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PIP: Malaria is the most prevalent and devastating public health problem in Africa despite much research and control effort over the last two decades. In most parts of Africa, individuals should take 200 mg of Proguanil daily together with chloroquine 5 mg/kg per week as prophylaxis. Pregnant women and individuals with underlying disease such as sickle cell making them susceptible to severe or complicated malaria, however, should take just 200 mg Proguanil daily. In hard-core multi-drug resistance areas, mefloquine 250 mg once weekly together with chloroquine 300 mg weekly is recommended as prophylaxis. Since no anti-malarial drug confers absolute protection against infection, however, using mosquito nets impregnated with permethrin, insecticides, and mosquito repellents is also advocated for those at high risk of severe malaria. The need also exists to treat cases of malaria when prevention is unsuccessful. Chloroquine in total dose 25 mg/Kg over three days is the first choice treatment of uncomplicated malaria in 4-aminoquinoline sensitive areas. Amodiaquine 25 mg/Kg over three days is the second line treatment, while pyrimethamine/sulphonamide combinations are useful in areas where there is resistance to 4-aminoquinalines. Finally, quinine 10 mg/kg every eight hours for seven days is the treatment of choice for severe and complicated malaria.

A new anthrone named knipholone anthrone was isolated from the stem of Kniphofia foliosa. Its structure was determined by spectral analysis as well as conversion to knipholone.

A new phenylanthrone, named knipholone cyclooxanthrone and a dimeric anthraquinone, 10-methoxy-
10,70-(chrysophanol anthrone)-chrysophanol were isolated from the roots of Kniphofia foliosa together
with the rare naphthalene glycoside, dianellin. The structures were determined by NMR and mass
spectroscopic techniques. The compounds showed antiplasmodial activities against the chloroquineresistant (W2) and chloroquine-sensitive (D6) strains of Plasmodium falciparum with 10-methoxy-10,70-(chrysophanol anthrone)-chrysophanol being the most active with IC50 values of 1.17 0.12 and 4.07 1.54 mg/ml, respectively.

Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;}   Genetic modification (GM) of mosquitoes (which renders them genetically modified organisms, GMOs) offers opportunities for controlling malaria. Transgenic strains of mosquitoes have been developed and evaluation of these to 1) replace or suppress wild vector populations and 2) reduce transmission and deliver public health gains are an imminent prospect. The transition of this approach from confined laboratory settings to open field trials in diseaseendemic countries (DECs) is a staged process that aims to maximize the likelihood of epidemiologic benefits while minimizing potential pitfalls during implementation. Unlike conventional approaches to vector control, application of GM mosquitoes will face contrasting expectations of multiple stakeholders, the management of which will prove critical to safeguard support and avoid antagonism, so that potential public health benefits can be fully evaluated. Inclusion of key stakeholders in decision-making processes, transfer of problem-ownership to DECs, and increased support from the wider malaria research community are important prerequisites for this. It is argued that the many developments in this field require coordination by an international entity to serve as a guiding coalition to stimulate collaborative research and facilitate stakeholder involvement. Contemporary developments in the field of modern biotechnology, and in particular GM, requires competencies beyond the field of biology, and the future of transgenic mosquitoes will hinge on the ability to govern the process of their introduction in societies in which perceived risks may outweigh rational and responsible involvement.

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Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up. Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes. Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address them. Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of
practical environmental and entomological skills for malaria control by communities at grassroots
level and should be supported to fulfil this neglected role.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Capacity strengthening of rural communities, and the various actors that support them, is needed to enable them to lead their own malaria control programmes. Here the existing capacity of a rural community in western Kenya was evaluated in preparation for a larger intervention. Focus group discussions and semi-structured individual interviews were carried out in 1,451 households to determine (1) demographics of respondent and household; (2) socio-economic status of the household; (3) knowledge and beliefs about malaria (symptoms, prevention methods, mosquito life cycle); (4) typical practices used for malaria prevention; (5) the treatment-seeking behaviour and household expenditure for malaria treatment; and (6) the willingness to prepare and implement community-based vector control. Malaria was considered a major threat to life but relevant knowledge was a chimera of scientific knowledge and traditional beliefs, which combined with socio-economic circumstances, leads to ineffective malaria prevention. The actual malaria prevention behaviour practiced by community members differed significantly from methods known to the respondents. Beside bednet use, the major interventions implemented were bush clearing and various hygienic measures, even though these are ineffective for malaria prevention. Encouragingly, most respondents believed malaria could be controlled and were willing to contribute to a community-based malaria control program but felt they needed outside assistance. Culturally sensitive but evidence-based education interventions, utilizing participatory tools, are urgently required which consider traditional beliefs and enable understanding of causal connections between mosquito ecology, parasite transmission and the diagnosis, treatment and prevention of disease. Community-based organizations and schools need to be equipped with knowledge through partnerships with national and international research and tertiary education institutions so that evidence-based research can be applied at the grassroots level.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up. Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes. Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address them. Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of practical environmental and entomological skills for malaria control by communities at grassroots level and should be supported to fulfil this neglected role.

Our study aimed to assess adult women's knowledge of human papillomavirus (HPV) and cervical cancer, and characterize their attitudes towards potential screening and prevention strategies.

Our study aimed to assess adult women's knowledge of human papillomavirus (HPV) and cervical cancer, and characterize their attitudes towards potential screening and prevention strategies.

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Invasive cervical cancer (ICC) is the leading cause of cancer-related death among women in developing countries. Population-based cytologic screening and early treatment does reduce morbidity and mortality associated with cervical cancer. Some of the factors related to the success of such a program include awareness about cervical cancer and its screening. The objective of this study was to assess knowledge and practice about cervical cancer and Pap smear testing among cervical cancer and noncancer patients using a structured questionnaire to obtain information. Fifty-one percent of the respondents were aware of cervical cancer while 32% knew about Pap smear testing. There were no significant differences in knowledge between cervical cancer and noncancer patients. Health care providers were the principal source of information about Pap testing (82%). Only 22% of all patients had had a Pap smear test in the past. Patients aware of cervical cancer were more likely to have had a Pap smear test in the past. The level of knowledge is low among ICC and noncancer patients. There is need to increase the level of knowledge and awareness about ICC and screening among Kenyan women to increase uptake of the currently available hospital screening facilities.

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

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OBJECTIVE:
To determine the knowledge, attitudes and practices (KAP) of parents and guardians of children with epilepsy regarding the illness.
DESIGN: cross-sectional study.
SETTING: Paediatric Neurology Clinic at Kenyatta National Hospital (KNH).
RESULTS: 116 parents and guardians were interviewed using a semi-structured questionnaire. Focused group discussions (FGDs) were also carried out on 42 other parents and guardians. More than 77% of the parents/ guardians (P/G) had some knowledge on the type of illness their children were suffering from, the features of a convulsion, the alerting features before convulsions, the type of antiepileptic drug treatment their children were receiving and the potential hazards to an epileptic child during a convulsion. Many P/G did not know the causes of epilepsy, alerting features prior to a convulsion or the complications of epilepsy. 60% of the P/G administered some recommended first aid measures to their epileptic children during a fit, but many of them combined these with potentially harmful first aid measures. 40% of the epileptic children of school going age in this study were not attending school because of problems which should not have interfered with school. Spiritual healing, and to a lesser extent traditional herbal medicine were perceived to be important components of therapy for epilepsy when used in conjunction with western treatment. A higher level of formal education of the P/G had a positive influence on their KAP towards epilepsy. The findings of the FGD’s corroborated those of the questionnaire interviews.
RECOMMENDATIONS: Health Education should be given at all levels of contact with P/G, to enhance their KAP towards epilepsy, as this was likely to impact positively on the care accorded the children living with epilepsy.

OBJECTIVE:
To determine the knowledge, attitudes and practices (KAP) of parents and guardians of children with epilepsy regarding the illness.
DESIGN: cross-sectional study.
SETTING: Paediatric Neurology Clinic at Kenyatta National Hospital (KNH).
RESULTS: 116 parents and guardians were interviewed using a semi-structured questionnaire. Focused group discussions (FGDs) were also carried out on 42 other parents and guardians. More than 77% of the parents/ guardians (P/G) had some knowledge on the type of illness their children were suffering from, the features of a convulsion, the alerting features before convulsions, the type of antiepileptic drug treatment their children were receiving and the potential hazards to an epileptic child during a convulsion. Many P/G did not know the causes of epilepsy, alerting features prior to a convulsion or the complications of epilepsy. 60% of the P/G administered some recommended first aid measures to their epileptic children during a fit, but many of them combined these with potentially harmful first aid measures. 40% of the epileptic children of school going age in this study were not attending school because of problems which should not have interfered with school. Spiritual healing, and to a lesser extent traditional herbal medicine were perceived to be important components of therapy for epilepsy when used in conjunction with western treatment. A higher level of formal education of the P/G had a positive influence on their KAP towards epilepsy. The findings of the FGD’s corroborated those of the questionnaire interviews.
RECOMMENDATIONS: Health Education should be given at all levels of contact with P/G, to enhance their KAP towards epilepsy, as this was likely to impact positively on the care accorded the children living with epilepsy.

Background: Glaucoma is a characteristic optic neuropathy which typically results in specific patterns of progressive visual field loss and who’s most important risk factor is raised intraocular pressure (IOP). It is second to cataract as a leading cause of global blindness and is the leading cause of irreversible visual loss. In Kenya it is ranked third after cataract and trachoma. Previous population and hospital based studies have shown patients to have very poor levels of knowledge on their condition. This has not been verified in our setting as no study on the levels of knowledge in glaucoma patients have been done in Kenya to date.

Results: We interviewed 78 patients, 47(60%) were male and 31(40%) were female. Age ranged from 19-89 years with a mean age of 61.1 (SD +11.5) years. Fifty three (67.9%) patients were classified as having some knowledge using a predefined classification system. Patients had wrong expectation of both treatment and surgery with 29.5% and 32.5% expecting cure from medical and surgical treatment respectively.

Conclusion: There is still a wide gap in knowledge that exists and that needs to be addressed through counseling and further patient education.

Creation and sustenance of competitive advantage continues to be the central agenda in strategic research and practice# Farms strive to survive and succeed in competition by pursuing strategies that enable them to perform better than their competitors# Therefore, the study seeks to assess knowledge management as source of sustainable competitive advantage and its impact on the performance of Egerton University farms# Performance was analyzed in terms of productivity and profitability# The productivity was assessed as mean yields per acre for crops such as wheat, barley and maize# The Dairy sector assessment looked at average milk productivity per cow per day# Profitability was analyzed using Net Farm Income and Rate of Return on Assets #ROA## The farm business is a function of land, capital, labuor and management particularly that of knowledge# In addition, it is subject to variability of prices, costs, yields and seasons# This study was necessary because the farm businesses are currently operating under a lot of competition, and thus the expected outcomes of effective knowledge management led to improved organizational effectiveness, improved productivity, a way to capture best practices, improved decision making, a more innovative organization, source of competitiveness and improved performance# The objectives were achieved by use of both secondary data obtained from the farm accounts and other productivity records while primary data was collected by the use of structured and semi-structured questionnaire from people who have had experience with or associated with the running of Egerton University
farms. The data collected was analyzed using descriptive and inferential statistics with assistance of SPSS software. The hypotheses were tested using Mann-Whitney U test and Chi-Square test. The study came out with the following major findings; first the study established that the private farms were more profitable than Egerton University farms. Secondly, the study established that private Farms were more productive in both crops and milk productivity. Third, the study found out that the private farms were more aware why they acquired the information compared to Egerton University farms, a scenario which will make the private farms be more competitive than the university farms which were not clear on their reasons for acquiring information. Fourth, the private farms acquired, stored and shared information for their competitive advantage from various sources compared to Egerton University farms, a situation which made the private farms be more competitive than the university.

In previous studies, Knowledge Management (KM) strategies have been examined as objects of organizations, instead of scrutinizing their characteristics or relative quality and content. This study aims to examine the key characteristics of KM strategies in Agricultural Research Organizations (AROs) in East Africa in terms of what exists, what does not exist and why. To comprehensively answer the research questions and understand the phenomena under investigation the study adopted a pragmatism paradigm to allow facts and concerns to arise from the context. Qualitative and quantitative methods were employed using semi-structured Key Informant Interviews (KIIs) and a questionnaire respectively. A novel empirical description and explanation of the key characteristics of KM strategies in AROs in East Africa is presented. The study identifies the key concepts and gaps in the characteristics of KM strategies and elucidates what AROs in East Africa should do differently to coherently formulate and execute KM strategies in practice. The main characteristics of KM strategies in AROs in East Africa are practicability, technology-focus, alignment, implementation processes and relevance. Through abstraction and theorization of the key concepts, a detailed description and explanation as a reference for scholars and practitioners in the KM field is provided. Further, the study highlights context as an important and relevant perspective in particularizing the characteristics of a KM strategy and interpretation of related empirical findings. Future studies can use the concepts presented in this study to develop a theoretical framework for analyzing the characteristics of KM strategies in organizations. The idea of linking the study outcome to an empirical situation is a novel contribution. The findings of this study shed new insights that confirm that understanding characteristics of KM strategies is beneficial to practitioners and scholars.

Keywords agricultural research organizations, characteristics, East Africa, knowledge management, KM strategies

Background:
Contraception is the intentional use of temporary, long-term or permanent methods to prevent
pregnancy. The consistent and correct use of contraceptives ensures that unintended pregnancies and pregnancy-related health risks are prevented.

Objectives:
To assess the prevalence, types and level of knowledge on the correct use of hormonal contraceptives among women of reproductive age at Kenyatta National Hospital.

Methodology:
A cross-sectional study was carried out targeting 400 women in their reproductive age at Kenyatta National Hospital, Nairobi, Kenya. Data was collected using an interviewer administered questionnaire and analyzed
using SPSS version 20 into descriptive and inferential statistics.

Results:
The prevalence of contraceptive use was 42.8%. Contraceptive use was associated with number of children [OR 1.7 (1.3-2.1)] p<0.001. 56.1% of contraceptive users were on hormonal contraceptives. Injectable contraceptives were the most preferred followed by implants and pills. The choice of contraceptive methods was associated with age [OR 2.003 (1.330-3.017)] p=0.001 and level of education [OR 1.697 (1.135-2.539)] p=0.010. The level of knowledge on the correct use of hormonal contraceptive use was limited and was associated with the level of education [OR 1.389 (1.144-2.051)] p=0.000.

Conclusion:
Contraceptive use is low compared to knowledge of contraceptives. Injectable contraceptives are the most preferred hormonal contraceptives. The level of knowledge on the correct use of hormonal contraceptive is low.

Key words: contraceptive use, hormonal contraceptives, knowledge, correct use

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Background: Diabetes mellitus (DM) is a disease that has significant morbidity and mortality worldwide resulting from complications arising from poor control. 1,3
There is no local data to show the level of diabetic patients' knowledge on this disease at KNH, an important aspect in DM management. In the present cross-sectional study, determination of the diabetic patient's knowledge of his/her disease was undertaken for the first time at KNH.
Study Objectives: To determine the proportion of KNH DM outpatients with adequate knowledge on the disease and to determine the level of provision of diabetic education to the DM outpatients.
Study design: This was a descriptive cross-sectional study from September 2007 to January 2008.105 DM patients (above 18 years) who had given informed consent were interviewed to determine the level of their knowledge on OM and hence the proportion of respondents with adequate knowledge. Codes were manually assigned to all questions and the respective answers. Five randomly selected KNH OM OPO healthcare providers were also interviewed to determine the level of KNH preparedness in the provision of diabetic education to the OM outpatients. A sequential sampling procedure was used to interview the diabetic patients. Every Wednesday during the course of the study one different OM healthcare provider was picked and interviewed.
Data Analysis: The data obtained were captured using Epi-data computer software which was then exported to SPSS version 15.0 for analysis. Statistical significance was determined using the Pearson Chi Square at p<0.05, at 95% confidence limit. Results: 105 diabetic patients aged 18 years and above were interviewed; 53(50.5%) were males and 52 (49.5%) females. The age categories 18-30, 31-40,41-50, 51-60, 61-70 and above 70 years accounted forl2 (11.4%), 24 (22.9%), 21 (20.0%),21 (20.0%),22 (21.0°) and 5(4.8%) OM patients respectively. The highest education levels; College/University, Secondary, Primary and Non-formal accounted for 27(25.7%), 42(40.0%), 25(23.8%) and 11(10.5%) DM patients respectively. 52 (49.5%)patients had sufficient knowledge on the diabetes mellitus disease itself, 64(61%) on DM complications, 35 (33.3%) on DM medications, 84 (80%), on the importance of dietary control, 73 (70%) on the importance of doing exercises and 11 (10.5%) on the importance of DM Affiliate Associations.
Patients with highest academic level had the highest proportion of patients with adequate knowledge on the disease (p=O.OOO 1), dietary control (p=O.O 1) and exercise (p=0.03). Patients' age influenced the proportion of patients with adequate knowledge on OM complications (p=0.03). The study also showed that diabetic patients' education was conducted mainly verbally at OPO clinic once a week for two hours and only one healthcare provider conducted the training at each education session though the number of staff was ten. Conclusion: Patients were mainly taught verbally. Two-thirds to three-quarter of the patients had sufficient knowledge on the OM disease, importance of dietary requirements and exercise programs.90% of patients had insufficient knowledge on diabetes organizations and two-thirds on rational use of DM medications. Recommendation: Hospital's training and education on rational use of DM medications should be improved. The hospital should make the healthcare providers and the DM patients aware of the DM' associations for patients' benefit. More research involving larger samples over longer periods should be carried out in order to reflect what happens over a longer period of time.

Knowledge on HPV Vaccine and Cervical Cancer Facilitates Vaccine Acceptability among School Teachers in Kitui County, Kenya.

Masika MM, Ogembo JG, Chabeda SV, Wamai RG, Mugo N

BACKGROUND: Vaccines against human papillomavirus (HPV) infection have the potential to reduce the burden of cervical cancer. School-based delivery of HPV vaccines is cost-effective and successful uptake depends on school teachers' knowledge and acceptability of the vaccine. The aim of this study is to assess primary school teachers' knowledge and acceptability of HPV vaccine and to explore facilitators and barriers of an ongoing Gavi Alliance-supported vaccination program in Kitui County, Kenya.
METHODS: This was a cross-sectional, mixed methods study in Central Division of Kitui County where the Ministry of Health is offering the quadrivalent HPV vaccine to grade four girls. Data on primary school teachers' awareness, knowledge and acceptability of HPV vaccine as well as facilitators and barriers to the project was collected through self-administered questionnaires and two focus group discussions.
RESULTS: 339 teachers (60% female) completed the survey (62% response rate) and 13 participated in 2 focus group discussions. Vaccine awareness among teachers was high (90%), the level of knowledge about HPV and cervical cancer among teachers was moderate (48%, SD = 10.9) and females scored higher than males (50% vs. 46%, p = 0.002). Most teachers (89%) would recommend the vaccine to their daughter or close relatives. Those who would recommend the vaccine had more knowledge than those who would not (p = <0.001). The main barriers were insufficient information about the vaccine, poor accessibility of schools, absenteeism of girls on vaccine days, and fear of side effects.
CONCLUSIONS: Despite low to moderate levels of knowledge about HPV vaccine among school teachers, vaccine acceptability is high. Teachers with little knowledge on HPV vaccine are less likely to accept the vaccine than those who know more; this may affect uptake if not addressed. Empowering teachers to be vaccine champions in their community may be a feasible way of disseminating information about HPV vaccine and cervical cancer.

PLoS One. 2015 Aug 12;10(8):e0135563. doi: 10.1371/journal.pone.0135563. eCollection 2015.

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Description
Hazardous health-care waste poses a great danger to public health and the environment if it is not properly managed. There is need for health-care workers involved in its management to understand the integral link between human health and environmental health. This study was done to identify gaps in knowledge, attitude and practice among the healthcare workers involved in its management hence endangering public health and polluting the environment. A self administered questionnaire was used in both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret to clinicians, nurses, laboratory technologists and hospital attendants to identify the gaps with a focus on their knowledge, attitude and practice. It was found that health and safety in health-care waste management, was not included in most of the curricula for training the three healthcare professionals. Most of them …

PIP: In this study, 273 university students (161 men and 112 women) were interviewed by means of a self-administered questionnaire to determine their knowledge, attitude, and practice concerning sexually transmitted diseases (STDs). The mean age of the men was 22.4 +or- 1.6 years and that of the women was 22.1 +or- 1.6 years. 97.4% of the students were sexually experienced. Knowledge of common STDs was high, but knowledge of their signs, symptoms, and consequences was low. 24.5% of the male and 3.7% of the female students had had an STD. The principal sources of information on STDs included books, films, and TV for 39.6% of the students and teachers for 16.8% of the students. Parents played a very minimal role. It is suggested that primary and secondary school students be taught about STDs as part of reproductive health education and that such education be continued at the college level in order to increase the awareness among young people. author's modified

PIP: In this study, 273 university students (161 men and 112 women) were interviewed by means of a self-administered questionnaire to determine their knowledge, attitude, and practice concerning sexually transmitted diseases (STDs). The mean age of the men was 22.4 +or- 1.6 years and that of the women was 22.1 +or- 1.6 years. 97.4% of the students were sexually experienced. Knowledge of common STDs was high, but knowledge of their signs, symptoms, and consequences was low. 24.5% of the male and 3.7% of the female students had had an STD. The principal sources of information on STDs included books, films, and TV for 39.6% of the students and teachers for 16.8% of the students. Parents played a very minimal role. It is suggested that primary and secondary school students be taught about STDs as part of reproductive health education and that such education be continued at the college level in order to increase the awareness among young people. author's modified

Institute of African Studies, University of Nairobi, Nairobi, Kenya. This article assesses knowledge, attitudes, and practices regarding cervical cancer among rural women of Kenya. One hundred and sixty women (mean age 37.9 years) who sought various health care services at Tigoni subdistrict hospital, Limuru, Kenya, were interviewed using a semistructured questionnaire. In addition, three focus group discussions (25 participants) were held, five case narratives recorded, and a free list of cervical cancer risk factors obtained from a group of 41 women respondents. All women were aged between 20 and 50 years. About 40% knew cervical cancer, although many still lack factual information. A history of sexually transmitted diseases (61.5%), multiple sexual partners (51.2%), and contraceptive use (33%) were identified as risk factors. Other factors mentioned include smoking, abortion, and poor hygiene standards. High parity, early sexual debut, and pregnancy were not readily mentioned as risk factors. We propose a folk causal model to explain the link between these factors and cervical cancer. Lack of knowledge constrains utilization of screening services offered at the clinics. Consequently, respondents support educating women as a way to tackling issues on cervical cancer. It is recommended that an integrated reproductive health program that addresses comprehensively women's health concerns be put in place.

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According to UN demographic projections, the world population aged 60 years and above is increasing rapidly. It is estimated that by the year 2025, there will be about 1.2 billion people above the age of 60 years worldwide. The older population in Africa currently estimated to be slightly over 42 million is projected to reach 205 million by 2050. Many of the elderly enter old age after a life of deprivation with limited access to resources. Objectives: The purpose of this study was to determine the nutritional and oral health status of elderly persons as a part of a wider study carried out in Nairobi, Kenya. Methods: Data were collected from 289 persons aged 45 years and above using a semi-structured questionnaire. Oral health status was assessed by dental examination, while nutritional status was assessed using Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Results: The study established that many of the elderly persons suffered from dental problems, especially periodontitis, dental caries, tooth mobility and missing teeth. The level of malnutrition using the MUAC was 18.8% while by BMI it was 11.4%. 46.4% had normal nutritional status while some of them (40.9%) were overweight, with more females (48.0%) than males (25.9%) being overweight. Conclusions: Undernutrition, obesity and dental problems are issues of concern among the elderly in Nairobi.

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Background: Glaucoma is a characteristic optic neuropathy which typically results in specific patterns of progressive visual field loss and who’s most important risk factor is raised intraocular pressure (IOP). It is second to cataract as a leading cause of global blindness and is the leading cause of irreversible visual loss. In Kenya it is ranked third after cataract and trachoma. Glaucoma is often diagnosed late and accompanied by poor patient compliance and follow-up as it is very slowly progressive and commonly asymptomatic until a very advanced stage of the disease is reached.
Results: We interviewed 78 patients, 47 were male and 31 were female. Age ranged from 19-89 years with a mean age of 61.1 (SD +11.5) years. Seventy nine percent of patients presented with normal visual acuity but 5 (6.4%) presented with bilateral blindness. Mean IOP at presentation was 23.85mmHg with a wide range of 9-60mmHg. Fifty three (67.9%) patients were classified as having some knowledge using a predefined classification system, having poor knowledge of risk factors and treatment options. On compliance to medication, 62 (78.7%) patients reported compliance while 54 (69.2%) reported compliance to all clinic visits. The most common challenges reported with drug use were drops falling on cheeks (41%), cost of drugs (23.1%), and side effects of drugs used (19.2%).The most common impediments to clinic attendance were forgetting (16.7%) and other incidental events (62.5%). Patients had wrong expectation of both treatment and surgery with 29.5% and 32.5% expecting cure from medical and surgical treatment respectively. Compliance to glaucoma medication was perceived to be very important in 88.5% of patients, while 89.7% of patients perceived compliance to follow-up clinics as being very important.
Conclusion: Forty four (56.4%) patients presented late with advanced disc damage and 40 (51.3%) had undergone surgery, the most common being trabeculectomy. There is still a wide gap in knowledge that exists and that needs to be addressed through counseling and further patient education. Self-reported compliance was high and patients had good attitudes towards treatment and follow-up of glaucoma.

Background: Glaucoma is a characteristic optic neuropathy which typically results in specific patterns of progressive visual field loss and who’s most important risk factor is raised intraocular pressure (IOP). It is second to cataract as a leading cause of global blindness and is the leading cause of irreversible visual loss. In Kenya it is ranked third after cataract and trachoma. Glaucoma is often diagnosed late and accompanied by poor patient compliance and follow-up as it is very slowly progressive and commonly asymptomatic until a very advanced stage of the disease is reached.
Results: We interviewed 78 patients, 47 were male and 31 were female. Age ranged from 19-89 years with a mean age of 61.1 (SD +11.5) years. Seventy nine percent of patients presented with normal visual acuity but 5 (6.4%) presented with bilateral blindness. Mean IOP at presentation was 23.85mmHg with a wide range of 9-60mmHg. Fifty three (67.9%) patients were classified as having some knowledge using a predefined classification system, having poor knowledge of risk factors and treatment options. On compliance to medication, 62 (78.7%) patients reported compliance while 54 (69.2%) reported compliance to all clinic visits. The most common challenges reported with drug use were drops falling on cheeks (41%), cost of drugs (23.1%), and side effects of drugs used (19.2%).The most common impediments to clinic attendance were forgetting (16.7%) and other incidental events (62.5%). Patients had wrong expectation of both treatment and surgery with 29.5% and 32.5% expecting cure from medical and surgical treatment respectively. Compliance to glaucoma medication was perceived to be very important in 88.5% of patients, while 89.7% of patients perceived compliance to follow-up clinics as being very important.
Conclusion: Forty four (56.4%) patients presented late with advanced disc damage and 40 (51.3%) had undergone surgery, the most common being trabeculectomy. There is still a wide gap in knowledge that exists and that needs to be addressed through counselling and further patient education. Self-reported compliance was high and patients had good attitudes towards treatment and follow-up of glaucoma.

To determine the knowledge, attitudes and practices (KAP) of mothers and the knowledge of health workers regarding care of the newborn umbilical cord.

According to UN demographic projections, the world population aged 60 years and above is increasing rapidly. It is estimated that by the year 2025, there will be about 1.2 billion people above the age of 60 years worldwide. The older population in Africa currently estimated to be slightly over 42 million is projected to reach 205 million by 2050. Many of the elderly enter old age after a life of deprivation with limited access to resources. Objectives: The purpose of this study was to determine the nutritional and oral health status of elderly persons as a part of a wider study carried out in Nairobi, Kenya. Methods: Data were collected from 289 persons aged 45 years and above using a semi-structured questionnaire. Oral health status was assessed by dental examination, while nutritional status was assessed using Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Results: The study established that many of the elderly persons suffered from dental problems, especially periodontitis, dental caries, tooth mobility and missing teeth. The level of malnutrition using the MUAC was 18.8% while by BMI it was 11.4%. 46.4% had normal nutritional status while some of them (40.9%) were overweight, with more females (48.0%) than males (25.9%) being overweight. Conclusions: Undernutrition, obesity and dental problems are issues of concern among the elderly in Nairobi.

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A cross-sectional descriptive study on knowledge, attitudes, and practice about emergency contraception (EC) was conducted among nurses and nursing students using a self-administered questionnaire. One-hundred-sixty-seven qualified nurses and 63 nursing students completed the questionnaire. Over 95% listed at least one regular contraceptive method but only 2.6% spontaneously listed EC as a contraceptive method, whereas 48% of the respondents had heard of EC. Significantly more nursing students than qualified nurses were familiar with EC. Knowledge about the types of EC, applications, and side effects was poor and 49% of the respondents considered EC as an abortifacient. Of those familiar with EC, 77% approved its use for rape victims and 21% for adolescents and schoolgirls. Only 3.5% of all respondents had personally used EC in the past, 23% of those familiar with EC intend to use it in the future, whereas 53% intend to provide or promote it. The view that EC was abortifacient negatively influenced the decision to use or provide EC in the future. The present findings suggest that the level of knowledge of EC is poor and more information is needed. These findings indicate the potential to popularize emergency contraception in Kenya among nurses and nursing students.

A cross-sectional descriptive study on knowledge, attitudes, and practice about emergency contraception (EC) was conducted among nurses and nursing students using a self-administered questionnaire. One-hundred-sixty-seven qualified nurses and 63 nursing students completed the questionnaire. Over 95% listed at least one regular contraceptive method but only 2.6% spontaneously listed EC as a contraceptive method, whereas 48% of the respondents had heard of EC. Significantly more nursing students than qualified nurses were familiar with EC. Knowledge about the types of EC, applications, and side effects was poor and 49% of the respondents considered EC as an abortifacient. Of those familiar with EC, 77% approved its use for rape victims and 21% for adolescents and schoolgirls. Only 3.5% of all respondents had personally used EC in the past, 23% of those familiar with EC intend to use it in the future, whereas 53% intend to provide or promote it. The view that EC was abortifacient negatively influenced the decision to use or provide EC in the future. The present findings suggest that the level of knowledge of EC is poor and more information is needed. These findings indicate the potential to popularize emergency contraception in Kenya among nurses and nursing students. PIP: A descriptive research study on knowledge, attitudes and practices with regard to emergency contraception (EC) was conducted using a questionnaire among 167 nurses and 63 nursing students in Nairobi, Kenya. Results revealed that 95% recorded at least one regular contraceptive method. About 48% of the respondents had heard about EC, but only 2.6% had used it. More nursing students than qualified nurses were aware of EC. There was poor knowledge about the types, applications and side effects of EC. Some 49% of the subjects regarded EC as an abortifacient. About 77% of those knowledgeable about EC approved its use for rape victims and 21% for adolescents and schoolgirls. Only about 3.5% had personally used it. Some 23% of those aware of EC intended to use it in the future. About 53% planned to provide or promote it. The perception that EC is abortifacient affected the decision whether to use or provide it. The data imply that there is potential for effective promotion of EC among nurses and nursing students in Kenya

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J. O. Midiwo, A. Yenesew, B. F. Juma, S. Dereses, J. A. Ayoo, A. Aluoch and S. Guchu There are several described medicinal plants in Kenya from a flora of approximately 10,000 members. Strong cross-medical information from the 42 ethnic groups points to the high potential of some of these species. The Myrsinaceae are well established ethno-anthelmintics and anti-bacterials. They are harbingers of long alkyl side chain benzoquinones which clearly have a protective function from their histochemical disposition. The main benzoquinone in the sub-family Myrsinodae is embelin while for the Maesodae it is maesaquinone together with its 5-acetyl derivative; the distribution of these benzoquinones by their alkyl side chain length or the presence/absence of a 6-methyl group is in accord with morphological sub-family de-limitation. The benzoquinones showed anti-feedant, anti-microbial, phytotoxic, acaricidal, insecticidal and nematicidal activity. Many other benzoquinones of medium and minor concentration were also isolated and characterised. Some plants belonging to the Polygonaceae which are widely used as ethno-anthelmintics have been studied. The common anthelmintic anthraquinones were obtained from all five Rumex species while the naphthalenic acetogenin derivative, nepodin was more selectively distributed. The leaf of Polygonum senegalense is up to 17% surface exudate; about thirteen non polar flavonoid derivatives (chalcones, dihydrochalcones, flavanones and a flavone) have been isolated from it. From the internal aerial tissues of this plant, the major flavonoids were common flavonoids, quercetin, kaempferol, luteolin and their glycosides. The only unique compound isolated from this plant was 2prime-glucosyl-6prime-hydroxy-4prime-methoxydihydrochalcone whose aglycone, uvangolatin is part of the exudate mixture. Other leaf exudate plants studied include the stomach-ache medicine, Psiadia punctulata (Compositae) from which novel methylated flavonoids, kaurene and trachyloban diterpenes have been found

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Department of Orthopaedic Surgery, College of Health Sciences, University of Nairobi, Kenya. A case report is presented of a 53 year old man who presented with posterior dislocation of the hip after a road traffic accident. Initial management by closed reduction failed due to presence of an occult free intra-articular fragment. This fragment was not visualised on plain A-P and lateral X-ray views. The cause of the failed closed reduction was eventually detected by CT scan. Open reduction and removal of the bone fragment was done and the hip remained stable thereafter. It is concluded that plain X-rays are not adequate in the diagnosis of free intra-articular bone fragments within the hip joint and CT scanning is advised for accurate detection of such occult bine fragments.

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Thirty eight symptomatic and two asymptomatic patients seropositive for human immunodeficiency virus type-1 (HIV-1) were treated with a natural human interferon alpha (HuIFN alpha). Patients were given 2 IU/kg HuIFN alpha orally once daily in powdered maltose held in the mouth to promote mucosal absorption. This oral immunomodulating HuIFN alpha therapy resulted in an increase in CD4+ lymphocytes, an increase in weight, and a dramatic alleviation of clinical symptoms related to HIV-1 infection.

Thirty eight symptomatic and two asymptomatic patients seropositive for human immunodeficiency virus type-1 (HIV-1) were treated with a natural human interferon alpha (HuIFN alpha). Patients were given 2 IU/kg HuIFN alpha orally once daily in powdered maltose held in the mouth to promote mucosal absorption. This oral immunomodulating HuIFN alpha therapy resulted in an increase in CD4+ lymphocytes, an increase in weight, and a dramatic alleviation of clinical symptoms related to HIV-1 infection.

One hundred and ninety nine symptomatic and 5 asymptomatic patients seropositive for the human immunodeficiency virus type 1 (HIV-1) were treated with KEMRON, a natural human interferon alpha (nHIF alpha) stabilized in a complex polysacchariche carrier. Treatment was given for at least 10 weeks at a daily oral dose of approximately 2.0 IU of nHIF alpha per kg body weight. Karnofsky performance score increased from an average of 60.5 on entry into the study to 100 by the 10th week after treatment. Similarly, common clinical complaints associated with HIV-1 infection rapidly reduced per patient from an average of 3.8 to 0.05 and 0 by week 8 and 10 of treatment. Eighteen of the patients serodeconverted by both ELISA and western blot assays during the study period. These observations suggest that KEMRON used as recommended is beneficial in HIV-1 seropositive individuals.

One hundred and ninety nine symptomatic and 5 asymptomatic patients seropositive for the human immunodeficiency virus type 1 (HIV-1) were treated with KEMRON, a natural human interferon alpha (nHIF alpha) stabilized in a complex polysacchariche carrier. Treatment was given for at least 10 weeks at a daily oral dose of approximately 2.0 IU of nHIF alpha per kg body weight. Karnofsky performance score increased from an average of 60.5 on entry into the study to 100 by the 10th week after treatment. Similarly, common clinical complaints associated with HIV-1 infection rapidly reduced per patient from an average of 3.8 to 0.05 and 0 by week 8 and 10 of treatment. Eighteen of the patients serodeconverted by both ELISA and western blot assays during the study period. These observations suggest that KEMRON used as recommended is beneficial in HIV-1 seropositive individuals.

Treatment of HIV infections has involved the use of antiviral drugs as well as those drugs that act against opportunistic infections. Immune modulators have also been used. A review of these drugs is reported emphasizing on those which have great promise in the clinical management of HIV infections in the light of our present knowledge on immunopathology of the disease.

Treatment of HIV infections has involved the use of antiviral drugs as well as those drugs that act against opportunistic infections. Immune modulators have also been used. A review of these drugs is reported emphasizing on those which have great promise in the clinical management of HIV infections in the light of our present knowledge on immunopathology of the disease.

Savanna ecosystems and origins of modern human behavior Hekima III (1) 27-42: (Journal of the Humanities and Social Sciences, University of Nairobi).

OBJECTIVE: To determine the dental caries experience and knowledge on the causes and preventive measures for dental diseases. DESIGN: A community based cross-sectional descriptive study. SETTING: Elwak sub-district hospital, North Eastern Province, Kenya. SUBJECTS: One hundred and forty one adults who presented themselves during a dental check up at a sub-district hospital and gave written consent. MAIN OUTCOME MEASURES: Dental caries status and knowledge on its causes and preventive measures. The importance of outreach programmes in obtaining information as well as helping to alleviate the pain and suffering caused by dental diseases among communities living in remote areas is also revealed. RESULTS: Of the one hundred and forty one individuals, who were included in the study, 63.1% were women and 36.9% were men. Their ages ranged between 18 and over 65 years. 41.1% were in the 18-24-year age bracket. Regarding the oral health knowledge, 43% did not know any causes of dental diseases while 36%, 17% and 12% knew that diet, "dirt" on teeth and bacteria were possible causes, respectively. Fifty percent did not know any preventive measures for dental diseases while the rest indicated abstention from the consumption of sugary foods; and only 0.8% mentioned use of fluoridated toothpaste as a preventive measure for dental caries. 56.7% of the subjects were caries free. The mean DMFT for all ages was 3.4. Of those with caries 72.1% were women. CONCLUSION: There is a low level of oral health awareness and a moderately high level of dental caries experience in this community with women apparently carrying the biggest burden of dental caries.

HIV diversity may limit the breadth of vaccine coverage due to epitope sequence differences between strains. Although amino acid substitutions within CD8(+) T cell HIV epitopes can result in complete or partial abrogation of responses, this has primarily been demonstrated in effector CD8(+) T cells. In an HIV-infected Kenyan cohort, we demonstrate that the cross-reactivity of HIV epitope variants differs dramatically between overnight IFN-gamma and longer-term proliferation assays. For most epitopes, particular variants (not the index peptide) were preferred in proliferation in the absence of corresponding overnight IFN-gamma responses and in the absence of the variant in the HIV quasispecies. Most proliferating CD8(+) T cells were polyfunctional via cytokine analyses. A trend to positive correlation was observed between proliferation (but not IFN-gamma) and CD4 counts. We present findings relevant to the assessment of HIV vaccine candidates and toward a better understanding of how viral diversity is tolerated by central and effector memory CD8(+) T cells.

OBJECTIVE: To determine the prevalence of HCV infection and HCV/HIV co-infection among voluntary blood donors at the National Blood Transfusion Centre and clients at the Kenyatta National Hospital HIV-Voluntary Counseling and Testing (VCT) Centre. DESIGN: A prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital and the National Blood Transfusion Services Centre, Nairobi. SUBJECTS: Volunteer blood donors and VCT attendants. RESULTS: The prevalence of HCV/HIV co-infection among 6154 blood donors in the NBTSC was very low, at 0.02. The HIV prevalence among the 353 KNH HIV-VCT clients was 9.3%, none of the clients tested positive for HCV. The incidence of risk factors in the persons with HCV and/or HIV infection(s) was low. CONCLUSION: The prevalence of HCV infection among pre-screened volunteer blood donors was low. However the current practice of screening all donated blood for HCV remains indispensable to prevent its transmission to blood recipients.

Introduction to Philosophy of Religion, University of Nairobi, 1988

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up. Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes. Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address them. Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of practical environmental and entomological skills for malaria control by communities at grassroots level and should be supported to fulfil this neglected role.