First, a number of human resource practices can be used as strategic weapons for organization to remain competitive. The key strategic resources management practices can be broken into two components. The first component is post-entry/ on-the-job strategic human resources management practices, which include the implementation of chosen human resources management strategy. The second component is pre-entry strategic human resources management practices, which include the recognition of the individual roles of employees before they are employed, keen selection and development. Secondly, the factors that have discouraged the adoption of strategic human resource management practices by commercial banks in Kenya can be broken into three components. The first component is poor communication and decision making process, which include failure of union representatives and managers to meet often to discuss concerns and cooperate in finding solutions to human resources issues. The second component is poor planning on HR issues, which include the failure to cover employees by a "non-traditional" incentive pay plan which applies across shifts of workers. The third component is on poor job orientations which includes lack of extensive efforts to set clear expectations about required work behaviors of the new workers.
Keywords: Strategic Human Resource Management Practice, Commercial Banks and Kenyas.

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Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

ABSTRACT
The adsorption of heavy metals on water hyacinth powder from both
wastewater and aqueous solution was studied using batch experiments. The
adsorption efficiency of water hyacinth powder was evaluated in this study.
The levels of heavy metals in wastewater were in the range of: 1.2-75.3 ppm
for lead, 0.4-87.6 ppm for chromium, 0.1-63.5 ppm for nickel, 0.5-95.5 ppm for
zinc and 0.8-52.7 ppm for cadmium. The levels of zinc, lead and cadmium were
above the limits set by the write NEMA in full then bracket (NEMA) for
discharge into the environment (0.01 ppm for cadmium and lead, 0.5 ppm for
zinc). The adsorption efficiency of hyacinth powder was higher in aqueous
solution than in wastewater while at low metal concentrations (0.1-3.2 ppm),
the adsorption efficiency of water hyacinth powder was 100% in both
wastewater and aqueous solution. The study showed that water hyacinth
powder is a low cost adsorbent which could be used to remove heavy metals
from wastewater and aqueous solution.

Description
Chitosan–zinc oxide composite with an average size of 33 nm was synthesized by facile chemical precipitation technique for application in the removal of water contaminants such as dyes. Malachite green (MG) was the model colorant for the sorption process. Material characterization was achieved using selected spectroscopic techniques. Elemental analysis results revealed that the material had high concentration levels of Zn (965,000 ± 53.2 mg/kg) compared to Fe (756.5 ± 45.3 mg/kg) and P (166 ± 26.6 mg/kg). Batch adsorption experiments of the dye onto chitosan–ZnO (CS–ZnO) composite was investigated with a UV–Visible photometer. The rate of dye removal was greatly influenced by pH, dye strength, amount of adsorbent and contact time. High removal capacity of 98.5% was achieved with reducing dye strength of 2.3 mg/L, dosage of 0.6 g and pH 8 within 180 min equilibration time. Langmuir model …

A study was done to evaluate the removal of a cationic dye from simulated waste water onto rice husks (RH). Spectroscopic methods such as FTIR and SEM/EDX were used for adsorbent characterization. Experimental dependency on solution pH, initial dye concentration, agitation speed, adsorbentparticle size, temperature of the solution and contact time was evaluated. The adsorption data was tested using both Langmuir and Freundlich isotherms. The data fitted well into Langmuir isotherm model with a monolayer adsorption capacity of 6.5 mg/g. Further, the separation factor (RL) value was less than unity indicating a favorable adsorption process. Adsorption kinetics was determined using pseudo-first-order, pseudo-second-order and intra-particle diffusion models. The results showed that the adsorption of malachite green onto rice husks followed pseudo-second-order model with a determination coefficient of 0.986. This work has revealed that rice husks have a great potential to sequester cationic dyes from aqueous solutions and therefore it can be utilized to clean contaminated effluents.

A study was done to evaluate the removal of a cationic dye from simulated waste water onto rice husks (RH). Spectroscopic methods such as FTIR and SEM/EDX were used for adsorbent characterization. Experimental dependency on solution pH, initial dye concentration, agitation speed, adsorbentparticle size, temperature of the solution and contact time was evaluated. The adsorption data was tested using both Langmuir and Freundlich isotherms. The data fitted well into Langmuir isotherm model with a monolayer adsorption capacity of 6.5 mg/g. Further, the separation factor (RL) value was less than unity indicating a favorable adsorption process. Adsorption kinetics was determined using pseudo-first-order, pseudo-second-order and intra-particle diffusion models. The results showed that the adsorption of malachite green onto rice husks followed pseudo-second-order model with a determination coefficient of 0.986. This work has revealed that rice husks have a great potential to sequester cationic dyes from aqueous solutions and therefore it can be utilized to clean contaminated effluents.

A study was done to evaluate the removal of a cationic dye from simulated waste water onto rice husks (RH). Spectroscopic methods such as FTIR and SEM/EDX were used for adsorbent characterization. Experimental dependency on solution pH, initial dye concentration, agitation speed, adsorbentparticle size, temperature of the solution and contact time was evaluated. The adsorption data was tested using both Langmuir and Freundlich isotherms. The data fitted well into Langmuir isotherm model with a monolayer adsorption capacity of 6.5 mg/g. Further, the separation factor (RL) value was less than unity indicating a favorable adsorption process. Adsorption kinetics was determined using pseudo-first-order, pseudo-second-order and intra-particle diffusion models. The results showed that the adsorption of malachite green onto rice husks followed pseudo-second-order model with a determination coefficient of 0.986. This work has revealed that rice husks have a great potential to sequester cationic dyes from aqueous solutions and therefore it can be utilized to clean contaminated effluents.

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The world is today faced with the global pandemic of HIV/AIDS that has evolved rapidly since it was first described. The pandemic has been termed the greatest development challenge for sub Saharan Africa and is rapidly evolving in the Asian continent. The pandemic ha had a significantly negative impact on individual families through loss of loved ones, communities by increasing the burden of caring for the ill, and countries through reduced productivity.     As we look forward to the 21st century, the human population is reminded that even in an age where drugs to treat most ailments are available, human behaviour and individual aspirations are critical in the control of disease. Factors that affect human and social behaviour, such as poverty, discrimination and disenfranchisement have to be addressed on a global basis if the HIV/AIDS epidemic is to be controlled. The HIV/AIDS epidemic presents special challenges and new frontiers for public health interventions and research. HIV/AIDS has revealed the gaps in the understanding of how human behaviour is motivated and how it can be changed.     In this publication we present a review of some of the programs that are specifically targeting the youth with HIV/AIDS prevention activities in the countries of   This publication records the stories of men and women in Eastern Africa, who have tremendous commitment to the work they do even with minimal resources, because they have a vision for the youth of the African continent. It is a story of innovation, creativity, determination and partnership between adults and youth, communities and governments, countries, aid agencies and NGOSs.

Description
Adsorption of crystal violet (CV) dye from aqueous solution using dried bark powder of mangrove species Rhizophora mucronata was studied. Characterization of adsorbent was done using FTIR and SEM. Batch experiment was carried out to examine the viability of using mangrove bark for adsorption of CV dye from aqueous solutions under different process conditions. The result revealed that removal of CV increased with contact time, adsorbent dose, initial dye concentration and decreased with increased particle size and ionic strength. pH 7 was the optimum pH for CV dye removal. The adsorption equilibrium for CV dye by Rhizophora mucronata stem-bark was attained within 60 min with removal efficacy of up to 99.8%. Pseudo-second-order kinetic model was best used to describe sorption kinetics while Freundlich isotherm model was appropriate for describing adsorption isotherm. The results demonstrated …

Description
Adsorption of crystal violet (CV) dye from aqueous solution using dried bark powder of mangrove species Rhizophora mucronata was studied. Characterization of adsorbent was done using FTIR and SEM. Batch experiment was carried out to examine the viability of using mangrove bark for adsorption of CV dye from aqueous solutions under different process conditions. The result revealed that removal of CV increased with contact time, adsorbent dose, initial dye concentration and decreased with increased particle size and ionic strength. pH 7 was the optimum pH for CV dye removal. The adsorption equilibrium for CV dye by Rhizophora mucronata stem-bark was attained within 60 min with removal efficacy of up to 99.8%. Pseudo-second-order kinetic model was best used to describe sorption kinetics while Freundlich isotherm model was appropriate for describing adsorption isotherm. The results demonstrated …

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INTRODUCTION
Kenya as an East African country is bordered by Sudan, Ethiopia, Tanzania and Uganda. It has an area of 581,677 sq km. The capital city is Nairobi. The country is divided into eight provinces namely Coast, Central, Eastern, Nairobi, Nyanza, North Eastern, Rift Valley and Western.

CURRENT SITUATION OR PRACTICE OF ALLL
According to the Kenya National Adult Literacy Survey (2006), 38.5 per cent or 7.8 million of the Kenyan Adult population is illiterate. The results of the National Adult literacy survey 2007 indicate that urban adult population that is literate is higher at 79.9 per cent compared to the rural adult population at 58.7 per cent.

SUCCESSES AND PROBLEMS
Several innovations have taken place in the field of adult literacy. These include, the implementation of the post literacy programs as a continuation of basic literacy. For example, many post literacy programs have been established in the several districts and such as Machakos, Homa Bay and Malindi.

There has been an improvement on the learner generated materials LGMS- Primers that are written by the community itself. This makes the reading materials relevant and interesting to the learners. There has been establishment of community libraries and mobile literacy classes in pastoral communities. In 2003, when the government of Kenya declared free primary education, there the oldest pupil in the Guiness book of record Mzee Kimani Nganga Maruge joined the formal education system at the age of 83.

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

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

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Analysis of 355 cases with fractures of the mandible indicated that 74.9% of the cases were due to interpersonal violence and 13.8% were caused by road traffic accidents. The men to women ratio was 8.4:1 and 75.5% of the fracture cases had single fractures while 24.5% had multiple fractures. In cases with a single fracture, the most commonly involved mandibular site was the body (42.2%). The angle of mandible was most frequently fractured (50.5%) in cases with multiple fractures.

Human Capital Externality and Returns to Education in Kenya

Human Capital Externality and Returns to Education in Kenya

Human Capital Externality and Returns to Education in Kenya

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OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

OBJECTIVE: To estimate the prevalence and pattern of conjuctival squamous cell carcinoma (CSCC) in patients with HIV infection. DESIGN: A hospital based cross sectional study. SETTING: Kenyatta National Hospital (KNH) and Kikuyu Eye Unit (KEU) during the period November 2003 and May 2004. SUBJECTS: Four hundred and nine HIV positive patients. RESULTS: Four hundred and nine HIV positive patients aged 25 to 53 years were screened. Male to Female ratio was 1:1. One hundred and three had conjunctival growths. Thirty two had histologically proven conjunctiva squamous cell carcinoma (CSCC). Estimated prevalence of CSCC among HIV positive patients was 7.8%. The average duration of growth of the conjunctival masses was 21.8 months. The average size of the lesions at the time of presentation was 6.6 mm. Twenty two (68.8%) patients had primary CSCC, while ten (31.2%) had recurrent lesions. The pattern of the histopathology results was: fifteen (46.9%) patients had poorly differentiated squamous cell carcinoma; nine (28%) had moderately differentiated squamous cell carcinoma; five patients (15.6%) had CIN; two patients (6.3%) had dysplasia and one patient (3.1%) had a well differentiated squamous cell carcinoma. CONCLUSIONS: Prevalence of CSCC in HIV/AIDS patients was 7.8%. Patients present late with advanced lesions. Recurrence rates from previous surgery are high. The often uncharacteristic complaints and findings on presentation complicate the clinical diagnosis. Active search for early manifestations of CSCC in HIV / AIDS patients, complete surgical excision and close follow up is necessary. Alternative treatment methods and techniques like the topical use of antimetabolites should be explored further.

OBJECTIVE: To provide an overview of the current global status of female genital mutilation (FGM) or female circumcision practised in various countries. DATA SOURCE: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier were also reviewed including the various techniques and tools used, the "surgeons or perpetrators" of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation has resulted in little or no success were also critically reviewed.
CONCLUSION: FGM remains prevalent in many countries including African countries where over 136 million women have been 'circumcised' despite persistent and consistent efforts by various governments, WHO and other bodies to eradicate the ritual by the year 2000 AD. This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation and adequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than through FGM.

OBJECTIVE: To provide an overview of the current global status of female genital mutilation (FGM) or female circumcision practised in various countries. DATA SOURCE: Major published series of peer reviewed journals writing about female genital mutilation (FGM) over the last two decades were reviewed using the index medicus and medline search. A few earlier publications related to the FGM ritual as practised earlier were also reviewed including the various techniques and tools used, the "surgeons or perpetrators" of the FGM ritual and the myriad of medical and sexual complications resulting from the procedure. Global efforts to abolish the ritual and why such efforts including legislation has resulted in little or no success were also critically reviewed.
CONCLUSION: FGM remains prevalent in many countries including African countries where over 136 million women have been 'circumcised' despite persistent and consistent efforts by various governments, WHO and other bodies to eradicate the ritual by the year 2000 AD. This is as a result of deep rooted cultures, traditions and religions. Although FGM should be abolished globally, it must involve gradual persuasion which should include sensitisation and adequate community-based educational and medical awareness campaign. Mere repression through legislation has not been successful, and women need to be provided with other avenues for their expression of social status approval and respectability other than through FGM.

Human Capital Externality and Returns to Education in Kenya

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