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

Towers are typical structures that can be found in many urban and rural landscapes the world over. From their basic design, they are usually exposed to severe environmental loads. It is therefore prudent to carry out periodic maintenance that includes checking that they are correctly aligned. This paper describes a method that was used for the re-alignment of a guyed tower in Limuru, Kenya. Angular and distance observations, made from two observation points detected a vertical misalignment that was larger than the acceptable tolerance of l/400. An iterative re-alignment procedure was then applied, resulting in an acceptable final misalignment of 1 / 520.

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

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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.

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

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Background: Cataract is a leading cause of blindness and vision impairment globally. Cataract surgery is one of the most frequently performed operations worldwide, but good quality services are not universally available. This scoping review aims to summarise the nature and extent of published literature on interventions to improve the quality of services for age-related cataract globally.

Methods: We used the dimensions of quality adopted by WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we added planetary health. On 17 November 2019, we searched MEDLINE, Embase and Global Health for manuscripts published since 1990, without language or geographic restrictions. We included studies that reported quality-relevant interventions and excluded studies focused on technical aspects of surgery or that only involved children (younger than 18 years). Screening of titles/abstracts, full-text review and data extraction were performed by two reviewers independently. Studies were grouped thematically and results synthesised narratively.

Results: Most of the 143 included studies were undertaken in high-income countries (n = 93, 65%); 29 intervention groups were identified, most commonly preoperative education (n = 17, 12%) and pain/anxiety management (n = 16, 11%). Efficiency was the quality element most often assessed (n = 58, 41%) followed by people-centredness (n = 40, 28%), while integration (n = 4) and timeliness (n = 3) were infrequently reported, and no study reported outcomes related to planetary health.

Conclusion: Evidence on interventions to improve quality of cataract services shows unequal regional distribution. There is an urgent need for more evidence relevant to low- and middle-income countries as well as across all quality elements, including planetary health.

Gachau, S; Njeru Njagi, E; Owuor, N; Mwaniki, P; Quartagno, M; Sarguta, R; English, M; Gachau, S; Njeru Njagi, E; Owuor, N; Mwaniki, P; Quartagno, M; Sarguta, R; English, M; Ayieko, P; - view fewer (2021) Handling missing data in a composite outcome with partially observed components: Simulation study based on clustered paediatric routine data. Journal of Applied Statistics (In press) … This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.

Gachau, S; Njeru Njagi, E; Owuor, N; Mwaniki, P; Quartagno, M; Sarguta, R; English, M; Gachau, S; Njeru Njagi, E; Owuor, N; Mwaniki, P; Quartagno, M; Sarguta, R; English, M; Ayieko, P; - view fewer (2021) Handling missing data in a composite outcome with partially observed components: Simulation study based on clustered paediatric routine data. Journal of Applied Statistics (In press) … This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.

Gachau, S; Njeru Njagi, E; Owuor, N; Mwaniki, P; Quartagno, M; Sarguta, R; English, M; Gachau, S; Njeru Njagi, E; Owuor, N; Mwaniki, P; Quartagno, M; Sarguta, R; English, M; Ayieko, P; - view fewer (2021) Handling missing data in a composite outcome with partially observed components: Simulation study based on clustered paediatric routine data. Journal of Applied Statistics (In press) … This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.

Emerald Publishing Limited, UK.

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This article summarizes the presentation of ocular HIV in East Africa.
The main ocular effects of HIV are related to immune-suppression and impaired tumour-surveillance. HIV compromises cell-mediated immunity increasing the risk of infection with bacteria (e.g. tuberculosis and syphilis); fungi (e.g. candida and cryptococcus); parasites (e.g. toxoplasmosis); and viruses (e.g. herpes zoster, human papilloma virus, Kaposi sarcoma-associated herpes virus, cytomegalovirus and Epstein-Barr virus).
Patients with lower CD4 counts are more likely to have ocular manifestations1, however use of antiretroviral therapy (ART) has modified the epidemiology of ocular manifestations, and variations in the predominant subtype of HIV may also lead to geographical differences in ocular disease.

Lodwar Municipality is one of the fastest-growing urban areas of Sub-Saharan Africa that depends mainly on groundwater for its municipal water supply. Most of the groundwater sources are located within the riparian zones of the Turkwel River. With limited understanding of its aquifers, the groundwater of Lodwar may be at risk of natural processes and anthropogenic activities. Statistical techniques and geochemical methods were applied to determine the aquifer hydrogeochemistry. Three distinct aquifers, which we collectively refer to as the Lodwar Alluvial Aquifer System, underlie Lodwar and its environs, the shallow alluvial, intermediate, and deep aquifers which are the main source of fresh water. A fourth, the shallow aquifer of the Turkana grit, is highly saline and with fluoride contamination. Just as the Turkwel River, the shallow alluvial aquifer (SAA) was dominated by Ca–HCO3 water type, while the TGSA was Na–Cl water type and became Na–HCO3 near the Holocene sediments. The intermediate aquifer (IA) was Na–HCO3water type. Pockets of Mg–HCO3 water occurred in the shallow alluvial and intermediate aquifers. The natural processes in the SAA include rock-water interaction, recharge by surface water, and oxidation reactions, while evaporation and dissolution are the major factors controlling the chemistry of the TGSA. Ion exchange, dilution, and dissolution are the major processes in the IA. Elevated levels of NO3− and SO42− during the wet season within the SAA and the IA reflects their vulnerability to pollution. Saline intrusion into the shallow and intermediate aquifers from the Turkana grit aquifers is likely to occur.

Missing information is a major drawback in analyzing data collected in many routine health care settings. Multiple imputation assuming a missing at random mechanism is a popular method to handle missing data. The missing at random assumption cannot be confirmed from the observed data alone, hence the need for sensitivity analysis to assess robustness of inference. However, sensitivity analysis is rarely conducted and reported in practice. We analyzed routine paediatric data collected during a cluster randomized trial conducted in Kenyan hospitals. We imputed missing patient and clinician-level variables assuming the missing at random mechanism. We also imputed missing clinician-level variables assuming a missing not at random mechanism. We incorporated opinions from 15 clinical experts in the form of prior distributions and shift parameters in the delta adjustment method. An interaction between trial intervention arm and follow-up time, hospital, clinician and patient-level factors were included in a proportional odds random-effects analysis model. We performed these analyses using R functions derived from the jomo package. Parameter estimates from multiple imputation under the missing at random mechanism were similar to multiple imputation estimates assuming the missing not at random mechanism. Our inferences were insensitive to departures from the missing at random assumption using either the prior distributions or shift parameters sensitivity analysis approach

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.

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In this paper we analyze a Chemostat model of two species competing for a single limiting nutrient input varied periodically using a Fourier series with discrete delays. To understand global aspects of the dynamics we use an extension of the Hopf bifurcation theorem, a method that rigorously establishes existence of a periodic solution. We show that the interior equilibrium point changes its stability and due to the delay parameter it undergoes a Hopf bifurcation.
Numerical results shows that coexistence is possible when delays are introduced and Fourier series produces the required seasonal variations. We also show that for small delays periodic variations of nutrients has more influence on species density variations than the delay.

Lodwar Municipality is one of the fastest-growing urban areas of Sub-Saharan Africa that depends mainly on groundwater for its municipal water supply. Most of the groundwater sources are located within the riparian zones of the Turkwel River. With limited understanding of its aquifers, the groundwater of Lodwar may be at risk of natural processes and anthropogenic activities. Statistical techniques and geochemical methods were applied to determine the aquifer hydrogeochemistry. Three distinct aquifers, which we collectively refer to as the Lodwar Alluvial Aquifer System, underlie Lodwar and its environs, the shallow alluvial, intermediate, and deep aquifers which are the main source of fresh water. A fourth, the shallow aquifer of the Turkana grit, is highly saline and with fluoride contamination. Just as the Turkwel River, the shallow alluvial aquifer (SAA) was dominated by Ca–HCO3 water type, while the TGSA was Na–Cl water type and became Na–HCO3 near the Holocene sediments. The intermediate aquifer (IA) was Na–HCO3water type. Pockets of Mg–HCO3 water occurred in the shallow alluvial and intermediate aquifers. The natural processes in the SAA include rock-water interaction, recharge by surface water, and oxidation reactions, while evaporation and dissolution are the major factors controlling the chemistry of the TGSA. Ion exchange, dilution, and dissolution are the major processes in the IA. Elevated levels of NO3− and SO42− during the wet season within the SAA and the IA reflects their vulnerability to pollution. Saline intrusion into the shallow and intermediate aquifers from the Turkana grit aquifers is likely to occur.

Lodwar Municipality is one of the fastest-growing urban areas of Sub-Saharan Africa that depends mainly on groundwater for its municipal water supply. Most of the groundwater sources are located within the riparian zones of the Turkwel River. With limited understanding of its aquifers, the groundwater of Lodwar may be at risk of natural processes and anthropogenic activities. Statistical techniques and geochemical methods were applied to determine the aquifer hydrogeochemistry. Three distinct aquifers, which we collectively refer to as the Lodwar Alluvial Aquifer System, underlie Lodwar and its environs, the shallow alluvial, intermediate, and deep aquifers which are the main source of fresh water. A fourth, the shallow aquifer of the Turkana grit, is highly saline and with fluoride contamination. Just as the Turkwel River, the shallow alluvial aquifer (SAA) was dominated by Ca–HCO3 water type, while the TGSA was Na–Cl water type and became Na–HCO3 near the Holocene sediments. The intermediate aquifer (IA) was Na–HCO3water type. Pockets of Mg–HCO3 water occurred in the shallow alluvial and intermediate aquifers. The natural processes in the SAA include rock-water interaction, recharge by surface water, and oxidation reactions, while evaporation and dissolution are the major factors controlling the chemistry of the TGSA. Ion exchange, dilution, and dissolution are the major processes in the IA. Elevated levels of NO3− and SO42− during the wet season within the SAA and the IA reflects their vulnerability to pollution. Saline intrusion into the shallow and intermediate aquifers from the Turkana grit aquifers is likely to occur.

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Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise.
Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related
morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal
management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention
must maintain function as well as preserve future vascular access sites.
Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients
undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates,
urea reduction ratio (URR) and Kt/V were analysed in 150 patients.
Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48%
achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88%
and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow
rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5%
and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not
haemodynamically significant.
Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered
dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis
dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine
surveillance and affordable interventional procedures to prevent loss of vascular access.

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.

Background: The number of patients requiring renal replacement therapy (RRT) worldwide has been on the rise. Vascular access is the lifeline for these patients when haemodialysis (HD) is the treatment of choice. Access-related morbidity is a leading cause of hospitalization so that the function and patency of access are essential for the optimal management of patients. There is a need to recognize when a vascular access is dysfunctional because intervention must maintain function as well as preserve future vascular access sites.Methods: This was a cross-sectional study that evaluated the haemodialysis vascular access function in patients undergoing chronic haemodialysis at the Kenyatta National Hospital, Nairobi, Kenya. Peak access blood flow rates, urea reduction ratio (URR) and Kt/V were analysed in 150 patients.Results: The temporary (non-tunnelled) central venous dialysis catheters had poor function, with only 48% achieving a mean blood flow rate > 300 mL/min. The comparable rate for arteriovenous fistulae (AVF) was 88% and for tunnelled dialysis catheters 82%. One-quarter of the patients had a URR < 65%. Higher mean blood flow rates were associated with higher URR (P = 0.004) and Kt/V (P = 0.009) values. AVF stenosis was present in 12.5% and thrombosis in 3% of patients. Aneurysms were the commonest AVF complication (47%) but were not haemodynamically significant.Conclusions: Tunnelled haemodialysis catheters offered adequate blood flows and achieved adequate delivered dialysis, comparable to arteriovenous fistulae. Non-tunnelled catheters delivered poor blood flow rates and dialysis dose. Greater blood flow rates were associated with a higher delivered dialysis dose. There is a need for routine surveillance and affordable interventional procedures to prevent loss of vascular access.

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.

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

Abstract

The industrialization process taking place in Africa has led to an overall increase in groundwater abstraction in most countries in the continent. However, the lack of hydrogeological data, as in many developing countries, makes it difficult to properly manage groundwater systems. This study presents a real case study in which a combination of different hydrogeological tools together with different sources of information allow the assessment of how increased competition for water may be affecting groundwater systems by analysing the sustainability of new abstraction regimes under different real climatic condition (before, during and after La Niña 2016). The area where this approach has been applied is Kwale County (in Coastal Kenya) in a hydrogeological context representative of an important part of the east coast of the continent, where new mining and agriculture activities co-exist with tourism and local communities. The results show that the lack of aquifer systems data can be overcome, at least partly, by integrating different sources of information. Most of the time, water-reliant users collect specific hydrogeological information that can contribute to defining the overall hydrogeological system, since their own main purpose is to exploit the aquifer with the maximum productivity. Therefore, local community water usage, together with different stakeholder's knowledge and good corporate water management act as a catalyst for providing critical data, and allows the generation of credible models for future groundwater management and resource allocation. Furthermore, complementary but simple information sources such as in situ interviews, Google Earth, Trip Advisor and easy-to use analytical methods that can be applied in the African context as in many developing countries, and enables groundwater abstraction to be estimated and the sustainability of the aquifer system to be defined, allowing potential future risks to be assessed.

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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 …

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

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

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

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

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

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.

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.

Human immunodeficiency virus seroconversion in late pregnancy: Effects on pregnancy and childbirth in Kenya

Background: In Kenya, there is limited empirical data on effects of seroconversion in pregnancy and child birth due to low uptake of HIV retesting despite there being a policy directive to do so.
Objectives: To determine the effect of seroconversion in late pregnancy regarding pregnancy and childbirth among women seeking delivery services in Kakamega County Hospital and Pumwani Maternity Hospital.
Methodology: A ten month quasi experimental longitudinal study design was employed whereby 1,156 respondents consecutively sampled.
Results: HIV seroconverters had a higher chance of developing premature rupture of membranes, hemorrhage and puerperal sepsis than HIV negative women. The incidence of Mother to Child Transmission of HIV among exposed newborns was 0.09%. There was a statistically significant relationship between PEP administration, infant morbidity and mortality.
Conclusion: HIV seroconversion was associated with complications during delivery. Recommendations: There’s need to intensify retesting in late pregnancy as well as skilled birth attendance among the women seroconverting in late pregnancy.

Human immunodeficiency Virus seroconversion: Rate and Retesting uptake. A case of Kakamega and Nairobi Counties, Kenya
Background: There is limited empirical data on the prevalence of Human Immunodeficiency Virus (HIV) seroconversion in late pregnancy due to the fact that majority of the women start seeking antenatal care late in pregnancy therefore rarely retest. This leaves a gap in the Elimination of Mother to Child Transmission (eMTCT) strategy thus contributing to high maternal and neonatal morbidity and mortality rates in Kenya.
Objectives: To establish the rate of HIV retesting uptake in late pregnancy and HIV seroconversion rate among women attending Antenatal Clinics in Pumwani Maternity Hospital and Kakamega County Hospital.
Methodology: A longitudinal study design was employed; 1,117 women confirmed as HIV negative in early pregnancy were followed up for three months and retested to ascertain their serostatus. Sample size was obtained through Census and consecutive sampling to recruit individual respondents. Clearance to conduct the study was sought from Ethics Review Committee, Pumwani and Kakamega County Hospitals and the respondents. Researcher administered questionnaires and HIV testing was done for data collection. Descriptive data involved calculation of measures of central tendency. Findings were presented in tables, graphs and narrative.
Results: HIV retesting uptake was 1,073 (96%) and the rate of HIV serocopositivity among initially HIV negative pregnant women that retested was 8 (0.75%).
Conclusion: HIV retesting uptake is very impressive and the rate of HIV seroconversion is very low. Kenya has made good progress towards eMTCT of HIV.

Direct rapid energy dispersive X-ray fluorescence and scattering (EDXRFS) analysis of trace biometals in soft body tissues is important because it has an immense potential for biomedical applications. Unfortunately this is challenging because soft body tissues are characterized by dark matrix problems, weak analyte fluorescence, scattering, poor signal-to-noise ratio (SNR) of the analyte and spectral overlaps due to the properties of the detector and detection process. We report on hybridized utility of robust chemometrics approach for spectral preprocessing towards improving the quality of spectra towards quantitative analysis of trace biometals in soft body tissue. The study was based on (5–20 µm thick) paraffin wax model ‘standards’ spiked with biometals Fe, Cu, Mn, Zn, Co, Na and Mg. Wavelet transform (WT) and principal component analysis (PCA) were used conjointly for de-noising and mathematical enhancement of resolution. There was improved SNR of spectra by a factor of 3 compared to use of WT alone. The preprocessed spectra were used as input to artificial neural network (ANN) and partial least squares (PLS) models for developing multivariate calibration strategies for quantitative analysis. Both models predicted the concentrations of the biometals better than when raw spectra were utilized (R2 ~ 0.892–0.954 before, and ~ 0.990–0.998 after preprocessing for ANNs; and R2 ~ 0.876–0.931 before, and ~ 0.977–0.992 after preprocessing for PLS). There was also improvement in prediction of Na and Mg in model tissue when both fluorescence and scatter were utilized conjointly (EDXRFS) i.e. R2 = 0.970 for fluorescence alone and R2 = 0.998 for both fluorescence and scatter for Na; and R2 = 0.934 for fluorescence alone and R2 = 0.993 for both fluorescence and scatter for Mg for ANN model. The accuracy of the calibration model was tested using Oyster tissue (NIST 1566b). The results of all analyzed elements were in agreement with certified values to ≤ 6%. This shows proof-of-concept for use of hybridized robust chemometrics approaches for direct rapid determination of trace biometals in soft tissue utilizing EDXRFS spectrometry; an approach that has potential for biomedical applications of EDXRF.

The 2015/2016 El Niño has been classified as one of the three most severe on record. El Niño teleconnections are commonly associated with droughts in southern Africa and high precipitation in eastern Africa. Despite their relatively frequent occurrence, evidence for their hydrological effects and impacts beyond agriculture is limited. We examine the hydrological response and impact pathways of the 2015/2016 El Niño in eastern and southern Africa, focusing on Botswana, Kenya, and Zambia. We use in situ and remotely sensed time series of precipitation, river flow, and lake levels complemented by qualitative insights from interviews with key organizations in each country about awareness, impacts, and responses. Our results show that drought conditions prevailed in large parts of southern Africa, reducing runoff and contributing to unusually low lake levels in Botswana and Zambia. Key informants characterized this El Niño through record high temperatures and water supply disruption in Botswana and through hydroelectric load shedding in Zambia. Warnings of flood risk in Kenya were pronounced, but the El Niño teleconnection did not materialize as expected in 2015/2016. Extreme precipitation was limited and caused localized impacts. The hydrological impacts in southern Africa were severe and complex, strongly exacerbated by dry antecedent conditions, recent changes in exposure and sensitivity and management decisions. Improved understanding of hydrological responses and the complexity of differing impact pathways can support design of more adaptive, region‐specific management strategies.

The 2015/2016 El Niño has been classified as one of the three most severe on record. El Niño teleconnections are commonly associated with droughts in southern Africa and high precipitation in eastern Africa. Despite their relatively frequent occurrence, evidence for their hydrological effects and impacts beyond agriculture is limited. We examine the hydrological response and impact pathways of the 2015/2016 El Niño in eastern and southern Africa, focusing on Botswana, Kenya, and Zambia. We use in situ and remotely sensed time series of precipitation, river flow, and lake levels complemented by qualitative insights from interviews with key organizations in each country about awareness, impacts, and responses. Our results show that drought conditions prevailed in large parts of southern Africa, reducing runoff and contributing to unusually low lake levels in Botswana and Zambia. Key informants characterized this El Niño through record high temperatures and water supply disruption in Botswana and through hydroelectric load shedding in Zambia. Warnings of flood risk in Kenya were pronounced, but the El Niño teleconnection did not materialize as expected in 2015/2016. Extreme precipitation was limited and caused localized impacts. The hydrological impacts in southern Africa were severe and complex, strongly exacerbated by dry antecedent conditions, recent changes in exposure and sensitivity and management decisions. Improved understanding of hydrological responses and the complexity of differing impact pathways can support design of more adaptive, region‐specific management strategies.

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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.

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.

More than 80% of available malaria rapid diagnostic tests (RDTs) are based on the detection of histidine-rich protein-2 (PfHRP2) for diagnosis of Plasmodium falciparum malaria. Recent studies have shown the genes that code for this protein and its paralog, histidine-rich protein-3 (PfHRP3), are absent in parasites from the Peruvian Amazon Basin. Lack of PfHRP2 protein through deletion of the pfhrp2 gene leads to false-negative RDT results for P. falciparum. We have evaluated the extent of pfhrp2 and pfhrp3 gene deletions in a convenience sample of 198 isolates from six sites in three states across the Brazilian Amazon Basin (Acre, Rondonia and Para) and 25 isolates from two sites in Bolivia collected at different times between 2010 and 2012. Pfhrp2 and pfhrp3 gene and their flanking genes on chromosomes 7 and 13, respectively, were amplified from 198 blood specimens collected in Brazil. In Brazil, the isolates collected in Acre state, located in the western part of the Brazilian Amazon, had the highest percentage of deletions for pfhrp2 25 (31.2%) of 79, while among those collected in Rondonia, the prevalence of pfhrp2 gene deletion was only 3.3% (2 out of 60 patients). In isolates from Para state, all parasites were pfhrp2-positive. In contrast, we detected high proportions of isolates from all 3 states that were pfhrp3-negative ranging from 18.3% (11 out of 60 samples) to 50.9% (30 out of 59 samples). In Bolivia, only one of 25 samples (4%) tested had deleted pfhrp2 gene, while 68% (17 out of 25 samples) were pfhrp3-negative. Among the isolates tested, P. falciparum pfhrp2 gene deletions were present mainly in those from Acre State in the Brazilian Amazon. These results indicate it is important to reconsider the use of PfHRP2-based RDTs in the western region of the Brazilian Amazon and to implement appropriate surveillance systems to monitor pfhrp2 gene deletions in this and other parts of the Amazon region.

The pattern of coronary artery atherosclerosis is valuable in informing mitigation strategies for coronary
heart disease. Histomorphological data on this disease among Africans living in Sub Saharan Africa are,
however, scarce. The left anterior descending is one of the most commonly afflicted arteries. This
study, therefore, examined the left anterior descending artery of 213 black Kenyans [Mean age 36.8
years, range 5 – 82 years] who had died of non cardiovascular causes for features of atherosclerosis.
The individuals were divided into male and female, then into 10-yr age groups. Specimens were
obtained from the proximal segment of the artery during autopsy at the Department of Human
Anatomy University of Nairobi, Kenya. They were processed routinely for paraffin embedding and
sectioning. Five micron sections were stained with Haematoxylin/Eosin and Mason’s trichrome and
examined with light microscope. Micrographs of representative features were taken using a high
resolution digital camera. At least one feature of atherosclerosis was present in 54 (25.4%) of the
individuals. The features observed included severe intimal hyperplasia (34; 63%), disintegration of the
internal elastic lamina [30; 55.6%]; atherosclerotic plaque (20; 37%), adventitial thicknening (14;
26%) and mural neovascularization (10; 18.5%). The mean age of those with features of
atherosclerosis was 38.4 years, range 6 – 62 years with 25 (46.3%) being aged 40 years and below. Of
these, the male: female ratio was 1.7:1. In conclusion, features of atherosclerosis are present in over
25% of the population studied. The disease affects young people, including women. Proactive
preventive measures including follow – up should commence early, and involve both men and women

The possibility of a causal relationship between Earth history processes and hominin evolution in Africa has been the subject of intensive paleoanthropological research for the last 25 years. One fundamental question is: can any geohistorical processes, in particular, climatic ones, be characterized with sufficient precision to enable temporal correlation with events in hominin evolution and provide support for a possible causal mechanism for evolutionary changes? Previous attempts to link paleoclimate and hominin evolution have centered on evidence from the outcrops where the hominin fossils are found, as understanding whether and how hominin populations responded to habitat change must be examined at the local basinal scale. However, these outcrop records typically provide incomplete, low-resolution climate and environmental histories, and surface weathering often precludes the application of highly sensitive, state-of-the-art paleoenvironmental methods. continuous and well-preserved deep-sea drill core records have provided an alternative approach to reconstructing the context of hominin evolution, but have been collected at great distances from hominin sites and typically integrate information over vast spatial scales. The goal of the Hominin Sites and Paleolakes Drilling Project (HSPDP) is to analyze climate and other Earth system dynamics using detailed paleoenvironmental data acquired through scientific drilling of lacustrine depocenters at or near six key paleoanthropological sites in Kenya and Ethiopia. This review provides an overview of a unique collaboration of paleoanthropologists and earth scientists who have joined together to explicitly explore key hypotheses linking environmental history and mammalian (including hominin) evolution and potentially develop new testable hypotheses. With a focus on continuous, high-resolution proxies at timescales relevant to both biological and cultural evolution, the HSPDP aims to dramatically expand our understanding of the environmental history of eastern Africa during a significant portion of the Late Neogene and Quaternary, and to generate useful models of long-term environmental dynamics in the region.

A households’ climate change adaptive (CCA) capacity simply refers to the household head’s potential to effectively respond to climate change induced forcings. The households’ adaptive capacity hinges on several factors. This paper reports the evaluation results of the households’ CCA capacity in the Lake Victoria Basin (LVB), Kenya. The knowledge, attitude and practices (KAP) of households are said to be predictors of households’ CCA capacity. There is evidence that over the past 30 years, a number of permanent streams in the LVB, Kenya, have dried up. Across sectional survey was conducted in Gwasi and Nyando areas within the LVB, Kenya. The level of education of respondents was 44.2% (n=523) primary, 35% high school and 20.8% diploma training and above. The level of awareness of CC was 62% and 94.6% among the male respondents in Gwasi and Nyando respectively. About 57.9% (n=523) stated that both human activities and natural changes are responsible for the CC. Approximately 27.2% (n=261) and 33.5 % (n=262) in Gwasi and Nyando respectively store roof catchment water. Approximately 35.3 % (n=261) and 22.2% (n=262) in Gwasi and Nyando respectively keep donkeys for water transport. These results reveals that the CCA was positively influenced by household heads’ KAP
Keywords: Households, adaptive capacity, climate change and variability.

This study was conducted in Kolla Temben district of the Tigray regional state, north Ethiopia. The main
aim of this study was to investigate the relationship between households’ adaptive capacity to climate change and
food security status. Data on generic and area specific indicators of food security status, adaptive capacity and
other factors were collected from 400 households and were statistically analysed. The study revealed that there was
a statistically significant positive relationship between adaptive capacity to climate change and food security status.
Rainfall fluctuation, small land holding, pest and insect infestation were found to be among the area specific
determinants of household’s food security status in the arid and semi-arid areas of northern Ethiopia. The
recommended solutions to improve household’s food security in the ever-changing climate were: institutionalize
measures to improve household’s adaptive capacity to climate change; reverse household’s vulnerability level to
climate change impacts through evidence based policy initiatives, and; revise existing system to deal with new
infestations of pests. Policy decision makers should also give attention to climate change impact research to
moderate damages related to climate change as the climate will continue to change for many decades regardless of
the extent of global efforts on mitigation.

Objective: To determine the prevalence of hypertension and obesity among HIV patients enrolled in the Sex Worker Outreach Programme (SWOP), Nairobi, Kenya.

Design: A retrospective a study.

Setting: SWOP managed by the University of Manitoba, Nairobi team.

Subjects: We selected clinic visit records from HIV patients seen between 2011 and 2014, which had valid blood pressure and age entries.

Interventions: We analysed data to determine prevalence and correlates of hypertension and obesity in the study population. Associations were tested using chi-square for categorical variables and t-test for continuous variables.

Main outcome measures: Hypertension and obesity.

Results: Three thousand one hundred ninety seven subjects were included in the study. All were HIV-positive and most (97.8%) were on ART. The mean age was 39.7 years (standard deviation = 8.8) and 72.4% of the subjects were female. The prevalence of hypertension was 7.7% (246/3197) and 31% of the study cases (798/2590) were either overweight or obese. Males were more likely to have hypertension (p < 0.001) while females were more predisposed to obesity (p < 0.001).

Conclusion: Hypertension and obesity are important co-morbidities among HIV patients. Preventive and management strategies should be adopted as part of the comprehensive packages on offer at all existing HIV care and ART centres targeting those enrolled for services as well as their relatives and the community at large.

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