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This paper reviews clinicopathological and hematological manifestations of sickle cell anemia as seen in Kenyan children in the first decade of life. The information is based on a study of 447 patients. The findings are similar to those that are well documented from America, West Africa, and other parts of Africa. However, local variations and complications such as malnutrition and topical infections that may affect prognosis are high-lighted.

Introduction: The objective of our study was to document the level of preparedness for renal replacement therapy assessed by incident hemodialysis vascular access and the access at least 3 months after initiation of hemodialysis at Kenyatta National Hospital, Nairobi.

Methods: Between June and July 2018, we carried out a cross-sectional descriptive study on the preparedness for hemodialysis by patients who were on chronic hemodialysis in the Kenyatta National Hospital Renal Department. Sociodemographic, medical history, duration of follow-up, and state of preparedness parameters were obtained through interview and entered into the questionnaire. The data were entered in preprogrammed format in the Statistical Package for the Social Sciences (SPSS) version 20.0 for analyses.

Results: Eighty-two patients were enrolled. Males were 50% (41). The mean age was 45.39 ± 15.96 years but females were 5 years younger than their male counterparts. About 85.4% of the patients were drawn from the hypertension and diabetes clinics, and the mean, mode, and median of the duration of follow-up were 41, 0, and 0 months, respectively, in these clinics. Almost three in every four patients (74.4%) were initiated on hemodialysis as emergency (p value < 0.001). About 80% were initiated hemodialysis via acute catheters placed in the jugular and subclavian veins (p value < 0.001). At least 3 months later, 40% still had acute catheters on the same veins (p value < 0.001). Acute venous catheters in the femoral veins were in 9.2% at initiation and 6.6% of the patients at least 3 months later. Less than 2% of the patients had arteriovenous fistulae at initiation, which rose to 14.5% in 3 months. Tunneled catheters were placed in 11.8% initially and at least 3 months, were almost in 40% of the patients.

Conclusion: In conclusion, our young hemodialysis population mainly drawn from hypertension and diabetes clinic requires more input in hemodialysis vascular access planning. Focused individualized follow-up and early referrals to nephrologists are required. Uptake of arteriovenous grafts for hemodialysis might reduce the prevalence of hemodialysis catheters. As it is, this population is threatened with iterative vascular accesses complications as well as real danger of exhaustion of their vascular capital. There is real danger of increase in mortality from access complications.

Keywords: Hemodialysis; arteriovenous fistula; arteriovenous graft; end-stage renal disease; tunneled catheter; vascular access.

Placebo and enalapril were added on a double-blind basis to conventional treatment in 14 patients with congestive heart failure (CHF), New York Heart Association class II-III. The patients were followed for 14 weeks and their performance was evaluated by a treadmill test, ejection fraction by nuclear scan, cardiothoracic ratio, and Yale Scale score. Metabolic studies were done to test any adverse effects of the drugs. Enalapril decreased arterial pressure and cardiothoracic ratio, and increased ejection fraction. Placebo exerted no significant effects. However, both drugs improved treadmill time and Yale Scale score. No adverse metabolic or clinical effects were observed with either drug. Based on these limited observations we conclude that: Enalapril is a useful ancillary agent to conventional treatment of CHF; it exerts its effects through afterload and preload reduction; and it is safe and well tolerated and has a prolonged duration of action.

Employing the rabbit's abdominal aorta as a suitable atherosclerotic model, transient three-dimensional blood flow simulations and monocyte deposition patterns were used to evaluate the following hypotheses: (i) simulation of monocyte transport through a model of the rabbit abdominal aorta yields cell deposition patterns similar to those seen in vivo, and (ii) those deposition patterns are correlated with hemodynamic wall parameters related to atherosclerosis. The deposition pattern traces a helical shape down the aorta with local elevation in monocyte adhesion around vessel branches. The cell deposition pattern was altered by an exercise waveform with fewer cells attaching in the upper abdominal aorta but more attaching around the renal orifices. Monocyte deposition was correlated with the wall shear stress gradient and the wall shear stress angle gradient. The wall stress gradient, the wall shear stress angle gradient and the normalized monocyte deposition fraction were correlated with the distribution of monocytes along the abdominal aorta and monocyte deposition is correlated with the measured distribution of monocytes around the major abdominal branches in the cholesterol-fed rabbit. These results suggest that the transport and deposition pattern of monocytes to arterial endothelium plays a significant role in the localization of lesions.

Abstract Understanding the biochemical mechanisms that enable high-altitude animals to survive and function under conditions of hypoxic stress can provide important insights into the nature of physiological adaptation. Evidence from a number of high-altitude vertebrates indicates that modifications of hemoglobin function typically play a key role in mediating an adaptive response to chronic hypoxia. Because much is known about structure–function relationships of mammalian hemoglobins and their physiological role in oxygen transport, the study of hemoglobin variation in high-altitude mammals holds much promise for understanding the nature of adaptation to hypoxia from the level of blood biochemistry to the level of whole-organism physiology. In this review I 1st discuss basic biochemical principles of hemoglobin function and the nature of physiological adaptation to high-altitude hypoxia in mammals. I then discuss a case study involving a complex hemoglobin polymorphism in North American deer mice (Peromyscus maniculatus) that illustrates how integrative studies of protein function and fitness-related physiological performance can be used to obtain evolutionary insights into genetic mechanisms of adaptation.

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This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

This paper reports on work which was done on the upper Tana in Eastern Kenya. The work revealed a number of iron-using sites which included smelting areas, so-called Gumba earth works and lot of pottery, belonging to triangular incised (TIW) and Kwale Ware. It is concluded that TIW post date Kwale Ware and it is likely the TIW makers/users were responsible for the iron working in the Area.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

There is a causal relationship between political leadership and economic development. There is evidence that the deterioration of economic conditions in African since independence is owed to poor management of public economic affairs by the incumbent state leadership. This argument implies that whereas the continent may not be very well endowed with natural resources, this may not be held solely responsible for the existing economic woes. Whatever resources exist are capable of generating economic development, indeed economic breakthrough, if they are harnessed and utilized effectively. Conversely, a country may be endowed with enormous natural and human resources, but may remain characterized by poverty and economic backwardness if it is not endowed with visionary, dedicated and rational political leadership capable of appropriating such resources for the purpose of national development and for the prosperity of the citizens.

A sacred site is a place which is considered holy, and is partially or wholly reserved for magico-religious or ceremonial functions. Because of this it is venerated and revered and is kept free from contamination by sin and evil. Sacred sites vary in size from very small places covering a few square metres to large areas covering several hectares of land. They are usually characterized by the presence of artefacts, ecofacts and features that are unique to them; they may be in the open air, or in rockshelters, caves and forests. In many cases, sacred sites have frightening tales told about them, in order to scare off those who would want to destroy or defile them. In the archaeological record, sacred sites may initially be identifiable as burial sites, ceremonial sites or butchery sites. It is on the basis of such clues that other attributes that are typical of sacred sites can be identified, isolated and studied. It is against this background that this chapter discusses the Mijikenda kaya (pi. makaya) as a sacred site.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

This paper reports on work which was done on the upper Tana in Eastern Kenya. The work revealed a number of iron-using sites which included smelting areas, so-called Gumba earth works and lot of pottery, belonging to triangular incised (TIW) and Kwale Ware. It is concluded that TIW post date Kwale Ware and it is likely the TIW makers/users were responsible for the iron working in the Area.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

A sacred site is a place which is considered holy, and is partially or wholly reserved for magico-religious or ceremonial functions. Because of this it is venerated and revered and is kept free from contamination by sin and evil. Sacred sites vary in size from very small places covering a few square metres to large areas covering several hectares of land. They are usually characterized by the presence of artefacts, ecofacts and features that are unique to them; they may be in the open air, or in rockshelters, caves and forests. In many cases, sacred sites have frightening tales told about them, in order to scare off those who would want to destroy or defile them. In the archaeological record, sacred sites may initially be identifiable as burial sites, ceremonial sites or butchery sites. It is on the basis of such clues that other attributes that are typical of sacred sites can be identified, isolated and studied. It is against this background that this chapter discusses the Mijikenda kaya (pi. makaya) as a sacred site.

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

There is a causal relationship between political leadership and economic development. There is evidence that the deterioration of economic conditions in African since independence is owed to poor management of public economic affairs by the incumbent state leadership. This argument implies that whereas the continent may not be very well endowed with natural resources, this may not be held solely responsible for the existing economic woes. Whatever resources exist are capable of generating economic development, indeed economic breakthrough, if they are harnessed and utilized effectively. Conversely, a country may be endowed with enormous natural and human resources, but may remain characterized by poverty and economic backwardness if it is not endowed with visionary, dedicated and rational political leadership capable of appropriating such resources for the purpose of national development and for the prosperity of the citizens.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

A sacred site is a place which is considered holy, and is partially or wholly reserved for magico-religious or ceremonial functions. Because of this it is venerated and revered and is kept free from contamination by sin and evil. Sacred sites vary in size from very small places covering a few square metres to large areas covering several hectares of land. They are usually characterized by the presence of artefacts, ecofacts and features that are unique to them; they may be in the open air, or in rockshelters, caves and forests. In many cases, sacred sites have frightening tales told about them, in order to scare off those who would want to destroy or defile them. In the archaeological record, sacred sites may initially be identifiable as burial sites, ceremonial sites or butchery sites. It is on the basis of such clues that other attributes that are typical of sacred sites can be identified, isolated and studied. It is against this background that this chapter discusses the Mijikenda kaya (pi. makaya) as a sacred site.

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Settlement pattern studies are concerned with relics of human occupation in the past. In an archaeological record, these relics either appear in clusters or individually in the form of pestholes, house floors, house foundations or as middens. On aerial photographs and topographic maps relics of past human occupation can be identified by the presence of circular or rectangular depressional features and stunted vegetation cover in the midst of a flourishing vegetation community. Past human settlements can also be identified in actual field observation as ruins: building structures, walled fortresses, moats, monuments and mounds.

Irrespective of their nature and conditions of preservation, past settlements are a reflection of human behaviour through time and space. The archaeological evidence that is found preserved in them can shed much light on our knowledge of past culture. The essential archaeological problem in the analysis and interpretation of settlement, however, is that architectural remains and other settlement data cannot be understood simply by their description, distribution, cultural attribution and chronology - as they have been from the early anthropological work of Morgan (1881) and Mindeleff (1890) through the first large-scale regional archaeological syntheses, such as Childe's (e.g. 1934) in Europe and Willey (1953) in South America up to the common archaeological survey work of today.

With the influence of modern cultural ecology, geography and sociobiology, settle­ment analysis has been transformed into a concern with environmental and ecological processes. Settlements are part of a complex integration of culture and ecology within a regional environment. As a result, settlement analysis in archaeology must attend not only to the physical layout of the environment, but also to the social and historical aspects of environmental interaction.

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

The precolonial trading systems of the East African interior have a great antiquity ml can best be understood by employing a multidisciplinary approach including archaeology, oral traditions, linguistic evidence and documentary sources. Two types oj trade, namely subsistence-oriented and nonsubsistence-oriented or long-distance frai, can be identified. In general, the nonsubsistence-oriented trade was a response demands for unevenly distributed resources at both local and international levels, This is demonstrated by some of the coastal and hinterland settlements for which there is evidence for periods of prosperity. Archaeological evidence from the pre-tenth-century AD settlements on the coast, and documentary evidence of the same period, show how this prosperity emanated from trade transactions between the coast and the interior in response to industrial and labor-force demands in the lands beyond the Indian Ocean, particularly the Orient and Mediterranean Europe. The steadily expanding market for commodities from the interior, particularly ivory and slaves, provided by the international maritime trade especially after the fifteenth century, brought new opportunities for the expansion of long-distance trade. These created and strengthened contacts between the East African interior and the coast, in order to satisfy the needs of the expanding markets in Europe and the Orient, for instance, the Akamba, the Nyamwezi, and the Yao caravans, to name just a few, collaborated with the Mijikenda, the Swahili, and Arab caravan traders to deplete tht interior of its resources for the markets overseas. Trade with the interior not only increased in volume but also witnessed the supplementing of traditional commodities with new ones. From the coast, for example, interior communities got luxury items such as cloth, beads, porcelain, glass, and later guns, which had not been seen in the interior before. In addition to these were cowrie shells, now as a form of currency, certain foodstuffs, and salt. These were exchanged for interior products of the hunt and jar slaves. It seems that interior communities never took the first initiative in tk international trade that characterized this region in the period under review. Ik initiative was always taken by coastal communities in response to industrial growth and labor-force demands overseas. Analyzing the balance sheet of this trade, it my k concluded that precolonial African societies in the interior were not what we would now call astute business people with long-term investment programs. There is little evidence to show that they benefited very much from these transactions, in spite of the active role that they played.

Schrebera alata is a deciduous fuel tree from which the Samburu people in Northern Kenya obtain bark for medicinal purposes. A pharmacologically active principle that produces analgesic effects can be extracted from the bark with hot water. When administered to rats daily for a period of 6 weeks, the extract of bark (referred to as II kau kawa by the Samburu) caused reduced activities of succinic dehydrogenase, an enzyme that is involved in oxidative processes, and cholinesterase in heart and liver tissues. Histological sections from the liver revealed extensive cellular degeneration and small areas with necrotic lesions. Only that fraction of the bark extracts which contained components less soluble in alcohol produced such lesions within a 2 weeks period. The same fraction is associated with pharmacological activity. Since hepatic injuries occur frequently and the incidence of primary hepatic carcinoma is high in tropical areas, the role of natural toxins as aetiologic factors for cirrhotic conditions must be adequately clarified. It is apparent that bark from S.alata possesses some toxicity and its effects on the liver indicate it can contribute significantly to prevalent hepatocellular damages.

The effects of infection of mice with Leishmania major on liver microsomal protein and cytochrome P-450 were examined. The levels of hepatic microsomal protein and cytochrome P-450 were monitored at 6, 7, 9 and 12 weeks post-infection. The results indicated that the amount of hepatic microsomal protein and cytochrome P-450 were unchanged throughout the course of infection with L. major, despite the high degree of parasite proliferation in Kupffer cells and marked reduction in phagocytosis. The current results clearly indicate that Leishmania-induced macrophage suppression has no inhibitory effect on hepatic microsomal protein and cytochrome P-450

Viral hepatitis is a major concern worldwide, with hepatitis A (HAV) and E (HEV) viruses showing sporadic outbreaks while hepatitis B (HBV) and C (HCV) viruses are associated with chronic hepatitis, cirrhosis and hepatocellular carcinoma. The present study determined the proportion, geographic distribution and molecular characterization of hepatitis viruses among patients seeking medical services at hospitals throughout Kenya.

Worldwide, primary liver cell carcinoma (PLC) is one of the most common tumours. Epidemiological evidence has implicated hepatitis B virus (HBV) in its aetiology and the mechanisms whereby HBV could operate at the genomic level have been investigated using the techniques of molecular biology. The resemblance of certain features of HBV to the retroviruses has also suggested mechanisms whereby malignant transformation may take place, but as yet there is no clear evidence for HBV being directly oncogenic. This has suggested to some that it is the persistent inflammatory reaction caused by HBV infection that is instrumental in causing PLC. We believe, however, that HBV can act independently of this mechanism and that the failure so far to show this at the molecular level may be due to technical reasons.

Hepatocellular carcinoma is the third most common malignancy in Kenyan males occurring with a peak incidence at 40 years of age. A worldwide correlation has been noted between the incidence of hepatocellular carcinoma and prevalence of hepatitis B virus. Liver biopsies with histological diagnosis of hepatocellular carcinoma (HCC), cirrhosis and the normals were reviewed by the authors. They were then stained for hepatitis B surface antigen (HBsAg) and hepatitis e core antigen (HBcAg). Only 2.5% of normal livers were positive for HBsAg compared with 33% of HCC and 25% of cirrhosis respectively. Hepatitis core antigen was not demonstrated in normal liver biopsies but it was present in 11.5% of HCC and 14% of cirrhosis. Background cirrhosis was noted in 52% of biopsies showing HCC. It is clear that a causal association exists between hepatitis B virus (HBV) and both liver cirrhosis and hepatocellular carcinoma. Higher antigen markers, up to 80% have been reported in South East Asia and India. This difference may be due to the type of biopsy examined (needle biopsy vs open biopsy) but the possibility that other factors such as aflatoxin and non A/non B hepatitis viruses play a more significant role in the causation of liver disease in Kenya than has previously been assumed should be explored.

In 1982-1984, an epidemiologic survey of the prevalence of hepatitis B virus surface antigen (HBsAg) in circulating blood (HBs-antigenemia) and of hepatitis delta virus infection was performed in Kenya. The distributions of hepatitis B virus and the delta virus were shown to be very variable. In southern Kenya, only two of 202 sera from HBsAg-positive individuals with no known liver disease and none from 123 HBsAg-positive patients with hepatitis B-related liver disease were positive for delta antibody. In contrast, in northern Kenya, there was an overall prevalence of delta antibody in healthy individuals of 31%. The distribution of delta infection is discussed in relation to lifestyle, ethnic group, and geographic area.

To evolve a simple oxygen electrode-based method to estimate alternative respiration, one needs to develop a procedure to prevent switch-over of electrons to either pathway upon inhibition by cyanide or salicylhydroxamic acid. It was hypothesized that the inclusion of appropriate electron acceptor, possessing redox potential close to one of the electron transport carriers in between ubiquinone (branch point) and cytochrome a-a3, should be able to stop switch-over of electrons to either pathway by working as an electron sink. To test the hypothesis, 2,6-dichloro-phenol indophenol (DCPIP; redox potential +0.217 V), an artificial electron acceptor having a redox potential quite similar to the site near cytochrome c1 (redox potential +0.22 V) on the cyanide-sensitive pathway, was used with isolated mitochondria and leaf discs in the absence and presence of inhibitors (potassium cyanide, antimycin A, and salicylhydroxamic acid). Polarographic data confirmed electron acceptance by DCPIP only from the inhibited (by cyanide or salicylhydroxamic acid) mitochondrial electron transport chain, hence preventing switch-over of electrons between the cyanide-sensitive and cyanide-insensitive pathway of respiration. Results with antimycin A and reduction status of DCPIP further confirmed electron acceptance by DCPIP from the mitochondrial electron transport chain. Possible implications of the results have been discussed. Copyright 1999 Academic Press.

Hepatitis G virus (HGV)/GB virus-C (GBV-C) has been identified as a blood-borne agent with disputed pathogenicity. This virus belongs to the flaviviridae with a distant relationship to hepatitis C virus (HCV). Genetically divergent HGV isolates have been reported from different parts of the world. This study describes the prevalence of HGV in multitransfused thalassaemic children in India and genomic sequence variations in 11 HGV isolates from the same geographical location. Hepatitis G virus RNA was detected in 39.7% multitransfused thalassaemic children. The seroprevalence of hepatitis B virus (HBV) and HCV was 23.8% and 17.1%, respectively, and 11.4% had dual infection. The nucleotide sequence of a 166 bp HGV genomic segment from the putative capsid-envelope region (nucleotide; nt 578-743) from 11 Indian isolates was compared to the sequences available in the nucleotide databases. The isolates from India were 81.3-94.5% homologous to the isolates from other parts of the world. On phylogenetic analysis, it was observed that HGV isolates from India may belong to two genetically divergent types.

Non-alcoholic fatty liver disease (NFLD) is the hepatic manifestation of the metabolic syndrome recognized as the most prevalent chronic liver disease across all age groups. NFLD is strongly associated with obesity, insulin resistance, hypertension and dyslipidemia. Extensive research efforts are geared, through pharmacological approach, towards preventing or reversing this. Erythrina abyssinica Lam ex DC is an indigenous tree used widely used in traditional medicine, including for the treatment of liver related diseases, and has been shown to possess hypoglycemic, anti-oxidant, antimicrobial and anti-plasmodia effects. The present study is aimed at establishing the effects of E. abyssinica on the development of Non-alcoholic fatty liver disease induced by a high-fat and high-sugar diet in rats, in-vivo model. Methods: Forty rats (40) were randomly divided into five groups: positive control (pioglitazone), Negative control (high fat/high sugar diet), low test dose (200 mg/kg), high test dose (400 mg/kg) and normal group (standard chow pellets and fresh water). The inhibitory effect of the stem bark extract of E. abyssinica on the development of NAFLD was evaluated by chronic administration the herb extracts to rats on a high-fat/high-sugar diet. Biochemical indices of hepatic function including serum lipid profile, serum aspartate transaminase and alanine transaminase levels were then determined. Histological analysis of liver samples was carried out to quantify the degree of steato-hepatitis. Liver weights were taken and used to determine the hepatic index. The data was analyzed using one-way ANOVA, and Tukey9s post-hoc tests

Sera from 124 adult Kenyan patients with chronic splenomegaly and from 93 geographically matched controls without splenomegaly were tested for evidence of Schistosoma mansoni infection by enzyme-linked immunosorbent assay (ELISA). Ova of S. mansoni were detected on stool or rectal snip examination in 23.4% of all patients, whereas 57.3% had a positive ELISA. All patients with parasitological or histological evidence of schistosomal infection had a positive ELISA, and a negative test reliably excluded schistosomiasis. On the basis of liver histology, 23 patients (18.5%) were considered to have hepatosplenic schistosomiasis, of whom 17 (73.9%) had a positive stool or snip. The ELISA was positive in 47.5% of cases of non-schistosomal splenomegaly, and in 52.7% of apparently normal controls. This high seropositive rate in the latter two groups emphasizes that schistosomal infection does not signify disease, and limits the diagnostic value of the test in individual cases of splenomegaly. Marked tribal and, therefore geographical, differences were noted in the prevalence of infection.

Hepcidin levels are high and iron absorption is limited in acute malaria. The mechanism(s) that regulate hepcidin secretion remain undefined. We have measured hepcidin concentration and cytokines in 100 Kenyan children with acute falciparum malaria and different degrees of anemia. Hepcidin was increased on admission and fell significantly one week and one month after treatment. The association of hepcidin with hemoglobin was not linear and hepcidin was very low in severe malarial anemia. Parasite density, IL-10 and IL-6 were significantly associated with hepcidin concentration. Hepcidin response to acute malaria supports the notion of iron sequestration during acute malaria infection and suggests that iron administration during acute malaria is futile. These data suggest iron supplementation policies should take into account the high hepcidin levels and probable poor utilization of iron for up to one week after treatment for the majority of patients with acute malaria.

This study was conducted in the northern part of Kenya, in Kakuma division, Turkana district. Kakuma is a semi-arid area under nomadic pastoralism as the main activity. The presence of a refugee camp has attracted many people from within the Turkana community and also the outside community. The study aimed at documenting the effects of emergent land use changes on vegetation resources and the socio-economic environment in Kakuma. Data on vegetation density and cover was collected. Socio-economic data was collected from the local Turkana population and the settlement camp. The data was analysed using SPSS computer package and descriptive statistics. There was a significant difference (P<0.05) in vegetation cover and density with increasing distance away from the settlement camp. The mean tree crown cover was low near the settlement camp (6.2%) but high away from the settlement camp (57.7%). Mean tree density was high near the settlement camp (13 individuals/ 100m2). Shrub crown cover was low (0.9%) in the areas that had settlements. The need for fencing and building materials was the main cause of low shrub cover. The density of the shrub species generally increased as one moved away from the settlement camp (17 individuals/ 16m2). Herb species cover and density was high near the settlement camp(68% and 202 individuals/ 1m2 respectively) but this comprised mostly of species unpalatable to livestock like Tribulus terrestris and Portulaca oleraceae. The study revealed that droughts and livestock raids in the previous years had set in motion social and ecological changes. The loss of livestock through raids and droughts encouraged sedenterization. This affected the cultural patterns and has had an effect on the rangeland condition. Lack of mobility concentrated livestock in specific areas, thus depleting the forage resources and creating conditions for soil erosion. Trading activities between the refugees and the Turkana had both positive and negative impact on the economic, social and cultural setup of the local community. The increase in population around Kakuma and the settlement camp has set in motion changes that have affected vegetation and social structures. The immediate social and economic returns from the exploitation of resources have overridden the long-term benefits. In regard to this there is a need for education on the impacts, both short-term and long-term, of the various activities on the vegetation, livestock resources and also the pastoral lifestyle. Key words: Pastoralism, Settlement, Land use, Environmental impact.

Introduction: Herbalists in Kenya use self-taught processing practices which are inadequate. The objective of
this study was to conduct an assessment of selected practices used by herbalists during drug processing and to identify knowledge gaps.

Method: Four long practicing traditional medicinal practitioners were identified using purposive sampling. An
interview guide and field visits were used to gather data. Data analysis was done using content thematic
approach.

Results: Sources of herbal knowledge were varied with the use of internet being a key finding. Regulatory
compliance presented various challenges to the herbalists. The wild and cultivation of herbs were identified as key medicinal sources although the protection of biodiversity was a key concern of the herbalists. The facilities, area of practice and general hygiene were inadequate. Positive and negative practices were identified in processing of the herbal medicines.

Conclusions: Secrecy by the herbalists has resulted in limited in innovation. More training of herbalists is
required to improve on the quality of their drugs. It is however encouraging that they have adopted some
modern methods in their practice.

Keywords: Herbalists, processing practices, herbal drugs

Herbal Product Processing Practices of Traditional Medicine Practitioners in Kenya-Key Informant Interviews
Irene Njeri Chege, Faith Apolot Okalebo, Anastasia Nkatha Guantai, Simon Karanja, Solomon Derese
Journal of Health, Medicine and Nursing, 2015, 16, 11-23

Abstract
Introduction: Herbalists in Kenya use self-taught processing practices which are inadequate. The objective of
this study was to conduct an assessment of selected practices used by herbalists during drug processing and to
identify knowledge gaps.
Method: Four long practicing traditional medicinal practitioners were identified using purposive sampling. An
interview guide and field visits were used to gather data. Data analysis was done using content thematic
approach.
Results: Sources of herbal knowledge were varied with the use of internet being a key finding. Regulatory
compliance presented various challenges to the herbalists. The wild and cultivation of herbs were identified as
key medicinal sources although the protection of biodiversity was a key concern of the herbalists. The facilities,
area of practice and general hygiene were inadequate. Positive and negative practices were identified in
processing of the herbal medicines.
Conclusions: Secrecy by the herbalists has resulted in limited in innovation. More training of herbalists is
required to improve on the quality of their drugs. It is however encouraging that they have adopted some
modern methods in their practice.
Keywords: Herbalists, processing practices, herbal drugs

Background: Premature infants contribute substantially to infant morbidity and mortality especially in low resource settings. Information on herbal remedy use, previous preterm birth and low social-economic status and their association with incidence of preterm birth in Kenya is scanty.
Objectives: To determine the use of herbal remedy use in pregnancy, previous preterm birth and low socio-economic status as risk factors for Preterm Birth in Kitui County among the immediate post-partum mothers.
Methods: Unmatched case control study with a 1:4 ratio of cases to controls. The study was done in Kitui and Mwingi District Hospitals. A total of 107 mothers with preterm birth (cases) and 453 mothers with term births (controls) were eligible and administered structured interviews.
Results: Of the sample, 98% of cases resided in rural areas compared to 90% of controls. The cases had a higher parity and were more likely to belong to the lowest three and four levels of socio-economic status. On multivariate logistic regression analysis, predictors of preterm birth were: preeclampsia (OR=9.06 [2.60-31.63], p=0.001), previous preterm, (OR=9.31 [2.82-30.68], p<0.001), low socioeconomic status (OR=1.51 [1.05-2.16], p=0.03), herbal use in first trimester for 2-5 days (OR=11.10 [4.34-28.41], p<0.001), herbal use in first trimester for 6-10 days (OR=44.87,[4.99-403.87] p=0.001), and herbal use in second trimester for 6-10 days (OR=16.43 [4.53-59.57], p<0.001). Use of prescribed folic acid in second trimester for more than 31 days was associated with lower risk of preterm birth (OR=0.20 [0.12-0.34], p<0.001).
Conclusion: Herbal use in pregnancy regardless of gestation, previous preterm birth and low socio-economic status and are risk factors for preterm birth in Kitui County Kenya. Interventions targeted to reduction of these risk factors will be an important additional prong in the reduction of preterm birth.
Key words: Preterm birth, herbal remedy, risk factors

Total number of pages: 515, including 35 pages of colour illustrations.

Total number of pages: 515, including 35 pages of colour illustrations.

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.

This is a retrospective study of 105 patients with herediatry haemorrhagic disorders seen at the Kenyatta National Hospital (KNH), between March 1975 and July 1980. Haemophilia forms 63% of the cases, Christmas disease 22% and von Willebrarid's disease (VWD) 9.5%. Rarer disorders encountered are factors X and VIII deficiency and one case of Glauzmann's disease. The study includes 3 subjects of Asian descent. Haernophilia co-existed witlt B-thalassaemia trait in 2 of the Asian subjects. Co-existing Christmas disease' and sickle cell anaemia was seen in one case. The clinical picture and course ' of the disorders are very similar to what is described elsewhere in the literature. It is. noted that although complications of replacement therapy in bleeding disorders are well documented elsewhere, only one of these patients' showed clinical evidence of such complications. There is now ample evidence that haemophilia is quite common in Africans, contrary to some reports in the past. This report serves as further evidence that haemophilia is not uncommon in Kenya and adds on to the already documented cases of hereditary haemorrhagic diseases in Kenya (1). With improving diagnostic and therapeutic facilities and increased use of hospital services more of these cases will be diagnosed

This is a retrospective study of 105 patients with herediatry haemorrhagic disorders seen at the Kenyatta National Hospital (KNH), between March 1975 and July 1980. Haemophilia forms 63% of the cases, Christmas disease 22% and von Willebrarid's disease (VWD) 9.5%. Rarer disorders encountered are factors X and VIII deficiency and one case of Glauzmann's disease. The study includes 3 subjects of Asian descent. Haernophilia co-existed witlt B-thalassaemia trait in 2 of the Asian subjects. Co-existing Christmas disease' and sickle cell anaemia was seen in one case. The clinical picture and course ' of the disorders are very similar to what is described elsewhere in the literature. It is. noted that although complications of replacement therapy in bleeding disorders are well documented elsewhere, only one of these patients' showed clinical evidence of such complications. There is now ample evidence that haemophilia is quite common in Africans, contrary to some reports in the past. This report serves as further evidence that haemophilia is not uncommon in Kenya and adds on to the already documented cases of hereditary haemorrhagic diseases in Kenya (1). With improving diagnostic and therapeutic facilities and increased use of hospital services more of these cases will be diagnosed

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

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic, dense fibrous connective tissue with acanthotic gingival epithelium. A family presented at the School of Dental Sciences, University of Nairobi with a complaint that some of the children developed swollen gums very early in life and that this got worse with eruption of the permanent teeth. The first born, a 23- year- old male, had had the swellings for over ten years. Other siblings aged 5,9 and 12 years were also affected. The swellings had affected the appearance, speech and the psychosocial wellbeing of the children. The parents were unaffected with apparently negative family histories. Following oral examination and appropriate investigations, conventional gingivectomy was performed of the maxillary and the mandibular gingivae for the siblings: the 23 -12- and the nine- year olds. The fourth affected child, a five- year- old, was still in primary dentition and had just started showing mild signs of gingival hyperplasia. The histopathological examination of the specimens from the present cases confirmed features consistent with those of HGF. This article highlights a familial presentation of HGF.

Hereditary gingival hyperplasia (HGF) is a rare condition characterised by hyperplastic, dense fibrous connective tissue with acanthotic gingival epithelium. A family presented at the School of Dental Sciences, University of Nairobi with a complaint that some of the children developed swollen gums very early in life and that this got worse with eruption of the permanent teeth. The first born, a 23- year- old male, had had the swellings for over ten years. Other siblings aged 5,9 and 12 years were also affected. The swellings had affected the appearance, speech and the psychosocial wellbeing of the children. The parents were unaffected with apparently negative family histories. Following oral examination and appropriate investigations, conventional gingivectomy was performed of the maxillary and the mandibular gingivae for the siblings: the 23 -12- and the nine- year olds. The fourth affected child, a five- year- old, was still in primary dentition and had just started showing mild signs of gingival hyperplasia. The histopathological examination of the specimens from the present cases confirmed features consistent with those of HGF. This article highlights a familial presentation of HGF.

Hereditary haemorrhagic telangiectasia, (HHT) or Rendu-Osler-Weber disease is a genetic autosomal dominant disorder that is characterised by telangiectasias, (small vascular malformations), in mucocutaneous tissues and arterial venous malformations, (AVMs), in various internal organs. Although HHT is relatively common in whites, the disorder has been reported to be rare in people of black African descent. Majority of HHT patients present with recurrent epistaxis, which in a significant proportion of patients is severe, warranting repeated blood transfusions and iron supplementation. Telangiectasias are most frequent on the tongue, hands, nose, lips and the gastrointestinal tract (GIT). AVMs occur in internal organs, particularly the lungs, brain, and the liver. Early and correct diagnosis of HHT is crucial as patients derive benefit from certain specific treatment modalities. Besides, AVMs which occur in various organs pose serious complications that may lead to death and therefore require early detection. We report a 55 year old black African male with HHT who presented with severe recurrent epistaxis and haematochezia leading to severe anaemia requiring repeated blood transfusions. His son, daughter and a maternal uncle experience milder recurrent epistaxis. The management of this patient and a brief review of the clinical features and management of HHT is presented. Our aim is to raise awareness of the occurrence of HHT in Kenya, in order to enhance early diagnosis and appropriate management

Five children, three sisters and two brothers aged between three months and 12 years, are described. They all developed a facial desquamating rash of butterfly distribution at the age of about two months, and motor retardation which later was characterized by spasticity, predominantly affecting the lower limbs. The three children who were old enough for speech to be tested had dysarthria. There was no family history of neurological disease, nor was there consanguinity among the parents or grandparents. EEGs were diffusely abnormal in four of the five children, but did not show any specific or diagnostic features. Plasma immunoglobulin tests were normal, and tests for collagen disease were negative. The authors are not aware of previous reports of this condition, but believe that it is a variant of familial spastic paraplegia, with atypical features.

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This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

Abstract
Whereas aesthetics and ethics form the axiological branch of philosophy, the latter’s prominence in the discourse of philosophy of education is quite obvious. More attention needs to be given on the role of aesthetics, especially the influence of women teachers’ body grooming on the education of preschoolers. This paper hermeneutically interprets the philosophical ideals of women teacher’s body grooming on preschoolers. The philosophical sensitisation of young minds for educational purposes is grounded on what they observe in preschool learning environments such as Kindergartens or Montessori centres or nursery schools where majority of teachers are females. Philosophic tenets for education which have long lasting impact on the human mind are greatly influenced by women teachers’ body grooming and clothing during the preschool days where the mind is stimulated to think, reason and produce knowledge. The paper contends that more interpretations can be discerned from body grooming of any gender that can lay the foundation of education.

OBJECTIVE: To determine whether herpes simplex virus type 2 (HSV-2) infection was associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-1) transmission and to define correlates of HSV-2 infection among HIV-1-seropositive pregnant women. METHODS: We performed a nested case control study within a perinatal cohort in Nairobi, Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1 RNA and cervical HSV DNA were measured at delivery. RESULTS: One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical secretions. Genital ulcers were associated with increased plasma HIV-1 RNA levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of transmitters versus 3% of nontransmitters had ulcers; P = .003), an association which was maintained in multivariable analysis adjusting for plasma HIV-1 RNA levels (P=.04). We found a borderline association for higher plasma HIV-1 RNA among women shedding HSV (P=.07) and no association between cervical HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1 transmission (P=.4 and P=.5, [corrected] respectively). CONCLUSION: Herpes simplex virus type 2 is the leading cause of genital ulcers among women in sub-Saharan Africa and was highly prevalent in this cohort of pregnant women receiving prophylactic zidovudine. After adjusting for plasma HIV-1 RNA levels, genital ulcers were associated with increased risk of intrapartum HIV-1 transmission. These data suggest that management of HSV-2 during pregnancy may enhance mother-to-child HIV-1 prevention efforts. LEVEL OF EVIDENCE: II

Departments of Epidemiology and Medicine, University of Washington, Seattle, WA 98195, USA. adrake2@u.washington.edu OBJECTIVE: To determine whether herpes simplex virus type 2 (HSV-2) infection was associated with risk of intrapartum human immunodeficiency virus type 1 (HIV-1) transmission and to define correlates of HSV-2 infection among HIV-1-seropositive pregnant women. METHODS: We performed a nested case control study within a perinatal cohort in Nairobi, Kenya. Herpes simplex virus type 2 serostatus and the presence of genital ulcers were ascertained at 32 weeks of gestation. Maternal cervical and plasma HIV-1 RNA and cervical HSV DNA were measured at delivery. RESULTS: One hundred fifty-two (87%) of 175 HIV-1-infected mothers were HSV-2-seropositive. Among the 152 HSV-2-seropositive women, nine (6%) had genital ulcers at 32 weeks of gestation, and 13 (9%) were shedding HSV in cervical secretions. Genital ulcers were associated with increased plasma HIV-1 RNA levels (P=.02) and an increased risk of intrapartum HIV-1 transmission (16% of transmitters versus 3% of nontransmitters had ulcers; P = .003), an association which was maintained in multivariable analysis adjusting for plasma HIV-1 RNA levels (P=.04). We found a borderline association for higher plasma HIV-1 RNA among women shedding HSV (P=.07) and no association between cervical HSV shedding and either cervical HIV-1 RNA levels or intrapartum HIV-1 transmission (P=.4 and P=.5, [corrected] respectively). CONCLUSION: Herpes simplex virus type 2 is the leading cause of genital ulcers among women in sub-Saharan Africa and was highly prevalent in this cohort of pregnant women receiving prophylactic zidovudine. After adjusting for plasma HIV-1 RNA levels, genital ulcers were associated with increased risk of intrapartum HIV-1 transmission. These data suggest that management of HSV-2 during pregnancy may enhance mother-to-child HIV-1 prevention efforts. LEVEL OF EVIDENCE: II. PMID: 17267842 [PubMed - indexed for MEDLINE]

Recent in vitro studies suggest that acyclovir may directly inhibit HIV-1 replication and can select for a specific HIV-1 reverse transcriptase mutation (V75I) with concomitant loss of an anti-HIV-1 effect. We tested for HIV-1 genotypic resistance at reverse transcriptase codon 75 in plasma from 168 HIV-1-infected persons from Botswana, Kenya, Peru, and the United States taking daily acyclovir or valacyclovir for between 8 weeks and 24 months. No V75I cases were detected (95% confidence interval, 0%-2.2%). These prospective in vivo studies suggest that standard-dose acyclovir or valacyclovir does not select for HIV-1 resistance.

Autosomal dominant polycystic kidney disease [ADPKB] is one of the commonest genetic diseases. Apart from the involvement of the kidneys, several other organs, viz. the liver, the central nervous system, the pancreas, the spleen, the ovaries and the gut, amongst others, are also sometimes involved. This makes ADFKD more of a systemic rather than an isolated renal disorder. This becomes more so considering that the involvement of the other organs contribute significantly to the morbidity and mortality of ADPKD. This review looks at the pattern and prevalence of involvement of other organs, apart from the kidney in ADPKD.

Two male patients aged 40 and 45 years with HIV infection and paraplegia are presented. The two had sub-acute onset paraplegia with a sensory level, which developed 10 days after herpes zoster dermatomal rash. They both had asymmetrically involvement of the lower limbs. Investigation including imaging of the spinal cord did not reveal any other cause of the neurological deficit. The two responded very well to treatment with acyclovir. Herpes zoster myelitis is a condition likely to rise with the upsurge of HIV infection and there is a need to identify the condition early. We also review the literature on the subject.

A case is described of an 8 year old child who presented with Herpes Zoster Ophthalmicus involving the left eye. He had a positive history of pulmonary tuberculosis, repeated hospital admissions and blood transfusion. He was confirmed to have Acquired Immune Deficiency Syndrome. During the course of his followup, he developed cotton-wool spots and perivasculitis in the right eye. The mother was found to be seropositive while the father was seronegative

Feulgen-Rossenbeck staining of lymphoid cells of quail-chicken hybrids in histologic sections revealed a pattern of heterochromatin arrangement distinguishable from that of either parental type. During interphase, hybrid lymphocytes exhibited combined characteristics of both the parental quail and the parental chicken. Hybrid heterochromatin was arranged in a large central mass as in the quail and in fairly evenly distributed small chromacenters around the periphery of the nucleus similar to the arrangement in the chicken. It is suggested that this pattern of staining can be used as a marker for hybrid cells in studies of genetic interactions.

Background HIV prevalence has recently declined in several African countries, and prior to this the risk of HIV acquisition per unprotected sex contact also declined in Kenyan sex workers. We hypothesized that heterogeneity in HIV host susceptibility might underpin both of these observations. Methods A compartmental mathematical model was used to explore the potential impact of heterogeneity in susceptibility to HIV infection on epidemic behavior, in the absence of other causative mechanisms. Results Studies indicated that a substantial heterogeneity in susceptibility to HIV infection,, may lead to an epidemic that peaks and then declines due to a depletion of the most susceptible individuals, even without changes in sexual behavior. This effect was most notable in high-risk groups such as female sex workers, and was consistent with empirical data. Discussion Declines in HIV prevalence may have other causes in addition to behavior change, including heterogeneity in host HIV susceptibility. There is a need to further study this heterogeneity and its correlates, particularly as it confounds the ability to attribute HIV epidemic shifts to specific interventions, including behavior change.

Knowledge of the characteristics of vascular smooth muscle cells is important in understanding
physicomechanical properties, functions, mechanisms of development, remodelling,
regeneration of blood vessels, development and progression of their diseases like
atherosclerosis. As the latter diseases become more common, there is need to understand their
pathogenesis to inform mitigation strategies. Goat is a suitable model for vascular studies but
the organization of vascular smooth muscle cells in its aorta have not been elucidated. This
study therefore examined the characteristics of smooth muscle cells in the aorta of goat.
Materials were obtained from aortae of six healthy young adult male domestic goats (Capra
hircus) [age range 12 – 36 months]. Specimens from thoracic aorta were fixed in
glutaraldehyde, post fixed in osmium tetroxide and processed for ducurpan embedding.
Ultrathin sections stained with uranyl acetate, counterstained with lead citrate were examined
by transmission electron microscope. The aortic tunica media contained several phenotypic
dispositions of smooth muscle cells; spindle shaped or elongated organelle - poor cells;
irregularly shaped cells rich in rough endoplasmic reticulum, mitochondria and a prominent
nucleus. The smooth muscle cells also ran in various directions: transverse, oblique and
longitudinal. These findings reveal that the smooth muscle cells of the tunica media of goat
aorta are phenotypically heterogeneous and run in multiple directions. These characteristics
probably confer mechanical strength and functional plasticity to the aortic wall. Designers of
aortic substitutes should bear this in mind.

High plasma HIV-1 RNA concentrations are associated with increased risk of
Initiation of antiretroviral therapy (ART) reduces plasma HIV-1 concentrations. We aimed to assess the effect of ART

use by patients infected with HIV-1 on risk of transmission to their uninfected partners

Background High plasma HIV-1 RNA concentrations are associated with increased risk of HIV-1 transmission. Initiation of antiretroviral therapy (ART) reduces plasma HIV-1 concentrations, but little empiric data are available on the rate of sexual HIV-1 transmission from persons receiving ART. Methods 3381 African heterosexual HIV-1 serodiscordant couples were followed prospectively for up to 24 months. At enrollment, HIV-1 infected partners had CD4 counts ≥250 cells/mm3 and did not meet country guidelines for ART initiation; during follow-up, CD4 counts were measured every 6 months and ART initiated following national guidelines. HIV-1 uninfected partners were tested for HIV-1 every 3 months. We compared genetically-linked HIV-1 transmission rates by ART initiation. Results 349 (10%) HIV-1 infected partners initiated ART, at a median CD4 count of 198 cells/mm3. Only one of 103 linked HIV-1 transmissions was observed from an HIV-1 infected partner who had initiated ART corresponding to HIV-1 transmission rates of 0.37 versus 2.24 per 100 person-years for those who had initiated versus not initiated ART, respectively (adjusted incidence rate ratio 0.08, 95% confidence interval 0.002–0.57, p=0.004). After ART initiation, plasma HIV-1 RNA concentrations decreased significantly (from median 4.88 to <2.38 log10 copies/mL, p<0.001) as did unprotected sex (6.2% of visits before to 3.7% of visits after ART initiation, p=0.03). Among those not on ART, the highest HIV-1 transmission rate (8.79 per 100 person-years) was from HIV-1 infected persons with CD4 counts <200 cells/mm3. In couples in which the HIV-1 infected partner had a CD4 ≥200 cells/mm3, 70% of transmissions occurred when plasma HIV-1 concentrations exceeded 50,000 copies/mL. Conclusions Among African heterosexual couples, ART initiation was followed by a 92% reduction in HIV-1 transmission risk, likely due to significantly reduced plasma HIV-1 levels, and was accompanied by increased self-reported condom use. The highest HIV-1 risk and greatest relative prevention benefit from ART was among couples in which the HIV-1 infected partner had CD4 counts <200 cells/mm3 or plasma HIV-1 RNA concentrations >50,000 copies/mL.

High plasma HIV-1 RNA concentrations are associated with increased risk of HIV-1 transmission. Initiation of antiretroviral therapy (ART) reduces plasma HIV-1 concentrations. We aimed to assess the effect of ART use by patients infected with HIV-1 on risk of transmission to their uninfected partners.

The Basilar Artery (BA), usually terminates by dividing into two posterior cerebral arteries [1,2]. Variant terminations described include double posterior cerebral arteries and common trunks for Posterior Cerebral Arteries (PCA) and Superior Cerebellar Arteries (SCA) trifurcation, quadrifurcation and pentafurcation [3-5]. Such variant branching patterns of arteries predisposes them to atherosclerosis and aneurysms [6,7], and may complicate surgery at basilar bifurcation angle and clivus [8]. The abnormalities may also alter the relationships with and compress occulomotor nerve [9]. There are, however, few reports on variant termination of the basilar artery. We recently reported up to 5 branches. In all cases of trifurcation, qudrifurcation and pentafurcation, the variation was due to duplication and rostral shift of superior cerebellar artery [4]. Potentially, more than five branches is possible but hitherto unreported in spite its importance. This study, therefore investigated the pattern of termination of the basilar artery in a black Kenyan population, for cases where there were more than five terminal branches.

The Rose-Bengal plate test (RBPT) was performed on 488 patients with flu-like symptoms from Narok district. There was poor agreement between RBPT results from four health facilities in Narok and from the central veterinary laboratory (CVL). Agreement was poorer for the three rural dispensaries than for the District Hospital. On the other hand, for tests conducted at the CVL, there was good agreement between RBPT, serum agglutination test (SAT) and complement fixation test (CFT) results, indicating that all these tests were probably performing well. Better training and quality control and the use of white rather than a clear background surface for judging agglutination results are recommended to improve the performance of test results in Narok District health facilities.

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The tunica adventitia is an active vascular compartment that actively participates in modulation of
vascular structure, function and pathophysiology. Adventitial thickness has recently been accepted as a
surrogate marker of atherosclerosis. The effects of salt and chemicals that ameliorate those effects are
important in understanding vascular structure, function and pathology. There are few studies on
hibiscus and high salt induced vascular pathology. This study, therefore, investigated the effects of
hibiscus on salt induced vascular changes on rat carotid artery. The experimental animals were divided
into 3 groups of 8 animals each – (i) controls; (ii) high salt diet alone and (iii) high salt + hibiscus
extract for a period of eight weeks. At ages 2, 5 and 8weeks 2 – 3 animals were sacrificed for study.
They were anaesthetized with ether and perfused with formal saline. Specimens were then obtained
from the middle of common carotid artery, fixed in 5% formaldehyde solution, processed routinely for
paraffin embedding and 5-micron thick sections stained with Hematoxylin / Eosin and also with Mason’s
Trichome/ Aniline blue. Adventitial thickness and volumetric densities of collagen were measured using
morphometric techniques. High salt consumption induced statistically significant increase in adventitial
thickness from 297.45μm at week 2 to 659.4μm in week 8. In hibiscus fed rats, this increase
progressively reduced to 482.55μm in week 8. Volumetric density of collagen was 57% in high salt fed
rats but reduced to 45.66% in hibiscus fed rats (p<0.001). The increase in tunica adventitial thickness
and collagen density which is induced by high salt can be mitigated by hibiscus extract. This implies
that hibiscus has potential to restore salt induced vascular injury. Further studies are recommended to
refine the extract.

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Low income earners have volatile incomes and most financial providers shun this group of borrowers even though they are motivated in managing the limited resources they have through savings and investments as a means to lower the fluctuations of their income. Peer groupings of the low income earners can assist in pooling the resources they have and improve the group risk mitigation process as group members act like social collateral in credit lending. The study used Kenya Kenya Financial Diaries data of 2013 from 280 households to analyze and understand the credit quality levels and credit scores of peer groups versus individuals among men and women. Hidden Markov model classified the low income earners into credit risk profiles wih a view of understanding the role of groups in low income group lending. Peer groups diversify risk inherent in individual borrowers with women only groups having higher credit quality levels as compared to men only groups. Women and their respective peer groups are more stable with less variability as compared to men. Financial technology providers can incorporate the wide array of soft information to lend to low income earners through mobile based peer groups.

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AIM: Passive immunotherapy using antibody against hepatitis B surface antigen (HBsAg) has been advocated in certain cases of Hepatitis B infection. We had earlier reported on the cloning and expression of a high affinity scFv derived from a mouse monoclonal (5S) against HBsAg. However this mouse antibody cannot be used for therapeutic purposes as it may elicit anti-mouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: We cloned the V(H) and V(L) genes of this mouse antibody, and fused them with CH1 domain of human IgG1 and C(L) domain of human kappa chain respectively. These chimeric genes were cloned into a phagemid vector. After initial screening using the phage display system, the chimeric Fab was expressed in soluble form in E. coli. RESULTS: The chimeric Fab was purified from the bacterial periplasmic extract. We characterized the chimeric Fab using several in vitro techniques and it was observed that the chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. This chimeric antibody fragment was further expressed in different strains of E. coli to increase the yield. CONCLUSION: We have generated a mouse-human chimeric Fab against HBsAg without any significant loss in binding and epitope specificity. This chimeric Fab fragment can be further modified to generate a full-length chimeric antibody for therapeutic uses.

Airborne black carbon (BC) particles have serious implications for human health and climate change and thus represent a prime target for mitigation policies. The sources of BC include vehicles burning diesel fuel, which are common in urban areas in low-income countries. The …

Cheap licit and artisanal illicit spirit drinks have been associated with numerous outbreaks of alcohol poisoning especially with methanol. This study aimed to evaluate the quality of cheap spirit drinks in Kibera slums in Nairobi County, Kenya. The samples consisted of cheap licit spirits (n = 11) and the artisanal spirit drink, ‘chang’aa’, (n = 28). The parameters of alcoholic strength and volatile composition were used as indicators of quality and were determined using gas chromatography with flame ionization detection (GC-FID) and gas chromatography-mass spectrometry (GC-MS) respectively. The ranges for alcoholic strength were 42.8–85.8% vol and 28.3–56.7% vol for chang’aa and licit spirit drinks respectively, while the pH ranges were 3.3–4.2 and 4.4–4.8 for chang’aa and licit spirit drinks respectively. The majority of volatiles were found in artisanal spirits and they included higher alcohols, ethyl esters and carbonyl compounds. The alcoholic strength of all the artisanal spirits (100%) and 91% of the licit spirits was above the 40% vol of standard spirits such as vodka. The high ethanol content of the alcohol products was the only element of public health significance in this study.

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1. Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya; Department of Biochemistry, University of Nairobi, Kenya. Background: There are limited reports on HIV-1 RNA load, CD4+ T-lymphocytes and antibody responses in relation to disease progression in HIV-1 infected untreated children in Africa. Methods: To describe the relationships between these parameters, we conducted a longitudinal cohort study involving 51 perinatally HIV-1 infected children aged between 1 and 13 years. HIV status was determined by ELISA and confirmed by western blot and PCR. Antibodies were quantified by limiting dilution ELISA, plasma HIV-1 RNA load by RT-PCR and CD4+ T-lymphocytes by FACSCount. Results: Asymptomatic and symptomatic disease had, respectively, a rise in median HIV-1 RNA load from 1,195 to 132,543 and from 42,962 to 1,109,281 copies/ml in children below 6 years. The increase in viral load was 10-fold higher for asymptomatic compared to other categories and 2-fold faster for children less than 6 years than those above. Similarly, symptomatic children below 6 years had initial median CD4+ T-lymphocyte counts of 647 (22%) cells/muL, declining to 378 (20%) while those above 6 years had initial values of below 335 (15%) but which increased to 428 (17%). Median viral load correlated significantly with median CD4+ T-lymphocyte percentage in children above 6 years (p=0.026) but not below. Conclusions: Viral load is lower in older than younger children and correlates significantly with percentage CD4+ T-lymphocytes. Survival by HIV-1 infected children requires a competent immune response early in infection to counter the rapidly replicating virus. Interventions aimed at boosting the naive immune system may prolong survival in these children.

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

A simple, sensitive, accurate and precise high performance liquid chromatography (HPLC) method for determination of artemisinin in crude plant material was developed and validated. Optimal separation of artemisinin from matrix components in the plant extracts was achieved using a Waters XTerra® RP18 , 5 m, 250 × 4.6 mm column, maintained at 40 °C, a mobile phase consisting of 0.05 M potassium phosphate buffer, pH 6.0 - acetonitrile (60:40) containing 5 mM hexane sulfonate in isocratic flow. The mobile phase flow rate was 1.0 ml/min while elution was monitored at 216 nm. The method satisfied the International Conference on Harmonization (ICH) validation criteria for linearity, accuracy, precision and sensitivity. The developed method is applicable in routine quality control of Artemisia annua crude extracts.

A survey of 461 HIV-infected Kenyan children receiving antiretroviral therapy found 143 (31%) failing virologically. Drug resistance mutations were found in 121; 37 had L74V/I mutations, with 95% receiving abacavir (ABC)-containing regimens. L74V/I was associated with current ABC usage (P = 0.0001). L74V/I may be more prevalent than previously realized in children failing ABC-containing regimens, even when time on treatment has been short. Ongoing rigorous pediatric drug resistance surveillance is needed.

OBJECTIVES: To assess the burden of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in high-risk HIV-1 negative men who have sex with men (MSM) in Africa. METHODS: Before the start of a pre-exposure prophylaxis trial, HIV-1 negative volunteers were screened for sexually transmitted infection (STI) including CT and NG, using a highly sensitive and specific nucleic acid amplification test. Samples positive for CT by Aptima testing, were evaluated for the presence of lymphogranuloma venereum (LGV) serovars using an in-house PCR assay. All men were asked to submit a urine specimen, and all had a rectal swab collected by a clinician. Men were asked if they had dysuria, urethral or rectal discharge, or rectal pain. RESULTS: 43 HIV-1 negative MSM were screened, of whom 13 reported sex with men only; the majority (27/43) reported sex work. One volunteer had dysuria and another, rectal pain. Eleven MSM (26%, 95% CI 14% to 41%) had infections with either or both pathogens. Homosexual men had a higher prevalence of any infection than bisexual men (46% vs 17%, p=0.04), and all cases of rectal infections, including one with CT, two with NG and two with CT/NG co-infection. All patients with CT were negative for LGV. One patient with a rectal NG infection reported rectal pain. CONCLUSIONS: A remarkably high burden of STI infection was found among HIV-1 negative MSM. Most (12/13) infections, including three of four rectal NG infections, were subclinical. These findings suggest that high-risk MSM will benefit from effective STI screening in Kenya.

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Infants born to HIV-1 infected mothers may have increased risk for tuberculosis (TB), but the prevalence of TB infection in this population is undefined. In contrast to tuberculin skin tests that are confounded by recent bacille Calmette-Guérin (BCG) vaccination, TB interferon gamma release assays (IGRAs) do not cross-react with BCG and enable detection of TB infection in infancy.

Infants born to HIV-1 infected mothers may have increased risk for tuberculosis (TB), but the prevalence of TB infection in this population is undefined. In contrast to tuberculin skin tests that are confounded by recent bacille Calmette-Guérin (BCG) vaccination, TB interferon gamma release assays (IGRAs) do not cross-react with BCG and enable detection of TB infection in infancy.