To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. Case control study. Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. Presence and severity of skin lesions related to the type of skin care products used by the child. Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. The study found no significant difference between the cases and controls regarding the type of skin care products used.

OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.

OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.

OBJECTIVE: To compare the pattern of use of skin care products between children with eczematous skin lesions and those without. DESIGN: Case control study. SETTING: Two well baby clinics at the Kenyatta National Hospital and the Mbagathi District Hospital in Nairobi. SUBJECTS: Eighty nine infants with eczematous skin lesions and 89 age and sex matched controls without skin lesions. MAIN OUTCOME MEASURES: Presence and severity of skin lesions related to the type of skin care products used by the child. RESULTS: Exposure to various products was not significantly different between infants with skin lesions and those without. However, more mothers whose children had a skin rash had made a change in the type of soap and or skin cream used for their child (p<0.0001). The principal reason for changing products was skin rash in the baby and most mothers made changes away from scented baby soap products. CONCLUSION: The study found no significant difference between the cases and controls regarding the type of skin care products used.

Glycated haemoglobin (HbA1C) measurement is the currently accepted gold standard biochemical indicator of long-term glycemic control in diabetic patients. The level of knowledge as well as the frequency of use of this test among diabetic patients in Kenya is unknown. The current study aimed to document this among patients attending the diabetes clinic at a national referral hospital in Kenya.

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Background: Elevated levels of serum transaminases are often detected in HIV patients. This has often been attributed to hepatic effects of antiretroviral drugs.
Objective: To determine the pattern and risk factors for alanine aminotransferase elevation in HIV patients positive on nevirapine based regimens.
Methodology: We conducted a retrospective cohort study of HIV infected patients on nevirapine containing regimens who attended the Kenyatta National Hospital comprehensive care clinic between May and August 2014. We sampled participants by convenient sampling method. Generalized linear regression was performed to establish patterns and predictors for hepatotoxicity (grade 1-4) which were the primary outcomes of interest. Predictor variables that were included in the analysis include; demographic information, baseline ALT and CD4 levels, ART regimens, comorbidities and treatment duration.
Results: Risk factors for ALT elevation differed by gender. Predictor variables that were significantly associated with ALT elevation in both sexes included; elevated baseline ALT level [β=10.14 (95%CI 7.34- 12.96); P<0.001], [β=13.52 (95%CI 9.36 –17.68); P < 0.001] and renal disease [β=5.44 (95%CI 2.62 – 8.25); P <0.001], [β=11.52 (95%CI 3.46 – 19.60); P = 0.005] in females and males respectively. Ethnicity had a protective effect in both sexes; [β-6.61(95%CI- 9.28, -3.93); P< 0.001] in males and [β-1.20 (95% CI-2.39, -0.01); P= 0.048] in females. Among the different ethnic groups, Nilotes and Cushites had lower ALT levels compared to Bantus. Other factors that were significant included; smoking (P=0.001), concurrent illnesses (P=0.045), previous adverse drug reactions (P=0.040) in females and a longer duration of anti-retroviral therapy [β 1.81(95%CI 0.89 – 2.73); P < 0.001] in males. Poor adherence had a protective effect [β -1.62(95%CI -3.20, -0.04); P=0.045] among females, whereas initiation on AZT+3TC+NVP had a significant protective effect [β-7.80 (95%CI -13.96, -1.63); P=0.013] in males.
Conclusion: Creatinine and transaminase testing should be done routinely to deal with delayed hepatotoxicity in patients with abnormal ALT baseline levels.
Key words: Alanine aminotransferase, hepatotoxicity, nevirapine.

Background: Elevated levels of serum transaminases are often detected in HIV patients. This has often been
attributed to hepatic effects of antiretroviral drugs.

Objective: To determine the pattern and risk factors for alanine aminotransferase elevation in HIV patients positive on nevirapine based regimens.

Methodology: We conducted a retrospective cohort study of HIV infected patients on nevirapine containing regimens who attended the Kenyatta National Hospital comprehensive care clinic between May and August 2014. We sampled participants by convenient sampling method. Generalized linear regression was performed to establish patterns and predictors for hepatotoxicity (grade 1-4) which were the primary outcomes of interest. Predictor variables that were included in the analysis include; demographic information, baseline ALT and CD4 levels, ART regimens, comorbidities and treatment duration.

Results: Risk factors for ALT elevation differed by gender. Predictor variables that were significantly associated with ALT elevation in both sexes included; elevated baseline ALT level [β=10.14 (95%CI 7.34- 12.96); P<0.001], [β=13.52 (95%CI 9.36 –17.68); P < 0.001] and renal disease [β=5.44 (95%CI 2.62 – 8.25); P <0.001], [β=11.52 (95%CI 3.46 – 19.60); P = 0.005] in females and males respectively. Ethnicity had a protective effect in both sexes; [β-6.61(95%CI- 9.28, -3.93); P< 0.001] in males and [β-1.20 (95% CI-2.39, -0.01); P= 0.048] in females. Among the different ethnic groups, Nilotes and Cushites had lower ALT levels compared to Bantus. Other factors that were significant included; smoking (P=0.001), concurrent illnesses (P=0.045), previous adverse drug reactions (P=0.040) in females and a longer duration of anti-retroviral therapy [β 1.81(95%CI 0.89 – 2.73); P < 0.001] in males. Poor adherence had a protective effect [β -1.62(95%CI -3.20, -0.04); P=0.045] among females, whereas initiation on AZT+3TC+NVP had a significant protective effect [β-7.80 (95%CI -13.96, -1.63); P=0.013] in males.

Conclusion: Creatinine and transaminase testing should be done routinely to deal with delayed hepatotoxicity in patients with abnormal ALT baseline levels.

Key words: Alanine aminotransferase, hepatotoxicity, nevirapine.

Elevated faecal pollution of water bodies poses public health risks for humans as well as livestock, and degrades aquatic ecosystems. This paper presents levels, patterns and sources of faecal pollution detected in a yearlong investigation of the River Njoro watershed, a crucial source of surface and ground water for communities and ecosystems in and surrounding the watershed, including Nakuru Municipality and Lake Nakuru. Under the SUMAWA Project, an extensive survey was conducted of the stream network and numerous point and non-point sources of faecal pollution. Then faecal coliform levels were monitored monthly throughout the River Njoro main stream and Little Shuru tributaly. New gene-based detection methods were tested to distinguish cow from human sources of faecal contamination, and test for markers of Cryptosporidium spp., a watcr-borne pathogen known to cause severe diarrhoea in very young, old, and immuno-compromised humans and cattle.

High levels of faecal water pollution were measured throughout the watershed, averaging 8,000 colony forming units (cfu) of faecal coliform per l00 ml of river water over the year. Periods and incidents exceeding 100,000 cfu/100 ml occurred at l0 out of l5 monitored locations, at some places during the dry season, and nearly everywhere during high runoff months of August and/or July. A pattern of faecal pollution peaking in August at all sites, significantly higher levels detected when cattle were present watering at a site, and the widespread detection of cow genetic source faecal markers, point to livestock, in particular cattle, as the dominant and most widespread likely cause of gross faecal pollution and a possible source of Cryptosporidiunz spp. in the River Njoro Watershed. Detailed findings are presented and actions explored to control identified sources and reduce high pollution levels and their damaging impacts on local ecosystems, livelihoods, and public health.

Elevated faecal pollution of water bodies poses public health risks for humans as well as livestock, and degrades aquatic ecosystems. This paper presents levels, patterns and sources of faecal pollution detected in a yearlong investigation of the River Njoro watershed, a crucial source of surface and ground water for communities and ecosystems in and surrounding the watershed, including Nakuru Municipality and Lake Nakuru. Under the SUMAWA Project, an extensive survey was conducted of the stream network and numerous point and non-point sources of faecal pollution. Then faecal coliform levels were monitored monthly throughout the River Njoro main stream and Little Shuru tributaly. New gene-based detection methods were tested to distinguish cow from human sources of faecal contamination, and test for markers of Cryptosporidium spp., a water-borne pathogen known to cause severe diarrhoea in very young, old, and immuno-compromised humans and cattle. High levels of faecal water pollution were measured throughout the watershed, averaging 8,000 colony forming units (cfu) of faecal coliform per l00 ml of river water over the year. Periods and incidents exceeding 100,000 cfu/100 ml occurred at l0 out of l5 monitored locations, at some places during the dry season, and nearly everywhere during high runoff months of August and/or July. A pattern of faecal pollution peaking in August at all sites, significantly higher levels detected when cattle were present watering at a site, and the widespread detection of cow genetic source faecal markers, point to livestock, in particular cattle, as the dominant and most widespread likely cause of gross faecal pollution and a possible source of Cryptosporidiunz spp. in the River Njoro Watershed. Detailed findings are presented and actions explored to control identified sources and reduce high pollution levels and their damaging impacts on local ecosystems, livelihoods, and public health.

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During the last decade, importation and use of pesticides and fertilizers in Kenya has more than tripled. Improper handling of these chemicals by the small scale farmers continues to pose untold health risks. In an effort to assess the magnitude of the problems emanating from improper handling of these agrochemicals, a study was conducted in a rural agricultural community in Kenya between 1987 and 1990. The study investigated the extent of use of agrochemicals by farmers, the level of awareness of the dangers posed by these chemicals, and attitudes toward agricultural chemicals. The study population consisted of all 1,797 households in 10 villages randomly selected by cluster sampling in the Githunguri location of Kiambu District. Despite their limited knowledge of safety in handling and storage of agrochemicals or of the antidote for accidental poisoning, 100 percent of the farmers used pesticides extensively. Various health complaints related to agrochemicals were reported. By and large the community's or the individuals' lack of awareness of the risks associated with use of agrochemicals is believed to have contributed to some of the agrochemical poisonings. An intervention program has been initiated with the community as a key participant. The main emphasis is on safe procedures for handling agrochemicals.

Recorded incidence of conflict between humans and elephants, in particular crop-raiding, is increasing in rural Africa and Asia, undermining efforts to conserve biological diversity. Gaining an understanding of the underlying determinants of human–elephant conflict is important for the development of appropriate management tools. This study analysed crop-raiding by African elephants (Loxodonta africana) in Laikipia District, covering 9700 km2 in north-central Kenya to identify spatial determinants of crop-raiding by elephants at different spatial extents. On average crop-raiding incidents occurred within 1.54 km of areas of natural habitat where elephants could hide by day undisturbed by human activities (‘daytime elephant refuges’). The occurrence of crop-raiding was predicted by settlement density, distance from daytime elephant refuges and percentage of cultivation. However the relationship between crop-raiding and six candidate variables varied with sampling extent, with some variables diminishing in importance at a finer spatial scale. This suggests a tiered approach to human-elephant conflict management, with different interventions to address factors important at different spatial scales. Our results show that small-scale farms are particularly vulnerable to crop-raiding at settlement densities below approximately 20 dwellings per km2, above which crop-raiding declines. Land-use planning is therefore critical in preventing settlement patterns that leave farms vulnerable to crop-raiding by elephants. Where human–elephant conflict exists, efforts should focus on identifying and managing elephant refuges, through the use of electrified fences where resources are sufficient to construct, maintain and enforce them. This approach has been adopted for mitigating human–elephant conflict in Laikipia and with a major investment in resources and human capital it has been successful. Where such resources and human capital are not available then efforts should instead focus on the application of farm-based deterrents among vulnerable farms.

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BACKGROUND: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. OBJECTIVE: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. DESIGN: Cross-sectional, prospective study. SETTING: Outpatient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. MAIN OUTCOME MEASURES: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. RESULTS: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85 (8.96) years and of the females was 55.68 (8.93) years. The mean (sd) total serum homocysteine for males of 12.97 (6.06) micromol/l was significantly higher than that of the females of 10.64 (4.41) micromol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. CONCLUSION: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

Background: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes.

Objective: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. Design: Cross-sectional, prospective study.

Setting: Outpatient diabetic clinic of the Kenyatta National Hospital.

Subjects: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease.

Main outcome measures: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. Results: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85(8.96) years and of the females was 55.68(8.93) years. The mean (sd) total serum homocysteine for males of 12.97(6.06) µmol/l was significantly higher than that of the females of 10.64(4.41) µmol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably.

Conclusion: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

East African Medical Journal Vol. 82(12) 2005: S180-S183

Background: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes.

Objective: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. Design: Cross-sectional, prospective study.

Setting: Outpatient diabetic clinic of the Kenyatta National Hospital.

Subjects: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease.

Main outcome measures: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. Results: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85(8.96) years and of the females was 55.68(8.93) years. The mean (sd) total serum homocysteine for males of 12.97(6.06) µmol/l was significantly higher than that of the females of 10.64(4.41) µmol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably.

Conclusion: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

BACKGROUND: Increased total homocysteine (tHcy) is an independent risk factor for cardiovascular disease. The measurement of tHcy in blood is therefore of potential great importance especially in patients with type 2 diabetes. OBJECTIVE: To determine the total homocysteine levels in ambulatory patients with type 2 diabetes. DESIGN: Cross-sectional, prospective study. SETTING: Outpatient diabetic clinic of the Kenyatta National Hospital. SUBJECTS: Ambulatory patients with Type 2 diabetes without overt cardiovascular, renal, liver or other chronic disease. MAIN OUTCOME MEASURES: Serum levels of tHcy, HbA1c, lipids and socio-demographic characteristics. RESULTS: A total of 115 patients, 48% males, with type 2 diabetes were included in the study. The mean (sd) age of the males was 56.85 (8.96) years and of the females was 55.68 (8.93) years. The mean (sd) total serum homocysteine for males of 12.97 (6.06) micromol/l was significantly higher than that of the females of 10.64 (4.41) micromol/l. The cholesterol, glycated haemoglobin, the body mass index and blood pressure of the study subjects did not show any statistically significant influence on their homocysteine levels. However, increasing age and duration of diabetes showed a significant linear relationship with rising level of total serum homocysteine. Some study participants reported smoking habit but unreliably. CONCLUSION: There was a significant proportion of the study patients with high levels of serum homocysteine, although most of them were of low to intermediate risk category. It may be prudent to assay homocysteine levels in patients with type 2 diabetes who are either older or have had diabetes for long duration for potential intervention.

Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

To describe injuries and outcomes among children who fall from a height Design: Prospective, convenience hospital based study. Setting: Paediatric surgical wards of Kenyatta National Hospital, Nairobi, from November 2006 to February 2007. Subjects: Children aged 1-13 years who sustained injuries after failing from any height. Results: Eighty children were recruited. There were 61 male (76%) and 19 female (24%), with an age range 1-13 years. Most injuries occurred at home (78.75%) after falling from buildings (33.75%), and were of mild-to-moderate severity. 13.4% sustained external haemorrhage, 16.5% sustained facial injuries, 25.2% sustained CNS injuries, 43.3% sustained various fractures, and 1.6% sustained abdominal trauma. The head and musculoskeletal systems were the most likely regions to be injured. The most common diagnoses were supracondylar fracture of humerus and mild head injury. No thoracic or pelvic fractures were recorded. Recovery was good in most instances. Conclusion: Most children who sustain injuries after a fall from height do so after falling from a building. The most common types of injuries sustained were to the head and distal limbs, especially fractures. They were mostly of mild-moderate severity and recovery usually complete.

Few people can be ignorant of or unmoved b~ the enormous increase in the mortality and the
morbidity caused by trauma caused by RTAs. The number of road traffic accidents has
increased in recent years to pandemic proportions. The health, medical and legal problems
posed affect all branches of surgery and medicine and fatal results are particularly relevant to
the pathologist.
In Kenya, it is estimated that over 13,000 accidents occur annually, killing 2,600 people and
seriously injuring another 11,000. In terms of economic losses up to 14 billion shillings are
lost annually not withstanding the human and emotional suffering (32).
This study was carried out at the Kenyatta National Hospital. It was a descriptive cross
sectional study that attempted to document the patterns of injuries, determine the cause of
death, correlate the fatalities as seen in pedestrians, drivers and passengers, determine the
proportion of those who die on the spot and those that die while undergoing treatment; and
determine injury severity scores.
One hundred (100) autopsies were performed after obtaining an informed consent over a
period of 25 weeks.
The study involved 81 males and 19 females with an age range of 4-80 years and a median
age of33.5 years. 45% arrived at casualty dead while 55% were admitted for a period
,
ranging between 1-730 days with a mean of 14 days.
Vulnerable groups were Pedestrians 62%, passengers 24%, drivers 9%, cyclists 4% and one
case was not specified.
Head injuries were commonest accounting for 76%, followed by chest injuries 70%,
abdominal injuries 60%, lower limb injuries 57%, upper limb injuries 35%, neck injuries
29% and pelvic injuries 16%.
The commonest cause of mortality was head injury 57%, followed by chest injury 33%,
abdominal injuries 17%, other secondary injuries 8% and lower limb injuries was least
accounting for 5%.
Majority 48% had a severe injury severity score (ISS) ranging 50-75, 44% had moderate
score of between 25-49 and 8% mild scores of up to 24.

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated
with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub-
Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the
disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well
as obesity prevalence in the patients with established disease.
Methods: A cross-sectional descriptive study, we examined patients with knee, hip and hand osteoarthritis
to describe the patterns of osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their
body mass indices were also studied to determine the prevalence of obesity in this cohort of patients
Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants,
77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants
were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease
while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA
(45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight
(44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese.
Bilateral OA was more prevalent in obese and overweight participants compared to normal weight
participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for
preventing as well as halting the progression of OA.

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated
with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub-
Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the
disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well
as obesity prevalence in the patients with established disease.
Design: A cross-sectional descriptive study.
Methods: Patients with knee, hip and hand osteoarthritis were examined to describe the patterns of
osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also
studied to determine the prevalence of obesity in this cohort of patients.
Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants,
77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants
were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease
while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA
(45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight
(44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese.
Bilateral OA was more prevalent in obese and overweight participants compared to normal weight
participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for
preventing as well as halting the progression of OA.
INTRODUCTION
Osteoarthritis (OA) is the most prevalent of chronic
rheumatic disorders in the world (1). The prevalence
is increasing as populations are aging and epidemic
obesity is in the rise. OA is estimated to be the fourth
leading cause of disability in most countries worldwide
(2). Worldwide, around 10% of the population who
are 60 years or older have symptomatic problems
attributable to OA (3). Knee, hip, hand and spine
are typically the affected joints. Knee OA is the most
common form and it is associated with profound
clinical and public health burden (4). Risk factors
include obesity, joint injury, previous joint surgery and
occupational bending and lifting. Of these, obesity is
the most powerful and modifiable risk factor for the
development of OA (5). It has been shown that 24%
of surgical cases due to knee OA can be prevented if
overweight and obese reduce their weights by 5Kg or
until they keep their BMIs in the recommended range
(6). On the other hand, maintaining an ideal weight not
only reduces the onset of the disease but also alleviates
the pain, reduces the disability and improves the quality
of life (7,8). The access to modalities of treatments of
the established disease, particularly the surgical aspect
of it, is beyond the reach of the most of the people living
in the developing countries like Kenya. We do not have
local data on the magnitude of the disease in our set up
as well as the prevalence of obesity in this population
with the disease. For these reasons and because obesity
is modifiable risk factor, we examined patients with
specific joint osteoarthritis and determined the obesity
prevalence in a simple descriptive cross-sectional
hospital based study.
MATERIALS AND METHODS
Subjects: Participants of this study were patients with
primary knee, hip and hand OA who were attending
the outpatient rheumatology and orthopaedic clinics in
Kenyatta National Hospital during the periods between
August and December 2012. A total of 2100 patients
with rheumatic diseases, (88%) from the orthopaedic
and rheumatology clinics (12%) were screened for
diagnostic label of knee, hip or hand OA confirmed
by ACR criteria. Of them, 210 (10%) patients were
eligible so 1890 (90%) patients were excluded. Nine
patients declined to give consent. In the final analysis,
201 patients were studied. Their consent was sought.
All procedures were in accordance with the institutional

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in Sub-Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well as obesity prevalence in the patients with established disease.
Design: A cross-sectional descriptive study.
Methods: Patients with knee, hip and hand OA were studied. Of these participants, 77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants were 41% and 32% were overweight. There were 89(44.3%) participants with bilateral knee or hip disease while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA(45.3% vs 10.3% respectively) P<0.001. The bilateral disease was higher in obese (55.2%) and overweight (44.6%) participants compared to participants with normal body mass indices (26.5%) P value <0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese. Bilateral OA was was more prevalent in obese and overweight participants compared to normal weight participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for preventing as well halting the progression of OA

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in subSaharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the disease. Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well as obesity prevalence in the patients with established disease. Design: A cross-sectional descriptive study. Methods: we examined patients with knee, hip and hand osteoarthritis to describe the patterns of osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also studied to determine the prevalence of obesity in this cohort of patients. Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants, 77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA (45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight (44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007. Conclusion: Knee OA was very common and the majority of the patients were overweight and obese. Bilateral OA was more prevalent in obese and overweight participants compared to normal weight participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for preventing as well as halting the progression of OA.

Previous studies have reported revascularization and reorganization of dental pulp chambers with periodontal tissues of monkeys following complete surgical transection through a portion of the apical roots. This study observed 128 teeth in four adult monkeys. Following surgical transection, the tissues were acquired by perfusion fixation, serially sectioned, and stained for cellular detail with hematoxylin and eosin. Collagen tissues were stained with Preece's trichrome and neural tissues with Rowles' silver cyanate for controlled impregnation. At 1 and 2 weeks the coronal tissues showed tissue disruption, necrosis, and degenerating nerves. The 3- and 4-week tissues that had been completely transected showed replacement healing of the pulp tissue with periodontal ligament connective tissue, but no nerves were present. At 6 weeks, no nerves were present in the coronal chambers of those teeth with complete vital transection. The 24-, 36-, and 52-week pulp chambers with complete transection failed to show nerve fibers in their reorganized connective tissues.

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Waterbird populations were censused each January from 1991 to 1999 at Lakes Naivasha, Elmenteita and Nakuru and from 1992 at Lake Bogoria. These shallow lakes in the Kenyan Rift Valley fluctuate greatly in water level and alkalinity. All but Naivasha are usually saline; Nakuru and Elmenteita at times support fish, while Bogoria is fishless. A standardized logarithmic index of relative abundance (value 1.0 for the mean) was calculated for each major waterbird group at each lake, and for Naivasha, Elmenteita and Nakuru combined (‘combined lakes’). Its variance was used to compare levels of variation within and across lakes. For the combined lakes, there was high variance in large piscivores (whether combined or separated into groups), grebes, rallids and flamingos. There was low variance in Palaearctic waders (combined or separated into groups), ibises and spoonbills and birds of prey. However, the lakes generally showed idiosyncratic patterns of variation across the different groups. Variance in the indices for birds of prey and kingfishers were consistently low (max. 0.036 and 0.042, respectively), but no group had consistently high variance across all sites. The variance for all birds (other than flamingos) combined was low (0.018 – 0.085) and similar across all lakes and for combined lakes (0.018). For the combined lakes, the variance for flamingos was five times higher than for all other birds (p<0.05), though the two variances were almost equal for Bogoria. Flamingos were the most variable at Naivasha (variance 0.281) followed by Elmenteita (0.177), Nakuru (0.101) and Bogoria (0.024, and significantly lower than all the rest, p<0.05). This was opposite in order to the mean numbers of flamingos recorded at each site. Large piscivores were relatively stable at Naivasha (variance 0.005) but much more variable at Elmenteita (0.199) and Nakuru (0.269). Patterns of variation within lakes were correlated for some groups, such as waders at Naivasha and large piscivores at Nakuru. These correlations could be related to local ecological conditions. However, there were few large correlations across sites, and these were mainly direct. There was, therefore, no evidence that a fixed population of waterbirds was distributing itself across sites according to conditions. Each lake thus seems to represent and independent entity, while the waterbirds they host evidently move much more widely afield than this portion of the Rift Valley.

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Ethnopharmacological relevance: Traditional medicines play an important role in the management of chronically painful and debilitating joint conditions, particularly in the rural Africa. However, their potential use as sources of medicines has not been fully exploited. The present study was carried to find the medicinal plants traditionally used to manage chronic joint pains in Machakos and Makueni counties in Kenya. Materials and methods: To obtain this ethnobotanical information, 30 consenting traditional herbal med-ical practitioners were interviewed exclusively on medicinal plant use in the management of chronic joint pains, in a pre-planned workshop. Results and discussion: In this survey, a total of 37 plants belonging to 32 genera and 23 families were cited as being important for treatment of chronic joint pains. The most commonly cited plant species were Pavetta crassipes K. Schum, Strychnos henningsii Gilg., Carissa spinarum L., Fagaropsis hildebrandtii (Engl.) Milve-Redh. and Zanthoxylum chalybeum Engl. Acacia mellifera (Vahl) Benth., Amaranthus albus L., Balanites glabra Mildbr. & Schltr., Grewia fallax K. Schum., Lactuca capensis, Launaea cornuta (Oliv. & Hiern) O. Jeffrey, Lippia kituiensis Vatke, Pappea capensis Eckl. & Zeyh. and Pennisetum glaucum (L.) R. Br. are documented for the first time as being important in the management of chronic joint pains. Conclusions: The findings of this study show that a variety of medicinal plants are used in the management of chronic joint pains and the main mode of administration is oral. Keywords: Ethnobotanical survey; Medicinal plants; Chronic joint pains; Rheumatoid arthritis; Akamba; Machakos-Kenya

OBJECTIVE: This study was undertaken to assess the value of clinical symptomatology, abdominal ultrasound (US), triple-phase CT (TPCT) and serum alpha-fetoprotein (AFP) estimation in predicting presence of hepatocellular carcinoma (HCC) among patients with cirrhosis. MATERIALS AND METHODS: In this cross-sectional study, Child's A/B cirrhosis patients were subjected to clinical evaluation, US, TPCT and serum AFP estimation. Sensitivity and specificity of clinical symptoms and of AFP at different cut-off levels were determined. Detection rate of HCC and agreement between US and TPCT was estimated. RESULTS: A high proportion of enrolled subjects had HCC at first presentation (40.7%). Significantly higher prevalence of abdominal pain, weight loss, and anorexia was seen in patients with cirrhosis with HCC compared to those without HCC. Sensitivity and specificity of any of these symptoms was 73 and 79%, respectively (positive and negative predictive values of 65 and 85%, respectively). A 100% agreement between TPCT and US was observed for diagnosing HCC cases. However, TPCT detected a greater number of smaller HCCs. Sensitivity of AFP at 400 ng/ml cut-off was only 25.7%, too low to be useful. Best mix of sensitivity (77.2%) and specificity (78.1%) of AFP was found to be at 10.7 ng/ml cut-off which falls within the conventional limits of normalcy. CONCLUSION: The study highlights the importance of symptomatology of weight loss, abdominal pain or anorexia as markers for HCC in patients with cirrhosis. AFP was not found to be a useful screening test. TPCT should be undertaken in all cirrhotics presenting to the hospital for the first time. Copyright 2007 S. Karger AG, Basel.

BACKGROUND/AIM: Despite bearing the main burden of HCC, prospective studies from developing countries are lacking. This prospective observational study was designed to estimate the incidence of HCC among Indian patients with hepatic cirrhosis. METHODS: Between April 2001 and November 2004, we enrolled 301 patients with liver cirrhosis. Patients found to be free of HCC using baseline abdominal ultrasound, triple-phase computed tomography (TPCT) and serum alpha-fetoprotein (AFP) levels were followed up prospectively for detection of HCC using ultrasound and AFP every 6 months, and TPCT annually. RESULTS: Among the 194 patients (mean age [SD] 45.1 [+/-13.1] years; male:female 6.1:1.0) followed up, 154 had Child's A and 40 had Child's B disease. The causes of cirrhosis were: hepatitis B-71 (36.6%), hepatitis C-54 (27.8%), dual infection with hepatitis B and C-12 (6.2%) and others including autoimmune, alcoholic and cryptogenic cirrhosis 57 (29.4%). During a cumulative follow up period of 563.4 person-years, 9 cases of HCC were detected, with an incidence rate of 1.60 per 100 person-years. CONCLUSION: In our study, the incidence of HCC among patients with liver cirrhosis was intermediate, being lower than that in Japan but higher than that reported from Europe.

The main objective of this study was to investigate how community water projects are influenced by water user fee payment by the stakeholders. This study was carried out in Kieni Constituency, Nyeri County in Kenya. The research was based on the models of sustainability and theories of capital structure. The study was carried out in all the 73 water projects in Kieni Constituency. The units of analysis were all the chairmen of these projects together with 381 beneficiaries of the water projects. Two district water officers and 9 local bank managers were also included in the study. Structured questionnaires, interview and observation schedules were used as research instruments. Pearson’s Product Moment correlation was used in ascertaining the relationships between the study variables and F statistic was used in testing the hypothesis that: there is no significant relationship between the amount of water user fees and sustainability of community water projects. The analysis showed that there was a correlation coefficient r=0.356 depicting a moderate positive correlation which was significant at 0.10 significant level. This indicated a significant moderate positive relationship between water user fee and sustainability of community water projects. It was therefore concluded that an increase in water user fee moderately improves sustainability of community water projects. From the study findings, it was recommended that there is need to establish a sufficient level of water user fee and also a proper management of the collected water user payments Keywords: Water user fee, Sustainability, community projects

Global risk assessment has become an important part of comprehensive CV evaluation and guides treatment. Most global risk tools require laboratory measurement of lipids, a test not readily available in resource-constrained countries. The Gaziano Risk Score (GRS) is a non-lab based model which includes age, gender, diabetes, smoking, systolic BP and substitutes BMI for cholesterol. In comparative effectiveness analysis the GRS has similar predictive value compared to the Framingham score. Objectives: The purpose of this study was to add risk stratification using clinical estimations of the number of CV risk factors (CVRF) and the GRS to our community-based CV screenings.

Global risk assessment has become an important part of comprehensive CV evaluation and guides treatment. Most global risk tools require laboratory measurement of lipids, a test not readily available in resource-constrained countries. The Gaziano Risk Score (GRS) is a non-lab based model which includes age, gender, diabetes, smoking, systolic BP and substitutes BMI for cholesterol. In comparative effectiveness analysis the GRS has similar predictive value compared to the Framingham score. Objectives: The purpose of this study was to add risk stratification using clinical estimations of the number of CV risk factors (CVRF) and the GRS to our community-based CV screenings.

Cardiovascular diseases are a major cause of mortality and morbidity worldwide. In a sub Saharan Africa cardiovascular and other metabolic diseases including diabetes are increasingly causing significant socio-economic and health burden. The increase has severely affected our health care systems already struggling with the burden of tropical and communicable diseases. Patients with diabetes are 2-4 times likely to develop cardiovascular disease and/or stroke. Although the risk factors for cardiovascular disease among type 2 diabetes may be known, there is inadequate information concerning diabetic patients attending Kenyatta National Hospital (KNH).

Cardiovascular diseases are a major cause of mortality and morbidity worldwide. In a sub Saharan Africa cardiovascular and other metabolic diseases including diabetes are increasingly causing significant socio-economic and health burden. The increase has severely affected our health care systems already struggling with the burden of tropical and communicable diseases. Patients with diabetes are 2-4 times likely to develop cardiovascular disease and/or stroke. Although the risk factors for cardiovascular disease among type 2 diabetes may be known, there is inadequate information concerning diabetic patients attending Kenyatta National Hospital (KNH).

Human Capital Externality and Returns to Education in Kenya

Peace and Conflict Management in Kenya (Nairobi: CCR, 2003)

This paper provides a critical appraisal of continental peace and development in Africa. Since the formation of Organization of African Unity (O.A.U) in early 1960s, African states agreed to strengthen their relalationship at continental and regional levels. The primary aim was a drive for liberty. With most of African countries attaining independence, there was a shift to regional economic cooperation, trade and conflict issues. Organizations such as the African Union (AU), the Economic Community of West African States (ECOWAS), the Intergovernmental Authority on Development (IGAD), and the Southern African Development Community (SADC) emerged in order to address security issues and economic development. This is as a result of the cooperation of countries in specific regions. With growing leadership crises, conflicts have developed in various regions leading to political unrest in most countries. This has led to security issues being focal points of concern. As a result, peace agreements were signed and developmental activities being initiated. The paper examines Global and African peace and security architecture. The paper further assesses prospects that have arisen because of peace. It also analyzes challenges that arise due to peace initiatives and how they affect development in Africa. Particular attention is given to the crises in the Central African Republic, Rwanda, DRC Congo, Ivory Coast, Egypt, Chad Angola, Sudan, Kenya, Zimbabwe, Nigeria, South Sudan, Uganda, and Somalia.

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BACKGROUND: Peptic ulcer disease (PUD) occurs in up to one fourth of patients with chronic renal failure (CRF). Some of the factors implicated in its causation include hypergastrinaemia, secondary hyperparathyroidism, drugs and, recently, Helicobacter pylori infection. Studies on the latter have been few, with none having been carried out in Kenya. OBJECTIVE: To evaluate the upper gastrointestinal tract endoscopic findings and to determine the prevalence of H. pylori in CRF patients with dyspepsia. STUDY DESIGN AND POPULATION: A prospective study of seventy seven consecutive patients with CRF and dyspepsia compared with consecutive age, sex and socio-economically matched seventy seven controls (no CRF) with dyspepsia. SETTING: Kenyatta National Hospital (KNH), the major referral and teaching hospital, Nairobi, Kenya. METHODS: In both the study population and the controls, upper gastrointestinal endoscopy was carried out. H. pylori was tested for using the biopsy urease test and histology. Patients were considered to have H. pylori if they tested positive on both tests. OUTCOME MEASURES: Findings at endoscopy and presence of H. pylori. RESULTS: Inflammatory lesions (gastritis, duodenitis) (42%) and duodenal ulcers (18.4%) were the commonest findings in the two groups combined. The prevalence of H. pylori in the 154 subjects studied was 54.5%. There was no statistically significant difference between the prevalence of H. pylori in CRF patients (53.2%) and the controls (55.8%) (p = 0.746). Patients with endoscopically proven PUD had a very high prevalence of H. pylori (87.3%) regardless of their renal function status. CONCLUSION: Dyspepsia in patients with or without CRF was due to multiple causes and over 50% were attributable to H. pylori. The prevalence of H. pylon in dyspeptic CRF patients was similar to that in dyspeptic patients with normal renal function.

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Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

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.

Abstract
The paper is based on the findings the Panafrican Research Agenda The purpose of the Panafrican Research Agenda on the Pedagogical Integration of ICT was to contribute to the broadening of knowledge of ICT usage in learning institutions. The research project aimed at enabling stakeholders better understand how the pedagogical integration of ICT can improve the quality of teaching and learning in Africa. This paper therefore presents an analysis of data collected in 10 Kenyan institutions. The paper focuses on the programmes and software usage and the impact on teaching and learning. It aims at exploring in detail the current impact of ICT usage in schools exploring the computer programmes, software and packages used in teaching and learning. A multi -case approach was used where by ten institutions were selected using similar procedures to allow comparison between the cases. The study used a mixed method approach. This approach borrows from diverse methodologies and facilitates triangulation of data. For every indicator understudy, information was gathered using three different questionnaires and directed interview schedules: The educator questionnaire for teachers, the administrative questionnaire for institutional heads the learner interview schedule and the parent’s interview schedule. The questionnaires and interviews were followed by focus group discussions with the respondents. The interviews and discussions were recorded while the videotaped classroom observations later encoded and analyzed. Data was then validated by a national team before it was uploaded to the Panafrican observatory. The findings presented in this paper are based on data uploaded on the Panafrican Research Agenda Observatory
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Keywords: ICT in education, pedagogical integration,

Anatomy has historically been a cornerstone in medical education regardless of nation or specialty. Revolution in the training of anatomy has been based on the lack of adequate instructors, cadavers and the general high cost of anatomy training. This has led to the abandonment of dissection by most countries in favour of other methods of learning. At the University of Nairobi, the need for more instructors has been addressed by training anatomists and by incorporating surgical resident students in the training of undergraduate medical students. The catchment of collecting cadavers has been increased to address the need for cadavers, with increased competition for this resource from other medical schools in Kenya. This article shares our experience at the Department of Human Anatomy, University of Nairobi, and presents arguments for the dissection course as a central tool for teaching macroscopic anatomy.

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Vaccination of infants against human immunodeficiency virus type 1 (HIV-1) may prevent mother-to-child
HIV-1 transmission. Successful trials and immunization efforts will depend on the willingness of individuals
to participate in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-sectional study,
pregnant women presenting to a Nairobi antenatal clinic for routine care were interviewed regarding their
attitudes toward participation in research studies and HIV-1 vaccine acceptability for their infants. Among
805 women, 782 (97%) reported they would vaccinate their infant against HIV-1 and 729 (91%) reported will-
ingness to enroll their infant in a research study. However, only 644 (80%) would enroll their infants if HIV-
1 testing was required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial participation. Rea-
sons for not wanting to enroll in a pediatric HIV-1 vaccine trial included concerns about side effects (75%),
partner objection (34%), and fear of discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1
results (5%). The strongest correlate of pediatric vaccine trial participation was maternal willingness to be a
vaccine trial participant herself; in univariate and multivariate models this was associated with a 17-fold in-
creased likelihood of participation (HR 17.1; 95% CI 11.7–25; p Ͻ 0.001). We conclude from these results that
immunizing infants against HIV-1 and participation in pediatric vaccine trials are generally acceptable to
women at high risk for HIV-1 infection. It will be important to address barriers identified in this study and
to include male partners when mobilizing communities for pediatric HIV-1 vaccine trials and immunization
programs.

Vaccination of infants against human immunodeficiency virus type 1 (HIV-1) may prevent mother-to-child HIV-1 transmission. Successful trials and immunization efforts will depend on the willingness of individuals to participate in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-sectional study, pregnant women presenting to a Nairobi antenatal clinic for routine care were interviewed regarding their attitudes toward participation in research studies and HIV-1 vaccine acceptability for their infants. Among 805 women, 782 (97%) reported they would vaccinate their infant against HIV-1 and 729 (91%) reported willingness to enroll their infant in a research study. However, only 644 (80%) would enroll their infants if HIV1 testing was required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial participation. Reasons for not wanting to enroll in a pediatric HIV-1 vaccine trial included concerns about side effects (75%), partner objection (34%), and fear of discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1 results (5%). The strongest correlate of pediatric vaccine trial participation was maternal willingness to be a vaccine trial participant herself; in univariate and multivariate models this was associated with a 17-fold increased likelihood of participation (HR 17.1; 95% CI 11.7–25; p 0.001). We conclude from these results that immunizing infants against HIV-1 and participation in pediatric vaccine trials are generally acceptable to women at high risk for HIV-1 infection. It will be important to address barriers identified in this study and to include male partners when mobilizing communities for pediatric HIV-1 vaccine trials and immunization programs.

Vaccination of infants against human immunodeficiency virus type 1 (HIV-1) may prevent mother-to-child HIV-1 transmission. Successful trials and immunization efforts will depend on the willingness of individuals to participate in pediatric vaccine research and acceptance of infant HIV-1 vaccines. In a cross-sectional study, pregnant women presenting to a Nairobi antenatal clinic for routine care were interviewed regarding their attitudes toward participation in research studies and HIV-1 vaccine acceptability for their infants. Among 805 women, 782 (97%) reported they would vaccinate their infant against HIV-1 and 729 (91%) reported willingness to enroll their infant in a research study. However, only 644 (80%) would enroll their infants if HIV- 1 testing was required every 3 months and 513 (64%) would agree to HIV-1 vaccine trial participation. Reasons for not wanting to enroll in a pediatric HIV-1 vaccine trial included concerns about side effects (75%), partner objection (34%), and fear of discrimination (10%), HIV-1 acquisition (8%), or false-positive HIV-1 results (5%). The strongest correlate of pediatric vaccine trial participation was maternal willingness to be a vaccine trial participant herself; in univariate and multivariate models this was associated with a 17-fold increased likelihood of participation (HR 17.1; 95% CI 11.7-25; p < 0.001). We conclude from these results that immunizing infants against HIV-1 and participation in pediatric vaccine trials are generally acceptable to women at high risk for HIV-1 infection. It will be important to address barriers identified in this study and to include male partners when mobilizing communities for pediatric HIV-1 vaccine trials and immunization programs.

Background—There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1–infected children and its role on their outcomes in resource-limited settings. Methods—HIV-1–infected infants were followed from birth to 24 months. Serial HIV-1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours–1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined. Results—Among 85 HIV-1–infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1 month vs. ≤1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36). Conclusions—Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality

Abstract
Background—There is limited information regarding the pattern and correlates of viral replication
in vertically HIV-1–infected children and its role on their outcomes in resource-limited settings.
Methods—HIV-1–infected infants were followed from birth to 24 months. Serial HIV-1 RNA
levels were compared in infants infected in utero (<48 hours), peripartum (48 hours–1 month), and
late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of
infection] and set point and mortality were determined.
Results—Among 85 HIV-1–infected infants, 24 were infected in utero, 41 peripartum, 13 late
postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1
month vs. ≤1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with
peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15%
predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate
analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36).
Conclusions—Infants infected after the age of 1 month contained virus better than infants infected
before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early
mortality.

Abstract
BACKGROUND:
There is limited information regarding the pattern and correlates of viral replication in vertically HIV-1-infected children and its role on their outcomes in resource-limited settings.
METHODS:
HIV-1-infected infants were followed from birth to 24 months. Serial HIV-1 RNA levels were compared in infants infected in utero (<48 hours), peripartum (48 hours-1 month), and late postnatal (after 1 month). Cofactors for viral peak [highest viral load (VL) within 6 months of infection] and set point and mortality were determined.
RESULTS:
Among 85 HIV-1-infected infants, 24 were infected in utero, 41 peripartum, 13 late postnatal; 7 had no 48-hour assay. HIV-1 VL set point was significantly lower in infants infected >1 month vs. < or = 1 month (5.59 vs. 6.24 log10 copies per milliliter, P = 0.01). Maternal VL correlated with peak infant VL (P < 0.001). Univariately, infant peak and set point VL and 6-month CD4% <15% predicted mortality; and 6-month CD4% <15% remained independently predictive in multivariate analyses (hazard ratio = 4.85, 95% confidence interval: 1.90 to 12.36).
CONCLUSIONS:
Infants infected after the age of 1 month contained virus better than infants infected before 1 month of age. Maternal VL predicted infant VL, which, in turn was associated with early mortality.

A 2 1/2-year-old female presented to the Department of Paediatrics with a fever (38.2 degrees C) and bilateral swelling of the parotid salivary glands. A month later, she presented with similar signs and symptoms. Three months later the patient had a third attack and was referred to the Paediatric Dental Department. A clinical examination and sialography showed a normal Stensen's duct. The parenchyma of the right parotid had a combination of punctate lesions (1-2 mm in diameter) and globular lesions (3 mm in diameter). In the left parotid there were punctate lesions approximately 1 mm in diameter. The patient was managed with antipyretics (acetaminophen) and penicillin. This condition should be referred to as sialadenitis pediatrica as it presents as a clinical entity with signs and symptoms of swelling and pyrexia in the absence of sialography and histological findings. It is referred to as sialectasis after histological and sialographic observations detect lesions affecting the parenchyma of the salivary glands.

The pattern of pediatric stroke displays ethnic and geographical variations. There are few reports from black Sub-Saharan Africa, although relevant data are important in prevention, clinical diagnosis, treatment and prognostication.

The pattern of pediatric stroke displays ethnic and geographical variations. There are few reports from black Sub-Saharan Africa, although relevant data are important in prevention, clinical diagnosis, treatment and prognostication.

Pediatric surgery in sub-Saharan Africa is disadvantaged by the large number of sick children, disease patterns specific to the region, late presentation, and advanced pathology. In addition, it is practiced in an environment of limited resources and facilities and other health priorities. Obstacles to better pediatric-surgical care (PSC) include a general lack of interest in surgical conditions affecting African children, its poorly defined role, and a lack of political commitment by governments and international agencies to see surgical care of children improve. Pediatric-surgical practice in Africa must be cognizant of the factors that limit delivery of surgical services and work toward developing cost-effective strategies that benefit the largest number of children. Demonstrating that childhood surgical conditions are a significant public health-care problem is the most likely way to change health-care policy and to ensure adequate resources for PSC. Other priorities should be to define a cost-effective package of pediatric surgical services, improve PSC at the community level, and strengthen pediatric surgical-education.

A fifteen-year-old female patient presented with a severe bilateral groin contracture for the last 8 years. She had sustained burns at the age of seven years. Three attempts to release the contracture with split thickness skin grafts had been done without success. A pedicled anterior lateral thigh flap was raised and advanced into the defect after the contracture had been released. Postoperatively the patient healed well without any complications and was able to achieve hip abduction of about 130 degrees.

The study involved development of pedotransfer functions (PTFs) for determining saturated hydraulic conductivity (Ks) used in surface flow prediction. This preceded evaluation of existing PTFs for Ks in flow simulation. The pedotransfer functions were developed to predict parameters used in the determination of Ks using selected basic soil properties. The Soil Water Assessment Tool (SWAT) model was used in flow prediction in the Naro Moru river catchment of the Ewaso Ng’iro river basin, Kenya. The developed pedotransfer functions were then used in the simulation of surface runoff on the catchment and their performance in surface flow prediction compared with that of existing pedotransfer functions. Initial model runs during flow simulation yielded poor daily flow simulations compared to monthly simulations. This was attributed to differences in the timing of peak discharges for the observed and simulated hydrographs. The model was calibrated for a three year period followed by a three year validation period based on monthly flows. Calibration results yielded acceptable, but modest agreement between observed and simulated monthly stream flows. The modest model performance was associated with input data deficiencies and model limitations. The results indicated that the model could be adapted to the local conditions. Manual flow calibration was performed to improve simulation results initially based on average annual conditions followed by monthly calibration. There was significant improvement in the model performance based on monthly flow simulations. The model simulation of surface flow registered better performance compared to base flow and total flow indicating the model to be a better simulator of surface flow than baseflow. Observed and predicted surface runoff was compared to evaluate performance of existing PTFs. Model performance was similar for the existing PTFs selected. There was diversity v in performance of PTFs when used for surface runoff prediction. It was felt there is the need for continued development of PTFs for predicting Ks. The developed PTFs were evaluated for accuracy and reliability. The PTFs developed for saturated soil moisture content (θs) produced better performance in reliability compared to the remaining parameters in the van Genutchen moisture retention equation. The developed pedotransfer functions were then used in predicting Ks for surface flow simulation. The model performance in surface runoff simulation using developed PTFs was found acceptable. The study provides insight in developing equations for predicting Ks from basic soil properties being an input parameter in hydrological models. Hydrologic modeling plays a significant role in enabling policy makers, watershed planners and managers make appropriate decisions consistent with sustainable management of watershed resources.

A safe, effective vaccine for breastfeeding infants born to HIV-1-positive mothers could complement antiretroviral therapy (ART) for prevention of mother-to-child transmission of HIV-1. To date, only a few HIV-1 vaccine candidates have been tested in infants.

A safe, effective vaccine for breastfeeding infants born to HIV-1-positive mothers could complement antiretroviral therapy (ART) for prevention of mother-to-child transmission of HIV-1. To date, only a few HIV-1 vaccine candidates have been tested in infants.

Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches.

Background: There is limited evidence on how implementation of peer support interventions influences effectiveness, particularly for individuals with diabetes. We conducted a cluster randomized controlled trial to compare the effectiveness of a peer-led health education package versus usual care to increase uptake of screening for diabetic retinopathy (DR).

Methods: Our process evaluation used a mixed-method design to investigate the recruitment and retention, reach, dose, fidelity, acceptability, and context of implementation, and was guided by the Consolidated Framework for Implementation Research (CFIR). We reviewed trial documents, conducted semi-structured interviews with key informants (n = 10) and conducted four focus group discussions with participants in both arms of the trial. Three analysts undertook CFIR theory-driven content analysis of the qualitative data. Quantitative data was analyzed to provide descriptive statistics relevant to the objectives of the process evaluation.

Results: The trial had positive implementation outcomes, 100% retention of clusters and 96% retention for participants, 83% adherence to delivery of content of group talks (fidelity), and 78% attendance (reach) to at least 50% (3/6) of the group talks (dose). The data revealed that intervention characteristics, outer setting, inner setting, individual characteristics, and process (all the constructs of CFIR) influenced the implementation. There were more facilitators than barriers to the implementation. Facilitators included the relative advantage of the intervention compared with current practice (intervention characteristics); awareness of the growing prioritization of diabetes in the national health policy framework (outer setting); tension for change due to the realization of the vulnerability to vision loss from DR (inner setting); a strong collective sense of accountability of peer supporters to implement the intervention (individual characteristics); and regular feedback on the progress with implementation (process). Potential barriers included the need to queue at the eye clinic (intervention characteristic), travel inconveniences (inner setting), and socio-political disruption (outer setting).

Conclusions: The intervention was implemented with high retention, reach, fidelity, and dose. The CFIR provided a valuable framework for evaluating contextual factors that influenced implementation and helped to understand what adaptations may be needed during scale up.

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Objective: To determine the prevalence and pattern of eye diseases and visual impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. Design: Community based survey conducted from October 15th to 31st 2007 Setting: Kibera and Dagoreti divisions of Nairobi City Subjects: 4200 people of all ages were randomly selected; 4056 were examined (96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined to be examined. Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only 241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti divisions are conjunctival disorders including allergic conjunctivitis and conjunctival growths. This was found to affect 7.6% of the subjects. This was followed by refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects (0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the subjects and corneal disorders in 0.5%. The prevalence of visual impairment was 0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates that most of the ocular disorders encountered were not visually threatening. The main cause of visual impairment is refractive errors and the causes of severe visual impairment and blindness are cataract, corneal opacity and glaucoma. Conclusion: The population of the NCES is relatively young and the prevalence of blindness and visual impairment is low. The main cause of visual impairment was refractive errors and the causes of severe visual impairment and blindness were cataract, corneal opacity and glaucoma. Recommendations: The level of blindness in NCES is low and the project should focus more on rendering eye care and not treatment of blindness. There is need to address the issue of refractive errors as this was one of the main ocular problems encountered. In this survey, it was not possible to perform detailed refraction and hence it was recommend that a refractive error survey be conducted; especially in school going children.

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BACKGROUND:

Pentoxifylline (PTX) affects many processes that may contribute to the pathogenesis of severe malaria and it has been shown to reduce the duration of coma in children with cerebral malaria. This pilot study was performed to assess pharmacokinetics, safety and efficacy of PTX in African children with cerebral malaria.
METHODS:

Ten children admitted to the high dependency unit of the Kilifi District Hospital in Kenya with cerebral malaria (Blantyre coma score of 2 or less) received quinine plus a continuous infusion of 10 mg/kg/24 hours PTX for 72 hours. Five children were recruited as controls and received normal saline instead of PTX. Plasma samples were taken for PTX and tumour necrosis factor (TNF) levels. Blantyre Coma Score, parasitemia, hematology and vital signs were assessed 4 hourly.
RESULTS:

One child (20%) in the control group died, compared to four children (40%) in the PTX group. This difference was not significant (p = 0.60). Laboratory parameters and clinical data were comparable between groups. TNF levels were lower in children receiving PTX.
CONCLUSIONS:

The small sample size does not permit definitive conclusions, but the mortality rate was unexpectedly high in the PTX group.

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.

Quality of health education during STD case management in Nairobi was assessed in 142 healthcare facilities, through interviews of 165 providers, observation of 441 STD patients managed by these providers, and 165 visits of simulated patients. For observations, scores were high for education on contact treatment (74-80%) and compliance (83%), but unsatisfactory for counselling (52%) and condom promotion (20-41%). The World Health Organization (WHO) indicator for STD case management Prevention Indicator 7 (PI7) (condom promotion plus contact treatment) was poor (38%). Public clinics strengthened for STD care generally performed best, whereas pharmacies and mission clinics performed worst. Compared with observations, scores were higher during interviews and lower during simulated patient visits, indicating that knowledge was not fully translated into practice. Interventions to improve the presently unsatisfactory service quality would be wide distribution of health education materials, ongoing training and supervision of providers, implementation of STD management checklists, and the introduction of pre-packaged kits for STD management.

The growth of the micro sector enterprise is influenced by many factors, which include marketing and personal characteristics of the entrepreneur, as well as the organizational characteristics of the enterprise. Previous studies have laid emphasis on entrepreneurial behavour, trying to explain the entrepreneurial characteristics that make one venture into entrepreneurship. Emphasis has been on such characteristics as age, gender and education of an entrepreneur. Little attention has been made on organizational characteristics and how they could influence growth of an enterprise. There is also very little that has been done to establish how marketing practices influence growth of an enterprise. This study therefore sought to establish the determinants of growth among the micro, small and medium sector enterprises in Mavoko municipality, Machakos county, Kenya. The study had three objectives, namely; To determine the influence of marketing practices on the growth of MSMEs in Mavoko municipality’ To establish the influence of personal characteristics of the entrepreneur on the growth of MSMEs in Mavoko municipality and To determine the influence of organizational characteristics on the growth of MSMEs in Mavoko municipality, Machakos county, Kenya. Descriptive cross-sectional survey design was used with a semi structured questionnaire being the main data collection instrument. A convenient sample of 100 MSMes in the two townships was be used, in which 79 firms responded, diving a response rate of 79 %. Descriptive analysis, ANOVA, regression and correlation analysis were used to analyze the data. The study found that marketing practices do influence the growth of micro medium and small sector enterprises. It was found that packaging, branding, penetration pricing, and always making products available hand significant influence on growth of the enterprises. Personal characteristics such as age and educational level of the entrepreneur were found to significantly influence the growth of an enterprise. Marital status, however, was not found to have a significant influence on growth. Organizational characteristics such as financial ability, Quality of employees and location of business were found to have positive influence on growth of enterprise, while cost of doing business had negative influence.

Key words: micro sector enterprise, growth, marketing practices, Personal characteristics, Organizational characteristics

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Dissection contributes significantly to anatomical knowledge and the development of professionalism for medical students. This study assessed student emotional stress and coping in the anatomy lab and the perception of dissection on learning. A survey of Medicine I students (n=100) assessed: demographics, emotions and stress of the first dissection, anxiety, coping, and learning. With a response rate of 40%, our findings include: positive attitude towards the first dissection (n=33) although some students still found it stressful (n=17); cultural views impacted the lab experience (n=24); some used spirituality (n=10) or humor (n=6) to cope; most agreed that dissection enhanced understanding of anatomy (n=31) and the connection of between theoretical and applied knowledge (n=37); promoted teamwork (n=35); and highlighted respect for the human body (n=31) and the spirit of organ donation (n=28). While some have assumed that students have a negative attitude towards human dissection, our study showed that the majority of students reported a positive impact on various aspects of professionalism and humanism. We conclude that dissection is useful for students to establish not only technical skills and knowledge of the body, but also qualities associated with inter-professional teamwork and a humanistic attitude, without posing significant emotional stress.

ABSTRACT
This study sought to determine how students of public secondary schools in Nairobi perceive entrepreneurship as a career and whether they would want to pursue a career in entrepreneurship upon completion of school. The study bore in mind that both exogenous and endogenous factors have the potential to influence the students’ perception of entrepreneurship and thus contribute in determining their entrepreneurial intentions. As such learning Business Studies in secondary school and having parents/ guardians in self employment was viewed as having prior exposure to entrepreneurship. Data for this study was obtained by use of a questionnaire administered to randomly selected students from selected schools that were representative of public secondary schools in Nairobi. They were 135 respondents who comprised of both male and female students and students ranging from Form one (1) to Form four (4). The research revealed that although majority of students had a positive perception of entrepreneurship as a career option, there were various factors that were perceived as hindrances or challenges. Key of these was the fear of failure, lack of sufficient knowledge to start and run own business and the inadequate funds to start business. The study also revealed that there was no significant difference in the perception of entrepreneurship between students who had had prior exposure through Business Studies subject at school and those who had not studied the subject. It was also observed that students who had parents/ guardians in self employment were not highly motivated to go into entrepreneurship so as to continue in family business.
Key words: Career choice, entrepreneurship, entrepreneurial perceptions

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

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

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Professionalism defines the relationship between colleagues, patients and the society as a whole. Furthermore, being a social construct, professionalism is sophisticated to be regarded simply as a single concept across different cultural contexts. This study sought to explore how professionalism is conceptualized by the clinicians, students and patients in a teaching hospital in Kenya.

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To determine perceptions, preferences and practices of vaginal birth after Caesarean. DESIGN: Cross-sectional descriptive study. SETTING: Private clinics of obstetricians in five major towns of Kenya. SUBJECTS: Obstetricians in private practice. MAIN OUTCOME MEASURES: Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL. RESULTS: Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria, 83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians' convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policy of "TOL whenever it is deemed as appropriate" was preferred by 88.7%. CONCLUSION: The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy.

To determine perceptions, preferences and practices of vaginal birth after Caesarean.