Information on the prevalence of hearing impairment and related ear pathologies in children in sub-Saharan Africa is scarce. A pilot study for a clinical trial of simple treatments for chronic suppurative otitis media (CSOM) in school children in Kiambu district, Kenya, provided information on the prevalence of hearing impairment and ear pathologies. Five-thousand-three-hundred-sixty-eight children from 57 randomly chosen primary schools in Kiambu district were examined. Simple otoscopy was performed by clinical officers with specialty training in ENT, and hering testing was performed by trained nurses, using a hand held field audiometer. Microbiological specimens were obtained from those children with CSOM. Five-point-six percent of the children had a hearing impairment of > 30 dB HL in one or both ears, with 2.2% having bilateral hearing impairment. Two-point-four percent had at least one perforated tympanic membrane, and 1.1% had CSOM. Eight-point-six percent of the children had wax obstructing the tympanic membrane. There is evidence of a relationship between hearing impairment and both CSOM and wax obstructing the tympanic membrane. The most common organisms found were Pseudomonas spp. (34%), Proteus spp. (34%) and Eschericia coli (19%). These results are comparable with other studies in Africa and indicate a considerable burden of ear disease in Kiambu district, Kenya.

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Mwaura F, K M Mavuti and W N Wamicha. . :

BACKGROUND AND AIM: The purpose of the present study was to evaluate the therapeutic response of north Indian patients with chronic hepatitis C (CH-C) to two different treatment regimens of interferon and ribavirin. METHODS: Consecutive patients with a diagnosis of CH-C attending the Liver Clinic at the All India Institute of Medical Sciences, New Delhi between April 1999 and April 2002 were included in the study. A competitive reverse transcription-polymerase chain reaction (RT-PCR) method developed in the authors' laboratory was used for quantification of hepatitis C virus (HCV)-RNA. Genotyping of HCV was also determined. The clinical, biochemical, virological and histological parameters were used to assess the therapeutic response among a clinical cohort of patients with chronic hepatitis C. They were treated with two different protocols (interferon [IFN]-alpha-2b, 3 million units daily and ribavirin 10.6 mg/kg daily in two divided doses for 6 months or IFN-alpha-2b, 3 million units thrice weekly and ribavirin 10.6 mg/kg daily for 6 months). RESULTS: Sixty-five patients with CH-C were included in the study. Blood transfusion (n = 28, 43%) and community-acquired (n = 23, 35%) HCV infections were the commonest. The mean HCV load was high (24.14 +/- 12.5 x 10(8) copies/mL). Genotype 2 and 3 were prevalent in 80% (41/51) of the patients. Forty-five patients received 3 million units of IFN thrice weekly and 20 received the same dose daily. All received the same dose of ribavirin. A sustained virological response (SVR) of 95% (19/20) was achieved among patients receiving daily IFN, whereas 64.4% (29/45) of those who received IFN thrice weekly had SVR. The virological relapse was significantly lower among patients who received daily IFN than in those treated with thrice weekly IFN (n = 1/20, 5% vs 10/39, 25.6%; P = 0.015). The proportion of patients receiving daily IFN among those achieving SVR (19/48, 40%) was significantly higher than the proportion of patients receiving similar therapy among patients without SVR (1/17, 6%; P = 0.02). CONCLUSIONS: Transfusion and community-acquired HCV infection were the major causes of CH-C. Genotype 2 and 3 HCV were most prevalent among these patients. Despite high viral load, these patients responded well to a combination of daily IFN-alpha-2b and ribavirin. Copyright 2004 Blackwell Publishing Asia Pty Ltd

This paper reports a study of 279 sera obtained from children attending five schools in Nairobi, the capital of Kenya which is situated in a non-malarious zone. Their ages ranged from six to 16 years. The surface antigen of hepatitis B virus (HBV) was detected in 13 children (4.7%) including seven boys and six girls. The core and surface antibodies were measured by radioimmunoassay on 125 of the samples to study the pattern of infection in childhood and the interrelationships of different parameters of the infection. The core antibody by itself was observed in four children (3.2%). A total of 31 samples (24.8%) had both core and surface antibodies, 19 (15.2%) had only surface antibody. Thus, 48% of all school children tested had serological evidence of past exposure to the virus. The implications of these findings are discussed.

Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV-HBV co-infected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly-active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg(+) and anti-HBs negative: 24 were HBeAg-negative, 18 had HBV DNA ≤10,000 IU/ml. Sustained HBV suppression to <100 IU/ml occurred in 89% of 19 evaluable patients. Resistance occurred in only 2 subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV-HBV co-infected patients with low baseline HBV DNA levels.

Summary.  Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV–HBV coinfected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg positive and anti-HBs negative, 24 were HBeAg negative, and 18 had HBV DNA levels ≤10 000 IU/mL. Sustained HBV suppression to <100 IU/mL occurred in 89% of 19 evaluable patients. Resistance occurred in only two subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV–HBV coinfected patients with low baseline HBV DNA levels.

Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV-HBV coinfected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg positive and anti-HBs negative, 24 were HBeAg negative, and 18 had HBV DNA levels ≤ 10,000 IU/mL. Sustained HBV suppression to <100 IU/mL occurred in 89% of 19 evaluable patients. Resistance occurred in only two subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV-HBV coinfected patients with low baseline HBV DNA levels.

Widespread use of lamivudine in antiretroviral therapy may lead to hepatitis B virus resistance in HIV-HBV coinfected patients from endemic settings where tenofovir is not readily available. We evaluated 389 Kenyan HIV-infected adults before and for 18 months after starting highly active antiretroviral therapy with stavudine, lamivudine and nevirapine. Twenty-seven (6.9%) were HBsAg positive and anti-HBs negative, 24 were HBeAg negative, and 18 had HBV DNA levels ≤ 10,000 IU/mL. Sustained HBV suppression to <100 IU/mL occurred in 89% of 19 evaluable patients. Resistance occurred in only two subjects, both with high baseline HBV DNA levels. Lamivudine resistance can emerge in the setting of incomplete HBV suppression but was infrequently observed among HIV-HBV coinfected patients with low baseline HBV DNA levels.

In an exercise to study the immunogenicity and reactogenicity of the Engerix B vaccine, 160 medical students were screened for Hepatitis B Markers (HBsAg, HBsAb and HBcAb) with a view to vaccinating those that were negative. 18% were HBsAg + ve, 33% were HBsAb + ve and 38% were positive for the HBcAb. These figures were extremely high and obviated the need to vaccinate the students as they begin their clinical years

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Cancer is causing a lot of suffering and death in Africa but is not considered a
major health problem in Africa. This needs to change. Cancer should be given
equal emphasis to HIV/AIDS, tuberculosis (TB) and Malaria. A national cancer
policy is required in Malawi to develop and improve evidence-based cancer
prevention, early diagnosis, curative and palliative therapy. A national cancer
policy is crucial to ensure a priotised, clear, coordinated and sustained fight
against cancer. When no policy exists, events are likely to be random,
stakeholders and practitioners in the fight against cancer may not agree on how
to proceed, may duplicate efforts or may neglect areas that would have greater
nationwide impact resulting in poor quality activities and haphazard development.

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The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

Poverty reduction strategies in developing countries are based on the need to develop and
improve the quality of life of people. The successful strategies link wealth creating activities
of adding value to local resources with employment creation. These strategies lead to
increased capacity to produce needed consumer goods such as food, fuel, construction
materials, textiles and pharmaceuticals starting from local resources. Most value-adding
transformations of materials to consumer goods use chemicals conversion processes

Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Olfactory acuity differs among animal species depending on age and dependence on smell. However, the attendant functional anatomy has not been elucidated. We sought to determine the functional structure of the olfactory mucosa in suckling and adult dog and sheep. Mucosal samples harvested from ethmoturbinates were analyzed qualitatively and quantitatively. In both species, the olfactory mucosa comprised olfactory, supporting and basal cells, and a lamina propria containing bundles of olfactory cell axons, Bowman’s glands and vascular elements. The olfactory cells terminated apically with an expanded knob, from which cilia projected in a radial fashion from its base and in form of a tuft from its apex in the dog and the sheep respectively. Olfactory cilia per knob weremorenumerous in the dog (19±3) compared to the sheep (7±2) (p < 0.05). In the dog, axonal bundles exhibited one to two centrally located capillaries and the bundles were of greater diameters (73.3±10.3_m) than those of the sheep (50.6±6.8_m), which had no capillaries. From suckling to adulthood in the dog, the packing density of the olfactory and supporting cells increased by 22.5% and 12.6% respectively. Surprisingly in the sheep, the density of the olfactory cells decreased by 26.2% while that of the supportive cells showed no change. Overall epithelial thickness reached 72.5±2.9_m in the dog and 56.8±3.1_m in the sheep. These observations suggest that the mucosa is better structurally refined during maturation in the dog than in the sheep.

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified–aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

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

Am J Public Health. 1994 Dec;84(12):1947-51.
Health care-seeking behavior related to the transmission of sexually transmitted diseases in Kenya.
Moses S, Ngugi EN, Bradley JE, Njeru EK, Eldridge G, Muia E, Olenja J, Plummer FA.
Source
Department of Community Health, University of Nairobi, Kenya.
Abstract
OBJECTIVES:
The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya.
METHODS:
A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors.
RESULTS:
Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic.
CONCLUSIONS:
Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.
Comment in
 The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface controlChallenges to the control of sexually transmitted diseases in Africa. [Am J Public Health. 1994]
PMID:
7998635
[PubMed - indexed for MEDLINE]
PMCID:
PMC1615368
Free PMC Article

OBJECTIVES. The purpose of this study was to identify health-care seeking and related behaviors relevant to controlling sexually transmitted diseases in Kenya. METHODS. A total of 380 patients with sexually transmitted diseases (n = 189 men and 191 women) at eight public clinics were questioned about their health-care seeking and sexual behaviors. RESULTS. Women waited longer than men to attend study clinics and were more likely to continue to have sex while symptomatic. A large proportion of patients had sought treatment previously in both the public and private sectors without relief of symptoms, resulting in delays in presenting to study clinics. For women, being married and giving a recent history of selling sex were both independently associated with continuing to have sex while symptomatic. CONCLUSIONS. Reducing the transmission of sexually transmitted diseases in Kenya will require improved access, particularly for women, to effective health services, preferably at the point of first contact with the health system. It is also critical to encourage people to reduce sexual activity while symptomatic, seek treatment promptly, and increase condom use.

The book is a biography of the author. He begins with fundamenbtal question whether we can determine our destiny or we are just fulfiling what has already been ordained. He then explains how he has grown over the yeas experiencing changes.  

The thread of this paper is that vested interests prevail consistently in the formulation of health policy and provision of health services. Several African countries illustrate how the health care standard becomes an end in itself, however ineffective it becomes as population and needs change. Policy is not an exclusive prerogative of governments. Industry of all sorts, non-governmental organizations (NGOs) and development agencies use policies to determine, guide and shape investments and, in the case of the private sector, prevail favourably in competition. With a few exceptions, planners plan to depict and alter a particular situation, to improve conditions according to a particular mode, ideology or belief. The planner, like the policy maker, assumes that certain changes will occur if certain decisions are made or actions are taken. In reality, however, policy makers and planners are seldom satisfied with the status quo. The policy maker decides on the basis of available information, albeit incomplete or inconclusive, and believes one option is better than another or that it will achieve the desired goal optimally and at least cost. To formulate policy is to choose a course of action and to plan is to pursue a particular interest. However implicitly, vested interests are entrenched in every policy action. There seems to be four main, but related reasons for any specific health policy: availability of adequate health care; equity of access; cost; and effectiveness/relevance of the system under the prevailing technology. While concerns differ, sometimes quite widely, concern for an effective health system is always paramount. Less than two decades ago, African countries had more robust economies than they have today.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

This study aimed to identify facility-level characteristics associated with prevention of mother-to-child HIV transmission service quality. This cross-sectional study sampled 60 health facilities in Mozambique, Côte d'Ivoire, and Kenya (20 per country). Performance score - the proportion of pregnant women tested for HIV in first antenatal care visit, multiplied by the proportion of HIV-positive pregnant women who received appropriate antiretroviral medications - was calculated for each facility using routine data from 2012 to 2013. Facility characteristics were ascertained during on-site visits, including workload. Associations between facility characteristics and performance were quantified using generalized linear models with robust standard errors, adjusting for country. Over six months, facilities saw 38,611 first antenatal care visits in total. On-site CD4 testing, Pima CD4 machine, air conditioning, and low or high (but not mid-level) patient volume were each associated with higher performance scores. Each additional first antenatal care visit per nurse per month was associated with a 4% (95% confidence interval: 1%-6%) decline in the odds that an HIV-positive pregnant woman would receive both HIV testing and antiretroviral medications. Physician workload was only modestly associated with performance. Investments in infrastructure and human resources - particularly nurses - may be critical to improve prevent mother-to-child HIV transmission service delivery and protect infants from HIV.

Hemorrhage is the leading cause of obstetric mortality. Studies show that Active Management of Third Stage of Labor (AMTSL) reduces Post Partum Hemorrhage (PPH). This study describes the practice of AMTSL and barriers to its effective use in Tanzania. A nationally-representative sample of 251 facility-based vaginal deliveries was observed for the AMTSL practice. Standard Treatment Guidelines (STG), the Essential Drug List and medical and midwifery school curricula were reviewed. Drug availability and storage conditions were reviewed at the central pharmaceutical storage site and pharmacies in the selected facilities. Interviews were conducted with hospital directors, pharmacists and 106 health care providers in 29 hospitals visited. Data were collected between November 10 and December 15, 2005. Correct practice of AMTSL according to the ICM/FIGO definition was observed in 7% of 251 deliveries. When the definition of AMTSL was relaxed to allow administration of the uterotonic drug within three minutes of fetus delivery, the proportion of AMTSL use increased to 17%. The most significant factor contributing to the low rate of AMTSL use was provision of the uterotonic drug after delivery of the placenta. The study also observed potentially-harmful practices in approximately 1/3 of deliveries. Only 9% out of 106 health care providers made correct statements regarding the all three components of AMTSL. The national formulary recommends ergometrine (0.5 mg/IM) or oxytocin (5 IU/IM) on delivery of the anterior shoulder or immediately after the baby is delivered. Most of facilities had satisfactory stores of drugs and supplies. Uterotonic drugs were stored at room temperature in 28% of the facilThe knowledge and practice of AMTSL is very low and STGs are not updated on correct AMTSL practice. The drugs for AMTSL are available and stored at the right conditions in nearly all facilities. All providers used ergometrine for AMTSL instead of oxytocin as recommended by ICM/FIGO. The study also observed harmful practices during delivery. These findings indicate that there is a need for updating the STGs, curricula and training of health providers on AMTSL and monitoring its practice.

Kenya has had a history of health financing policy changes since its independence in 1963. Recently, significant preparatory work was done on a new Social Health Insurance Law that, if accepted, would lead to universal health coverage in Kenya after a transition period. Questions of economic feasibility and political acceptability continue to be discussed, with stakeholders voicing concerns on design features of the new proposal submitted to the Kenyan parliament in 2004. For economic, social, political and organisational reasons a transition period will be necessary, which is likely to last more than a decade. However, important objectives such as access to health care and avoiding impoverishment due to direct health care payments should be recognised from the start so that steady progress towards effective universal coverage can be planned and achieved.

Results of four years' studies from a number of hospitals in Kenya have shown that nosocomial infections in burns units are due to Methicillin Resistant Staphylococcus aureus (MRSA). Through chromosomal DNA and plasmid DNA, the stain is highly resistant to sulphonamide ointment and other antibiotics. 90% of patients admitted in burns units get colonized or infected with MRSA. The strain prolongs the duration of patients in hospitals. The burns degenerate to second and third degree burns, thereby necessitating skin grafting. The environment has been found to be contaminated with this strain with some staff members having chronic throat infections. Minocycline was found to be effective in treating the infected staff members. Cleaning this environment with Sodium dichloroisocyanurate (precepts)/Sodium hypochlorite (JIK) reduced drastically the mechanical transmission of bacteria in the units. The duration of stay of the patient was reduced. This shows that MRSA which is spread in government and private hospitals can cheaply be controlled by the proper use of disinfectants, antiseptics, and use of effective antibiotics when necessary.

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

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OBJECTIVE: To assess the clinical outcome of successful percutaneous transluminal coronary angioplasty (PTCA) in patients with poor ventricular function. METHODS: Analysis of angiographic, echocardiographic and clinical records of patients with severe LV dysfunction who underwent PTCA from January 1, 1995 to December 31, 1997 was undertaken. Forty-one patients aged 63+/-10 years, 36 men, all with significant coronary artery disease and impaired LV function (fractional shortening, FS

PIP: A consulting firm conducted interviews with managers of 16 businesses in 3 Kenyan cities, representatives of 2 trade unions, focus groups with workers at 13 companies, and an analysis of financial/labor data from 4 companies. It then did a needs assessment. The business types were light industry, manufacturing companies, tourism organizations, transport firms, agro-industrial and plantation businesses, and the service industry. Only one company followed all the workplace policy principles recommended by the World Health Organization and the International Labor Organization. Six businesses required all applicants and/or employees to undergo HIV testing. All their managers claimed that they would not discriminate against HIV-infected workers. Many workers thought that they would be fired if they were–or were suspected to be–HIV positive. Lack of a non-discrimination policy brings about worker mistrust of management. 11 companies had some type of HIV/AIDS education program. All the programs generated positive feedback. The main reasons for not providing HIV/AIDS education for the remaining 5 companies were: no employee requests, fears that it would be taboo, and assumptions that workers could receive adequate information elsewhere. More than 90% of all companies distributed condoms. 60% offered sexually transmitted disease diagnosis and treatment. About 33% offered counseling. Four companies provided volunteer HIV testing. Almost 50% of companies received financial or other external support for their programs. Most managers thought AIDS to be a problem mainly with manual staff and not with professional staff. Almost all businesses offered some medical benefits. The future impact of HIV/AIDS would be $90/employee/year (by 2005, $260) due to health care costs, absenteeism, retraining, and burial benefits. The annual costs of a comprehensive workplace HIV/AIDS prevention program varied from $18 to $54/worker at one company.

The book is a biography of the author. He begins with fundamenbtal question whether we can determine our destiny or we are just fulfiling what has already been ordained. He then explains how he has grown over the yeas experiencing changes.  

Concrete is one of the commonly used materials worldwide in the construction industry due to its durability [1]. Civil infrastructures such as power plants, bridges and large buildings are typically built using concrete. It is typically composed of aggregate, sand, cement, water as …

J Acquir Immune Defic Syndr. 1988;1(6):566-70.
Health outreach and control of HIV infection in Kenya.
Ngugi EN, Plummer FA.
Source
Department of Community Health, College of Health Sciences, University of Nairobi, Kenya.
Abstract
This paper highlights the role of mobilization of individuals and community groups and health professionals in prevention of HIV transmission. It traces the educational strategy employed to reach the general population and selected groups at risk. In Kenya, the general awareness about AIDS started to grow in late 1985 and increased in 1986-87. This has resulted in reduction of the incidence of some sexually transmitted diseases (STDs). The importance of pretesting education material as well as monitoring and evaluation of educational efforts to lay the ground for culturally appropriate and more effective health education messages to combat HIV transmission is presented. The paper concludes by emphasizing the importance of developing the HIV infection programs with the people and for the people.
PMID:
3225743
[PubMed - indexed for MEDLINE]
The following toggler user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.

This paper highlights the role of mobilization of individuals and community groups and health professionals in prevention of HIV transmission. It traces the educational strategy employed to reach the general population and selected groups at risk. In Kenya, the general awareness about AIDS started to grow in late 1985 and increased in 1986--87. This has resulted in reduction ofthe incidence of some sexually transmitted diseases (STDs). The importance of pretesting education material as well as monitoring and evaluation of educational efforts to lay the ground for culturally appropriate and more effective health education messages to combat HIV transmission is presented. The paper concludes by emphasizing the importance of developing the HIV infection programs with the people and for the people. Key Words: Human immunodeficiency rvirus-Prevention-Kenya-Sexually transmitted diseases.

This paper examines the specialty of health psychology which is concerned with individual behaviours and lifestyles affecting physical health. The beneficial role of health psychology interventions in ameliorating the impact of emerging health care issues, in particular, the increasing prevalence of 'Western' diseases in Africans, is presented. The effect of behaviour and lifestyle on chronic illnesses such as cancer and hypertension, and the benefits of health psychology interventions on these illnesses, are discussed.

Background: Health related quality of life is increasingly being recognized as a primary outcome measure in treatment of end stage renal disease. The health related quality of life of patients on maintenance haemodialysis is reduced. Several interventions directed at modifiable risk factors have been shown to improve quality of life of patients on haemodialysis.
Objective: To assess the health related quality of life of patients on maintanance haemodialysis at Kenyatta National Hospital.
Design: Cross sectional descriptive study
Setting: Kenyatta National Hospital, Renal Unit.
Subjects: The study was conducted on 96 patients with end stage renal disease on maintenance haemodialysis. Socio-Demographic and clinical factors were recorded for all patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life-36 questionnaire. Two summary scores and three sub-scale scores were calculated.
Results: The mean physical composite summary and mental composite summary scores were 39.09+/- 9.49 and 41.87+/- 10.56 respectively. The burden of kidney disease sub-scale, symptom and problems sub-scale and effect of kidney disease on daily life sub-scale score were 16.15+/- 21.83, 73.46+/-18.061 and 67.63+/-23.45 respectively.
Conclusion: Health related quality of life of patients on maintenance hemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. The burden of kidney disease sub-scale is the most affected sub-scale score.

Background: Health related quality of life is increasingly being recognized as a primary outcome measure in treatment of end stage renal disease. The health related quality of life of patients on maintenance haemodialysis is reduced. Several interventions directed at modifiable risk factors have been shown to improve quality of life of patients on haemodialysis.
Objective: To assess the health related quality of life of patients on maintanance haemodialysis at Kenyatta National Hospital.
Design: Cross sectional descriptive study
Setting: Kenyatta National Hospital, Renal Unit.
Subjects: The study was conducted on 96 patients with end stage renal disease on maintenance haemodialysis. Socio-Demographic and clinical factors were recorded for all patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life-36 questionnaire. Two summary scores and three sub-scale scores were calculated.
Results: The mean physical composite summary and mental composite summary scores were 39.09+/- 9.49 and 41.87+/- 10.56 respectively. The burden of kidney disease sub-scale, symptom and problems sub-scale and effect of kidney disease on daily life sub-scale score were 16.15+/- 21.83, 73.46+/-18.061 and 67.63+/-23.45 respectively.
Conclusion: Health related quality of life of patients on maintenance hemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. The burden of kidney disease sub-scale is the most affected sub-scale score.

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.

Prompt and appropriate health seeking is critical in the management of childhood illnesses. This paper examines the health seeking behaviour in under-five child morbidity. It explores in detail actions taken by 28 mothers when their children become sick. Sixty-two in-depth interviews with mothers were conducted from four study communities. The mothers were identified from a demographic surveillance system. The interviews were tape-recorded, transcribed and thematically analysed. The study shows that mothers classify childhood illnesses into four main categories: (1) not serious—coughs, colds, diarrhoea; (2) serious but not life-threatening—malaria; (3) sudden and serious—pneumonia; and (4) chronic and therefore not requiring immediate action—malnutrition, tuberculosis, chronic coughs. This classification is reflected in the actions taken and time it takes to act. Shops are used as the first source of healthcare, and when the care moves out of the home, private health facilities are used more compared to public health facilities, while even fewer mothers consult traditional healers. Consequently we conclude that there is a need to train mothers to recognize potentially life-threatening conditions and to seek appropriate treatment promptly. Drug vendors should be involved in intervention programs because they reach many mothers at the critical time of health seeking.

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified–aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

The book is a biography of the author. He begins with fundamenbtal question whether we can determine our destiny or we are just fulfiling what has already been ordained. He then explains how he has grown over the yeas experiencing changes.  

Demography India 32 (2): 26-32

Small hospitals sit at the apex of the pyramid of primary care in many low-income country health systems. If the Millennium Development Goal for child survival is to be achieved hospital care for severely ill, referred children will need to be improved considerably in parallel with primary care in many countries. Yet we know little about how to achieve this. We describe the evolution and final design of an intervention study attempting to improve hospital care for children in Kenyan district hospitals. We believe our experience illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system rather than an individual level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question - does it work? While there are increasing calls for more health systems research in low-income countries the importance of strong, broadly-based local partnerships and long term commitment even to initiate projects are not always appreciated.

Small hospitals sit at the apex of the pyramid of primary care in the health systems of many low-income countries. If the Millennium Development Goal for child survival is to be achieved, hospital care for referred severely ill children will need to be improved considerably in parallel with primary care in many countries. Yet little is known about how to achieve this. This article describes the evolution and final design of an intervention study that is attempting to improve hospital care for children in Kenyan district hospitals. It illustrates many of the difficulties involved in reconciling epidemiological rigour and feasibility in studies at a health system, rather than an individual, level and the importance of the depth and breadth of analysis when trying to provide a plausible answer to the question: does it work? Although there are increasing calls for more health systems research in low-income countries, the importance of strong, broadly based local partnerships and long-term commitment even to initiate projects is not always appreciated.

HEALTH POLICY AND PLANNING; 16(Suppl. 1): 33-39 © Oxford University Press 2001
The Health Workers for Change impact study in Kenya
WASHINGTON ONYANGO-OUMA,l FREDERICK W THIONG'O,2 THERESA MA ODERO.1 AND JOHN H OUMA2
'KEDAHR Project, Division of Vector-Borne Diseases, Ministry of Health, Kisumu, 2Divi§ion of Vector Borne
Diseases, Ministry of Health, Nairobi and 3Department of Nursing Sciences, University of Nairobi, Nairobi, Kenya
This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC)
workshop series on clients' perceptions of health services, relationships within the health centre and relations
between the health facility and the district health system. The study was carried out in three stages: baseline,
intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were
collected at three levels: client, facility and system. Results indicate that relations between health workers
and clients improved a great deal after the intervention while those between the facility and the system
remained to a large extent unchanged. The paper concludes that, with external support and help, especially
from the health system level, health workers can work towards improving health services and their job satisfaction,
which can lead to better health worker-client relations

The Health Workers for change impact study in Kenya. Health Policy & Planning 16 (1): 33-39.

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

Background: Health-care providers form the backbone of health information and service delivery in many African communities. This study investigated health-care providers' (HCPs) attitudes towards a novel method of HIV prevention for women-a microbicide-embedded intravaginal ring (IVR). Methods: Qualitative interviews were conducted, covering initial attitudes towards IVRs, potential use among female sex workers, herbal practices for sexually transmitted infection (STI) management and the ways in which populations can access the rings should they become available. Twenty HCPs were interviewed in Mukuru and Kibera, which are informal settlements in Nairobi, Kenya, with high HIV prevalence, unemployment and commercial sex work. Results: The majority of HCPs had positive attitudes towards IVRs as a method of HIV prevention in this environment. HCPs liked that IVRs are female controlled and can be used covertly. Overall, HCPs reported a willingness to participate in the distribution of IVRs, and favoured distribution through health facilities at no cost. Conclusion: Findings from this study demonstrate that HCPs are willing to serve as the primary source of IVR information in target communities. However, they require adequate knowledge regarding microbicides and IVRs before these products reach the market

Description
There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level, [2006] for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer …

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

Objectives: To determine the prevalence and type of hearing disorders in HIV positive patients not on anti - retroviral drugs (ARVs) and correlate this with the world health Organization (WHO) stage of HIV disease and CD4 positive cell counts.
Design: Case control study.
Setting: comprehensive care clinic (CCC) and voluntary counseling and testing centre at Kenyatta National Hospital.
Subjects: One hundread and ninety four HIV positive patients attending CCC and 124 HIV negative subjects recruited from voluntary counseling and testing (VCT) centre.
Results: Hearing loss (HL) was present in 33.5% of HIV positive compared to 8.1% in negative subjects. No gender bias in HL Sensorineural hearing loss (SNHL) was the most common and the frequencies most ‘affected were four and eight kHz

Conclusion: Hearing loss is more prevalent in HIV positive individuals not on anti - retroviral drugs than negative normal subjects. Low CD4 cell count and advanced HIV diseases were associated with increased chance of having a hearing loss. Otological care should be part of the comprehensive care of HIV positive patients.

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The Lake Bogoria basin, here in referred to as the study area, is located in the greater Baringo-Bogoria basin (BBB), about 100 km to the north of Menengai geothermal prospect on the floor of Kenya Rift Valley (KRV). It is bound by latitudes 0o 00’ and 0o 30’N and longitudes 35o45’E and 36o15’E within the rift graben. The study area is characterised by geothermal surface manifestations which include hot springs, spouting geysers, fumaroles/steam jets and mud pools. The area is overlain by Miocene lavas mainly basalts and phonolites, and Pliocene to recent sediments and pyroclastics such as tuffs, tuffaceous sediments, superficial deposits, volcanic soils, alluvium and lacustrine silts. The terrain is characterized by extensive faulting forming numerous N-S ridges and fault scarps.

Gravity and magnetotelluric (MT) surveys were undertaken in the basin in an attempt to determine the heat source, characterize the geothermal reservoir, and evaluate the geothermal resource potential of the basin.

Gravity survey results indicate Bouguer anomaly having an amplitude of ~40 mGals aligned in a north-South direction and interpreted to be due to a series of dyke injections and hence the heat source in the basin. The interpretation of Bouguer anomaly has been constrained by using previous seismic results. Seismic velocities were converted to densities using the expression derived from Gardner et al. (1974). The MT survey results show that the geothermal prospect in Lake Bogoria basin is overlain by high resistivity (50-1000 -m) thin (100-500 m) layer which forms a cap rock for the geothermal reservoir, which is subsequently underlain by three distinct relatively thick layers within the geothermal prospect. The first of these thick layers is ~3 km thick and has resistivities ranging between 4-30 -m. This layer is interpreted as the geothermal reservoir and the low resistivities are due to circulating hot mineralized geothermal fluids. The underlying layer is ~10 km thick and resistivity values range between 85-2500 -m and is interpreted to be a fractured and hydrothermally altered basement metamorphic rocks. The relatively high degree of fracturing allows deep circulation of water where it gets heated up by the underlying dyke injections, and convective heat transport to the geothermal reservoir. The substratum is characterized by resistivities ranging between 0.5-47 -m and is interpreted as hot dyke injections which are the heat sources for this geothermal prospect.

On the basis of gravity and MT results, the heat source in Lake Bogoria basin is due to cooling dyke injections occurring at depths of ~6 – 12 km in the subsurface. Gravity method however favours depths of ~3 – 6 km for the heat source. The geothermal reservoir is probably two-phase and the temperature ranges between 150-400oC (Karingithi, 2006). Previous microseismic studies by Young et al. (1991), Tongue (1992) and Tongue et al., (1992, 1994) show that Lake Bogoria basin geothermal prospect is characterised by high frequency of low magnitude (< 3) seismic events which are correlated with surface faulting and multiple episodes of dyke injections. The gravity and MT results in this study are therefore fairly consistent with results from previous microseismic studies undertaken in the basin.

The Lake Bogoria basin, here in referred to as the study area, is located in the greater Baringo-Bogoria basin (BBB), about 250 km to the north of the city of Nairobi and about 100 km to the north of Menengai geothermal prospect on the floor of Kenya Rift Valley (KRV). It is bound by latitudes 0o 00’ and 0o 30’N and longitudes 35o45’E and 36o15’E within the rift graben. The study area is characterised by geothermal surface manifestations which include hot springs, spouting geysers, fumaroles/steam jets and mud pools. The area is overlain by Miocene lavas lavas, mainly basalts and phonolites, and Pliocene to recent sediments and pyroclastics such as tuffs, tuffaceous sediments, superficial deposits, volcanic soils, alluvium and lacustrine silts. The terrain is characterized by extensive faulting forming numerous N-S ridges and fault scarps.

Gravity survey was undertaken in the study area to map the possible heating source and evaluate the geothermal resource potential of the basin. Gravity survey results indicate Bouguer anomaly having an amplitude of ~40 mGals aligned in a north-South direction and interpreted to be due to a series of dyke injections and hence the heat source in the basin. The interpretation of Bouguer anomaly has been constrained by using results from previous seismic surveys undertaken in the Kenya rift valley by Simiyu and Keller (2001), Keller et al., (1994a) and Braile et al., (1994). P-wave velocities have been converted to densities using the equation derived from Gardner et al. (1974).

Microseismic studies in Lake Bogoria basin by Young et al. (1991), Tongue (1992) and Tongue et al., (1992, 1994) show that the basin is characterised by high frequency of low magnitude (< 3) seismic events which are correlated with surface faulting and multiple episodes of dyke injections. The gravity results in this study are therefore fairly consistent with results of previous microseismic studies undertaken in the basin.

On the basis of the gravity results, the heat source in Lake Bogoria basin is due to cooling dyke injections occurring at depths of ~3 – 6 km. Since a heat source, in addition to fluid circulation, is an integral component of a geothermal system, it is evident that a geothermal reservoir exists in Lake Bogoria basin and the fluids can be tapped for generation of geothermal power.

Background: Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin.

Methods: We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively.

Results: A total of 29,645 women underwent randomization. The frequency of blood loss of at least 500 ml or the use of additional uterotonic agents was 14.5% in the carbetocin group and 14.4% in the oxytocin group (relative risk, 1.01; 95% confidence interval [CI], 0.95 to 1.06), a finding that was consistent with noninferiority. The frequency of blood loss of at least 1000 ml was 1.51% in the carbetocin group and 1.45% in the oxytocin group (relative risk, 1.04; 95% CI, 0.87 to 1.25), with the confidence interval crossing the margin of noninferiority. The use of additional uterotonic agents, interventions to stop bleeding, and adverse effects did not differ significantly between the two groups.

Conclusions: Heat-stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial. (Funded by Merck Sharpe & Dohme; CHAMPION Australian New Zealand Clinical Trials Registry number, ACTRN12614000870651 ; EudraCT number, 2014-004445-26 ; and Clinical Trials Registry-India number, CTRI/2016/05/006969 .).

Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin.

This study examined patterns of alcohol use and its association with unsafe sex and related sequelae among female sex workers in Mombasa, Kenya. A community-based cross-sectional study was conducted using snowball sampling. Binge drinkers (> or =5 alcoholic drinks on > or =1 occasion in the previous month) were compared with non-binge drinkers. Of 719 participants, 22.4% were lifetime-alcohol abstainers, 44.7% non-binge and 33.0% binge drinkers. Compared with non-binge drinkers, binge drinkers were more likely to report unprotected sex (adjusted odds ratio (AOR)=1.59, 95% confidence interval [CI]=1.00-2.53; P=0.047) and sexual violence (AOR=1.85, 95% CI=1.27-2.71; P=0.001) and to have either syphilis, Neisseria gonorrhoeae or Trichomonas vaginalis infection (AOR=1.56, 95% CI=1.00-2.41; P=0.048). HIV prevalence was higher among women having ever drunk (39.9%) than lifetime abstainers (23.2%; P<0.001), but was not associated with drinking patterns. Interventions are needed to assist female sex workers adopt safer drinking patterns. Investigation is needed for the effectiveness of such interventions in reducing unprotected sex, sexual violence and sexually transmitted infections.

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Air pollution studies in Nairobi are indicating a rising trend in the particulate matter loading. The trend is mainly attributed to increased volume of motor vehicles, the physical change of the environment, agricultural and industrial activities. In this study, total suspended …

Lake Victoria is the main source of fish that is consumed in the major towns in Kenya, including the city of Nairobi. Some of the fish is also exported to Europe. Surveillance and assessment of heavy metals in the fish is important to ensure compliance with stipulated standards for human consumption. Obviously, noncompliance would lead to adverse health effects to the consumers as well as a ban on our fish exports.

Food crops are an important source of minerals that are important to the health of human beings. The main source of these minerals is the soils that they are grown in. The quality of these soils is ameliorated using additives such as fertilizers and manure. Sewage sludge contains important nutrients such as nitrogen, phosphorus and potassium in enough quantities to warrant it being used as manure. Some scale farmers who are close to major urban centers use it as a form of manure. However, sludge may also contain harmful heavy metals which when assimilated by the plants will enter the food chain.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

Staphylococcus aureus strains were isolated from 183 of 300 raw milk samples collected at the Kenya Cooperative Creamery (Dandora). Ninety seven percent of the 183 strains isolated  were assayed for the production of enterotoxin A, B, C and D. Seventy two (74.2 %) of these were found to produce either a single or a combination of enterotoxins. Raw milk is a potential source of enterotoxigenic S. aureus in milk and milk products especially if there is defective pasteurization.

Arsenic and Lead are naturally occurring elements whose toxicity in humans has been documented throughout history. These metals are widely present in our environment due to their natural occurrence and human activities that have introduced them into the general environment such as the use of borehole water and leaded gasoline. Because arsenic and lead may be present in environments where food crops are grown and animals used for food are raised, various foods such as milk may contain unavoidable but small amounts of arsenic and lead that do not pose a significant risk to human health. However, in certain circumstances they may contain high levels that may lead to contamination of milk with levels that may pose a risk to human health. Camel milk samples (n=15) were collected from Nanyuki, Kenya for arsenic and lead analysis. The heavy metals were determined using atomic absorption spectrophotometry following protein precipitation by use of trichloroacetic acid. All the samples analyzed had arsenic levels that ranged from 0.007 ppm to 0.099 ppm. These levels were found to be lower than the Food and Drug Administration (FDA) recommended maximum level of 0.1 parts per million (0.1 ppm), while 14 out of 15 samples (93%) had lead levels ranging from 0.072 ppm to 0.449 ppm and were observed to be above the codex standard (193- 1995) recommended maximum level of 0.02 ppm. The above results indicate that the sampled camel milk may not be safe for human consumption.

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Kenya is a country of marked environmental and ethnic diversity. A study of osteogenic sarcoma occurring in Kenya from 1968 to 1978 revealed 251 cases, representing between 89% and 100% of the predicted number. Variations in age, sex and anatomical location were within classical limits. However, the incidence of osteogenic sarcoma amongst the Central Bantu was significantly higher than predicted (P less than 0.0001), whilst the incidence among the Western Bantu was significantly lower (P less than 0.002), despite their similar ethnic origins. Two geographically dissimilar areas likewise exhibited significant differences in incidence. The Eastern province showed a higher incidence (P less than 0.02), whereas the Nyanza Province (P less than 0.001) and the adjacent Western Province (P less than 0.005) showed a lower than predicted incidence. These observations suggest that in Kenya a geomedical variable affects the incidence of osteogenic sarcoma and that genetic variation has no effect on incidence.

Runoff and soil loss was studied on steep terraced slopes containing various combinations of lines of Grevillea robusta, hedgerows of Calliandra calothyrsus and strips of Pennisetum purpureum in Kabale, southwest Uganda. A factorial design, replicated three times, included three levels of intra-row spacing (0, 3 and 5m) of Grevillea spp. and three understorey types (none, Pennisetum and Calliandra spp). The understorey and Grevillea were interplanted along a contour in the middle of the terrace parallel to the two adjacent risers. Results indicate that when contour lines of trees are on fallow ground there is little or possibly a negative effect in controlling soil and water loss. When contour lines are on steep cultivated terraces they have a significant effect in reducing losses. The understoreys appear to filter out much of the sediment from the runoff, holding it in or above the contour line of the vegetation. The potential for using contour lines of Pennisetum and Calliandra for controlling soil and water loss is discussed.

Runoff and soil loss was studied on steep terraced slopes containing various combinations of lines of Grevillea robusta, hedgerows of Calliandra calothyrsus and strips of Pennisetum purpureum in Kabale, southwest Uganda. A factorial design, replicated three times, included three levels of intra-row spacing (0, 3 and 5m) of Grevillea spp. and three understorey types (none, Pennisetum and Calliandra spp). The understorey and Grevillea were interplanted along a contour in the middle of the terrace parallel to the two adjacent risers. Results indicate that when contour lines of trees are on fallow ground there is little or possibly a negative effect in controlling soil and water loss. When contour lines are on steep cultivated terraces they have a significant effect in reducing losses. The understoreys appear to filter out much of the sediment from the runoff, holding it in or above the contour line of the vegetation. The potential for using contour lines of Pennisetum and Calliandra for controlling soil and water loss is discussed.

Emerald Publishing Limited, UK.

Objectives: To determine whether height can be used as an alternative to weight in mass treatment of children aged 1-15 years with active trachoma using azithromycin and propose a height-based dose stick for Kenyan children.
Design: community based operational research Subjects: A total of 2,020 children were included: 987(48.9%) male and 1033 (51.1%) female. 369 (18.3%) were from Kajiado, 772 (38.2%) from West Pokot and 879 (43.5%) from Baringo.
Settings: The study was carried out in three trachoma endemic districts: West Pokot, Baringo and Kajiado. A baseline trachoma survey had been conducted in the three districts in preparation for the implementation of SAFE.
Results: Children from West Pokot were heavier and taller than those from Kajiado and Baringo (P < 0.001). The body mass index (BMI) of the children in the three study areas was comparable. There was a close relationship between weight and height and the distribution was near linear. Height explained 92.8% of the variance of weight. A height based dose stick that recommends the use of 40mg/ml suspension and 125mg (half tablet) incremental dosage predicted doses within tolerance limits (15-30mg/kg) to 98.8% of children and 100%
with extended dose range (13 -35 mg/kg). If 40mg/ml suspension and 1 tablet (250mg) incremental dosage were to be used, the height stick would predict doses within tolerance limits to 97.5% of the children and 99.9% with extended dose range (13 -35 mg/kg).
Conclusions: The theoretical model based on the use of 40mg/ml suspension and
125mg (half tablet) incremental offers better dosing ranges to all the children of West Pokot, Baringo and Kajiado districts when the extended dosage range (13-35mgs/kg) is applied.
Recommendations: Similar studies should be conducted in other trachoma endemic communities in Kenya to determine whether a single height-based dose stick can be used in the entire country. The manufacturer should look into the possibility of producing 125mg tablet for mass treatment.

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Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who has become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in the identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even is such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.

Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who has become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in the identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even is such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.

Oyieke H.A. and Misra A.K:

Background. Helicobacter pylori is associated with several upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor-based triple therapies are considered the standard regimens for H. pylori eradication, but the optimal duration of therapy is controversial. To prevent infection and complications, local studies should be undertaken to evaluate H. pylori eradication rates in a country. Objectives. We compared 7-day and 14-day regimens to determine the optimum duration of triple therapy for H. pylori eradication. Methods. We undertook a prospective randomised comparative trial of 7-day and 14-day triple therapy regimen for H. pylori eradication at the Aga Khan University Hospital, Nairobi; 120 patients with dyspepsia and H. pylori infection were randomised to receive esomeprazole, amoxicillin and clarithromycin for either 7 days (EAC 7) or 14 days (EAC 14). Compliance and side-effects were assessed 2 weeks after the start of therapy and H. pylori eradication was assessed by stool antigen tests 4 weeks after treatment. Results. Both the intention-to-treat (ITT; N=120) and per protocol (PP; N=97) analyses showed no significant differences between the eradication rates of EAC 7 (ITT 76.7%; PP 92%) and EAC 14 (ITT 73.3%; PP 93.6%) (ITT p=0.67; PP p=0.76). Poor compliance was reported in one patient in the EAC 14 group. The incidence of adverse events was comparable in the two groups. Conclusion. One-week and 2-week triple treatments for H. pylori eradication are similar in terms of efficacy, safety and patient compliance.

In Kenya data on poultry helminthiasis are scarce and its research has received little attention owing to the less visible and chronic symptoms of helminthiasis that are difficult to discern. To bridge this gap, we examined 604 chicken guts from local slaughter houses in Kenya and then visited 22 homesteads in Central Province rearing indigenous free ranging chicken. A questionnaire dealing with clinical signs of helminthiasis and poultry management practices to assess whether the farmers discerned ill health in their flock was administered. Ninety percent of the slaughter house guts were positive for one or more helminth parasites, including Heterakis spp (28%), Strongyloides spp (24%), Ascaridia galli (14%), Acuaria spp (13.6%), Tetrameres spp (2.5%) and Davainea spp (2.1%) among others. Of the 22 homesteads, one or more reported abnormal conditions in their flock. Ninety percent observed depressed egg-laying, 59% saw weakness in legs and slimy/bloody stool, while 46% observed late maturity (>8months). Eighty two percent of the homesteads feedback tallied with the clinical signs associated with the helminth parasites identified from their poultry at coprology

The root of Solanum incanum is used by some Kenyan communities as a folklore remedy for fever, wounds, toothache, and stomach ache. However studies have not been done to validate these claims. The aim of this study was to investigate antinociceptive and antipyretic effects of Solanum incanum root extract using animal models. The antinociceptive assays were carried out using tail flick and hot plate tests on CBA mice. The 100 and 200 mg doses of Solanum incanum root extract showed significant antinociceptive activity (p < 0.05) in both hot plate and tail flick tests. In the antipyretic, assay fever was induced in Sprague Dawley rats using lipopolysacharide (LPS). The 50 mg dose of Solanum incanum extract exhibited significant antipyretic effect (p < 0.05) at 180 minutes while the 100 mg dose of S. incanum exhibited significant antipyretic effect (p < 0.05) at 120 and 180 minutes after the lipopolysaccharide pyrogen injection. The results obtained renders support to folklore use of Solanum incanum root extract for pain and fever. Keywords: Solanum incanum, Antinociceptive, Analgesic, Antipyretic, Fever.

The root of Solanum incanum is used by some Kenyan communities as a folklore remedy for fever, wounds, toothache, and stomach ache. However studies have not been done to validate these claims. The aim of this study was to investigate antinociceptive and antipyretic effects of Solanum incanum root extract using animal models. The antinociceptive assays were carried out using tail flick and hot plate tests on CBA mice. The 100 and 200 mg doses of Solanum incanum root extract showed significant antinociceptive activity (p < 0.05) in both hot plate and tail flick tests. In the antipyretic, assay fever was induced in Sprague Dawley rats using lipopolysacharide (LPS). The 50 mg dose of Solanum incanum extract exhibited significant antipyretic effect (p < 0.05) at 180 minutes while the 100 mg dose of S. incanum exhibited significant antipyretic effect (p < 0.05) at 120 and 180 minutes after the lipopolysaccharide pyrogen injection. The results obtained renders support to folklore use of Solanum incanum root extract for pain and fever. Keywords: Solanum incanum, Antinociceptive, Analgesic, Antipyretic, Fever.

Background: Pethidine, an opioid analgesic is used for pain management. Clomipramine a tricyclic antidepressant primarily used for mood management is also used to treat pain. The objective of this study was to investigate the potentiation of the analgesic effects of sub-threshold dose of pethidine by a tricyclic antidepressant, clomipramine. Methods : The antinociceptive activities of clomipramine and pethidine alone and in combination were investigated in Swiss albino mice using the formalin test. Normal saline was employed as the control. Ten animals were used in each experiment. Results: Pethidine 5mg / kg failed to cause any significant effect while the 6.25, 7.5, 8.75 and 10.0mg /kg showed highly significant antinociceptive effect (p< 0.01) compared to the controls in the late phase of formalin test. Clomipramine 0.5 mg / kg did not show any significant effect while 0.75 mg / kg caused a significant effect (p< 0.05) while 1.00 and 1.25mg /kg caused a very highly significant antinociceptive effect (p< 0.001) in the late phase of formalin test compared to the vehicle treated animals. The combination of pethidine 5mg / kg and clomipramine 0.75mg / kg caused a highly significant antinociceptive effect (P<0.01) in the late phase of formalin test.  Conclusion: This study demonstrates a marked reduction in the time spent in pain behaviour produced by the combination of low dose pethidine and clomipramine in the late phase of formalin test. The findings demonstrate the potentiation of a narcotic analgesic by a tricyclic antidepressant.

Aim of Investigation: Approximately 80% of the world population relies on traditional healers who use herbal remedies. Seventy percent of sub Saharan Africa is reported to be using herbal medicine for management of various medical conditions. Based on anecdotal evidence, herbal remedies used in most communities are claimed to be effective and there is need to evaluate their effectiveness for the benefits to the general population. Natural products still hold the promise for the future of drug discovery in the management pain. Analgesic substances have been purified from plants resulting in the identification of novel structures with known mechanism of actions. The roots and bark of Toddalia asiatica have been traditionally used in the treatment of pain. The aim of this study is to investigate the antinociceptive activities of T. asiatica root extract using the formalin test in mice. Methods: Roots of Toddalia asiatica were sourced, air-dried, powdered and extraction done using dichloromethane and methanol in the ratio of 1:1. The extracts were then concentrated and reconstituted in 5% dimethylsulfoxide (DMSO) and 95% normal saline to achieve working concentrations of 50,100 and 200 mg / kg body weight. The experimental and control animals were injected intraperitoneally 1 hour prior to the experiment. 8 mice were used in each group and each animal was used once. Sensorimotor test was performed on each animal prior to the formalin test. Results: None of the animals showed sensorimotor defect. The 50mg /kg dose showed no significant antinociceptive effect in either the early or the late phase of formalin test.The 100mg / kg dose showed highly significant antinociceptive effect (p < 0.001) in the late phase (15-30 mins) of formalin test while the 200mg / kg dose showed a significant antinociceptive effect (p < 0.01) in the early phase (0-5mins) of formalin test compared to the vehicle treated animals. The 200 mg / kg dose showed no significant effect in the late phase of formalin test. Conclusions: These results suggest that the root extract of Toddalia asiatica has significant antinociceptive effects in the formalin test using mice.

Rhus natalensis and Senna singuaenae are traditional African plants commonlyused as medicinal plant in East Africa for the management of pain. The plants areused for management of rheumatism among others. This study investigated theantinociceptive activities of R. natalensis and S. singuaenae in Swiss albino miceusing the tail-flick and hot plate tests. Extract solvent (vehicle), morphine andaspirin were employed as controls. Root extract of R. natalensis (100 and 200 mg /kg) and 100 mg /kg of S. singuaenae showed no significant antinociceptive activity in the hot plate while the 200mg /kg of S. singuaenae showed significant antinociceptive activity (p<0.05). In the tail flick tests, root extract of R. natalensis (100 and 200 mg / kg) showed highly significant antinociceptive activity (p<0.01) while 200mg / kg of S. singuaenae showed significant antinociceptive activity (p<0.05) compared to the controls. The 100 mg /kg of S. singuaenae showed no significant antinociceptive activity in the tail flick. This study lends support to the anecdotal evidence for use of R. natalensis and S. singuaenae in the management of painful conditions..Keywords: Rhus natalensis; Senna singuaenae; analgesic,;

Toddalia asiatica within the context of traditional African medicine is a commonly used medicinal plant in East Africa for the management of pain and inflammatory conditions. It is used by the Masai in both Kenya and Tanzania for management of rheumatism among others. The present study was undertaken to investigate the antinociceptive activities of T. asiatica in Swiss albino mice in acetic acid-induced writhing, tail-flick and hot plate pain tests. The extract solvent (vehicle), morphine and aspirin were employed as negative and positive controls respectively. The acetic acid -induced writhing test was used as the screening test and as the root bark extract was found to be more potent than the leaf extract, the former was investigated using the hot plate and the tail flick tests. The root bark extract (200 mg / kg) showed highly significant (p < 0.001) antinociceptive activity in the hot plate and the tail flick tests. The 100mg/kg dose showed significant (p < 0.05) activity in the tail flick test but not significant in the hot plate test. The present study, therefore lends support to the anecdotal evidence for use of T. asiatica in the management of painful condition.

Virology Research Division, Institute of Primate Research, Karen, Nairobi, Kenya. ipr@elci.sasa.unep.no The objective of this study was to investigate the gastro-intestinal (GIT) parasites commonly occurring in captive and wild-trapped (WT) non-human primates (baboons, vervets and Sykes) in Kenya and compare their prevalence. Three hundred and fifteen faecal samples were subjected to a battery of diagnostic tests, namely, direct smear, modified formal ether sedimentation, Kato thick smear, Harada-Mori techniques for parasite detection and culture to facilitate nematode larvae identification. Of these, 203 (64.4%) harboured helminths and 54 (17.1%) had protozoa. The helminth parasites comprised Strongyloides fulleborni 141 (44.8%), Trichuris trichuira 200 (63.5,%), Oesophagostomum sp. 48 (15.2%), Trichostrongylus sp. 73 (23.2%), Enterobius vermicularis 44 (14.0%), Schistosoma mansoni 4/92 (4.3%) and Streptopharagus sp. 68 (21.6%). Protozoan parasites consisted of Entamoeba coli 204 (64.8%), Balantidium coli 127 (40.3%) and Entamoeba histolytica 78 (24.8%). Both WT and colony-borne (CB) primates had similar species of parasites, but higher prevalences of protozoan infection were observed in CB baboons while helminth infections were relatively more common in WT primates. Some of the parasites observed in this study are reported to be zoonotic in various parasitological literatures. Chemoprophylaxis and other managerial practices were believed to be responsible for the lower worm prevalence in CB primates. Similar intervention against protozoa and other agents will not only improve primate health, but also increase safety to animal handlers and colony workers. PMID: 9760061 [PubMed - indexed for MEDLINE]

A survey was undertaken to study the epidemiology and intensity of nematode infection among goats on eight randomly selected mixed farms in a coffee marginal area of Central Kenya.

Various age groups of goats were ear tagged and faecal sampled at the beginning of the study. They were treated with albendazole 10% at manufacturers recommended dose. These goats were faecal sampled fortnightly. Weights and blood for PCV and serum albumin were taken monthly.

The intensity of infection varied with age groups of the goats and the individual farms.

Fourteen days after treatment, the faecal egg counts were reduced to zero except one farm. Coprocultures revealed that Haemonchus contortus was the main nematode species infecting these goats. Cooperia curticei occurred in low numbers in a few farms.

A study was carried out on 456 indigenous poultry intestinal specimens from various towns in Kenya to determine the occurrence and distribution of helminth parasites in the intestinal tract of the birds. Of the specimens examined, 414 had parasites whereas the remaining 42 had none, which is an infection rate of 90.78%. The main species of helminths found in the intestines were Raillietina sp. (47.53%), Heterakis gallinarum (21.33%), Ascaridia galli (10.03%), Strongyloides avium (9.96%), Choanotaenia infundibulum (4.61%), Cotugnia digonopora (3.6%), Capillaria sp. (1.5%), Trichostrongylus tenius (1.04%) and Syngamus trachea (0.40%). Most helminths were present in both the mid- and hindguts. Syngamus trachea and C. digonopora were only found in the foregut and midgut, respectively. Although chickens from which the specimens were collected appeard healthy, the high prevalence of helminthiasis observed shows the poor level of helminth infection control practiced by the indigenous poultry keepers in the country, which might affect the health status of the birds and their growth rates. Poultry keepers should be encouraged to prevent, control and treat such cases.

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