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Tetracyclines have been among the most widely used antibiotics worldwide. Plasmid-mediated tetracycline resistance among hospital strains of bacteria has continued to rise and of major concern has been the transfer of resistance to pathogenic organisms. Bacteraemia due to hospital acquired S. typhimurium has been a major cause of morbidity at Kenyatta National Hospital (KNH), hence the need to study drug susceptibility pattern of this organism. This study also characterized the tetracycline resistance genes using oligonucleotide probes. Ninety seven S. typhimurium strains isolated from patients at KNH were used. Agar dilution method was used to determine minimum inhibitory concentration (MIC). Plasmids were isolated from each strain and the different plasmid profiles were grouped by their molecular weights into 6 patterns. Out of 97, 87 (88%) strains were resistant. MIC ranged from 1 microgram/ml to 128 micrograms/ml. Genes encoding for tetracycline resistance were located on plasmids of molecular weights 65 MDa, 5.2 or both. Plasmid-encoded antimicrobial resistance is likely to spread to other pathogenic organisms, reduce our ability to treat the infection and increase the cost and duration of treatment.

Tetracyclines have been among the most widely used antibiotics worldwide. Plasmid-mediated tetracycline resistance among hospital strains of bacteria has continued to rise and of major concern has been the transfer of resistance to pathogenic organisms. Bacteraemia due to hospital acquired S. typhimurium has been a major cause of morbidity at Kenyatta National Hospital (KNH), hence the need to study drug susceptibility pattern of this organism. This study also characterized the tetracycline resistance genes using oligonucleotide probes. Ninety seven S. typhimurium strains isolated from patients at KNH were used. Agar dilution method was used to determine minimum inhibitory concentration (MIC). Plasmids were isolated from each strain and the different plasmid profiles were grouped by their molecular weights into 6 patterns. Out of 97, 87 (88%) strains were resistant. MIC ranged from 1 microgram/ml to 128 micrograms/ml. Genes encoding for tetracycline resistance were located on plasmids of molecular weights 65 MDa, 5.2 or both. Plasmid-encoded antimicrobial resistance is likely to spread to other pathogenic organisms, reduce our ability to treat the infection and increase the cost and duration of treatment.

An outbreak of epididymitis and orchitis associated with Actinobacillus seminis infection is reported. In the outbreak, both young unmated rams and mature breeding rams were affected. Infected rams were found to have abscessed testes and epididymi and semen of poor quality when compared with uninfected rams. Testicular and epididymal lesions in affected rams were similar to those observed in cases of brucellosis. While no other body systems were observed to be affected by the disease, severe losses may be incurred by farmers through the loss of breeding rams. Infection by A. seminis should be considered as a differential diagnosis in cases of epididymitis and orchitis in Kenya.

Ogutu EO. A 10-year (1976-1986) retrospective study was done on 30 cases with histological diagnosis of pancreatic carcinoma. The male to female ratio was 1.3:1 and the peak incidence was in the 6th and 7th decades. The head of the pancreas was involved in 96% of cases while solid adenocarcinoma of duct cell origin accounted for 73.3% of cases, followed by anaplastic carcinoma (23.3%). The commonest complications were distinct metastasis (86.6%), obstructive jaundice (73.3%) and upper gastrointestinal bleed (13.6%).

Data available on the role of the opioid systems of the naked mole-rat in nociception is scanty and unique compared to that of other rodents. In the current study, the effect of DAMGO, DPDPE and U-50488 and U-69593 on formalin-induced (20 μl,10%) nociception were investigated. Nociceptive-like behaviors were quantified by scoring in blocks of 5 min the total amount of time (s) the animal spent scratching/biting the injected pawin the early (0–5 min) and in the late (25–60 min) phase of the test. In both the early and late phases, administration of 1 or 5 mg/kg of DAMGO or DPDPE caused a naloxone-attenuated decrease in the mean scratching/biting time. U-50488 and U-69593 at all the doses tested did not significantly change the mean scratching/biting time in the early phase. However, in the late phase U-50488 or U-69593 at the highest doses tested (1 or 5 mg/kg or 0.025 or 0.05 mg/kg, respectively) caused a statistically significant and naloxone-attenuated decrease in the mean scratching/biting time. The data showed that mu, delta or kappa-selective opioids causes antinociception in the formalin test in this rodent, adding novel information on the role of opioid systems of the animal on pain regulation.

Data available on the role of the opioid systems of the naked mole-rat in nociception is scanty and unique compared to that of other rodents. In the current study, the effect of DAMGO, DPDPE and U-50488 and U-69593 on formalin-induced (20 μl,10%) nociception were investigated. Nociceptive-like behaviors were quantified by scoring in blocks of 5 min the total amount of time (s) the animal spent scratching/biting the injected pawin the early (0–5 min) and in the late (25–60 min) phase of the test. In both the early and late phases, administration of 1 or 5 mg/kg of DAMGO or DPDPE caused a naloxone-attenuated decrease in the mean scratching/biting time. U-50488 and U-69593 at all the doses tested did not significantly change the mean scratching/biting time in the early phase. However, in the late phase U-50488 or U-69593 at the highest doses tested (1 or 5 mg/kg or 0.025 or 0.05 mg/kg, respectively) caused a statistically significant and naloxone-attenuated decrease in the mean scratching/biting time. The data showed that mu, delta or kappa-selective opioids causes antinociception in the formalin test in this rodent, adding novel information on the role of opioid systems of the animal on pain regulation.

Data available on the role of the opioid systems of the naked mole-rat in nociception is scanty and unique compared to that of other rodents. In the current study, the effect of DAMGO, DPDPE and U-50488 and U-69593 on formalin-induced (20 μl,10%) nociception were investigated. Nociceptive-like behaviors were quantified by scoring in blocks of 5 min the total amount of time (s) the animal spent scratching/biting the injected pawin the early (0–5 min) and in the late (25–60 min) phase of the test. In both the early and late phases, administration of 1 or 5 mg/kg of DAMGO or DPDPE caused a naloxone-attenuated decrease in the mean scratching/biting time. U-50488 and U-69593 at all the doses tested did not significantly change the mean scratching/biting time in the early phase. However, in the late phase U-50488 or U-69593 at the highest doses tested (1 or 5 mg/kg or 0.025 or 0.05 mg/kg, respectively) caused a statistically significant and naloxone-attenuated decrease in the mean scratching/biting time. The data showed that mu, delta or kappa-selective opioids causes antinociception in the formalin test in this rodent, adding novel information on the role of opioid systems of the animal on pain regulation.

is widely used in Sub-Saharan Africa for treating many diseases, including HIV-1 infection. We have recently described the chemical structures of 28 compounds isolated from an alcoholic crude extract of barks and roots of , and showed that six bioactive compounds inhibit HIV-1 infection. In the present study, we demonstrate that the six compounds block HIV-1 entry into cells: oleanolic acid, palmitic acid, taxifolin, piceatannol, guibourtinidol-(4α→8)-epiafzelechin, and a novel compound named as cassiabrevone. We report, for the first time, that guibourtinidol-(4α→8)-epiafzelechin and cassiabrevone inhibit HIV-1 entry (IC of 42.47 µM and 30.96 µM, respectively), as well as that piceatannol interacts with cellular membranes. Piceatannol inhibits HIV-1 infection in a dual-chamber assay mimicking the female genital tract, as well as HSV infection, emphasizing its potential as a microbicide. Structure-activity relationships (SAR) showed that pharmacophoric groups of piceatannol are strictly required to inhibit HIV-1 entry. By a ligand-based in silico study, we speculated that piceatannol and norartocarpetin may have a very similar mechanism of action and efficacy because of the highly comparable pharmacophoric and 3D space, while guibourtinidol-(4α→8)-epiafzelechin and cassiabrevone may display a different mechanism. We finally show that cassiabrevone plays a major role of the crude extract of by blocking the binding activity of HIV-1 gp120 and CD4.

Abstract
BACKGROUND:

Few large-scale studies of epilepsy have been done in sub-Saharan Africa. We aimed to estimate the prevalence of, treatment gap in, and possible risk factors for active convulsive epilepsy in Kenyan people aged 6 years or older living in a rural area.
METHODS:

We undertook a three-phase screening survey of 151,408 individuals followed by a nested community case-control study. Treatment gap was defined as the proportion of cases of active convulsive epilepsy without detectable amounts of antiepileptic drugs in blood.
FINDINGS:

Overall prevalence of active convulsive epilepsy was 2.9 per 1000 (95% CI 2.6-3.2); after adjustment for non-response and sensitivity, prevalence was 4.5 per 1000 (4.1-4.9). Substantial heterogeneity was noted in prevalence, with evidence of clustering. Treatment gap was 70.3% (65.9-74.5), with weak evidence of a difference by sex and area. Adjusted odds of active convulsive epilepsy for all individuals were increased with a family history of non-febrile convulsions (odds ratio 3.3, 95% CI 2.4-4.7; p<0.0001), family history of febrile convulsions (14.6, 6.3-34.1; p<0.0001), history of both seizure types (7.3, 3.3-16.4; p<0.0001), and previous head injury (4.1, 2.1-8.1; p<0.0001). Findings of multivariable analyses in children showed that adverse perinatal events (5.7, 2.6-12.7; p<0.0001) and the child's mother being a widow (5.1, 2.4-11.0; p<0.0001) raised the odds of active convulsive epilepsy.
INTERPRETATION:

Substantial heterogeneity exists in prevalence of active convulsive epilepsy in this rural area in Kenya. Assessment of prevalence, treatment use, and demographic variation in screening response helped to identify groups for targeted interventions. Adverse perinatal events, febrile illness, and head injury are potentially preventable associated factors for epilepsy in this region.

The East African Rift System (EARS) has natural hazards – earthquakes, volcanic eruptions, and landslides along the faulted margins, and in response to ground shaking. Strong damaging earthquakes have been occurring in the region along the EARS throughout historical time, example being the 7.4 (Ms) of December 1910. The most recent damaging earthquake is the Karonga earthquake in Malawi, which occurred on 19th December, 2009 with a magnitude of 6.2 (Ms). The earthquake claimed four lives and destroyed over 5000 houses. In its effort to improve seismic hazard assessment in the region, Eastern and Southern Africa Seismological Working Group (ESARSWG) under the sponsorship of the International Program on Physical Sciences (IPPS) carried out a study on active fault mapping in the region.

The fieldwork employed geological and geophysical techniques. The geophysical techniques employed are ground magnetic, seismic refraction and resistivity surveys but are reported elsewhere. This article gives findings from geological techniques. The geological techniques aimed primarily at mapping of active faults in the area in order to delineate presence or absence of fault segments. Results show that the Karonga fault (the Karonga fault here referred to as the fault that ruptured to the surface following the 6th–19th December 2009 earthquake events in the Karonga area) is about 9 km long and dominated by dip slip faulting with dextral and insignificant sinistral components and it is made up of 3–4 segments of length 2–3 km. The segments are characterized by both left and right steps.

Although field mapping show only 9 km of surface rupture, maximum vertical offset of about 43 cm imply that the surface rupture was in little excess of 14 km that corresponds with Mw = 6.4. We recommend the use or integration of multidisciplinary techniques in order to better understand the fault history, mechanism and other behavior of the fault/s for better urban planning in the area.

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BACKGROUND:

Active management of the third stage of labour reduces the risk of post-partum haemorrhage. We aimed to assess whether controlled cord traction can be omitted from active management of this stage without increasing the risk of severe haemorrhage.

METHODS:

We did a multicentre, non-inferiority, randomised controlled trial in 16 hospitals and two primary health-care centres in Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda. Women expecting to deliver singleton babies vaginally (ie, not planned caesarean section) were randomly assigned (in a 1:1 ratio) with a centrally generated allocation sequence, stratified by country, to placental delivery with gravity and maternal effort (simplified package) or controlled cord traction applied immediately after uterine contraction and cord clamping (full package). After randomisation, allocation could not be concealed from investigators, participants, or assessors. Oxytocin 10 IU was administered immediately after birth with cord clamping after 1-3 min. Uterine massage was done after placental delivery according to local policy. The primary (non-inferiority) outcome was blood loss of 1000 mL or more (severe haemorrhage). The non-inferiority margin for the risk ratio was 1·3. Analysis was by modified intention-to-treat, excluding women who had emergency caesarean sections. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN 12608000434392.

FINDINGS:

Between June 1, 2009, and Oct 30, 2010, 12,227 women were randomly assigned to the simplified package group and 12,163 to the full package group. After exclusion of women who had emergency caesarean sections, 11,861 were in the simplified package group and 11,820 were in the full package group. The primary outcome of blood loss of 1000 mL or more had a risk ratio of 1·09 (95% CI 0·91-1·31) and the upper 95% CI limit crossed the pre-stated non-inferiority margin. One case of uterine inversion occurred in the full package group. Other adverse events were haemorrhage-related.

INTERPRETATION:

Although the hypothesis of non-inferiority was not met, omission of controlled cord traction has very little effect on the risk of severe haemorrhage. Scaling up of haemorrhage prevention programmes for non-hospital settings can safely focus on use of oxytocin.

FUNDING:
United States Agency for International Development and UN Development Programme/UN Population Fund/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research

BACKGROUND:
The third stage of labour refers to the period between birth of the baby and complete expulsion of the placenta. Some degree of blood loss occurs after the birth of the baby due to separation of the placenta. This period is a risky period because uterus may not contract well after birth and heavy blood loss can endanger the life of the mother. Active management of the third stage of labour (AMTSL) reduces the occurrence of severe postpartum haemorrhage by approximately 60-70%. Active management consists of several interventions packaged together and the relative contribution of each of the components is unknown. Controlled cord traction is one of those components that require training in manual skill for it to be performed appropriately. If it is possible to dispense with controlled cord traction without losing efficacy it would have major implications for effective management of the third stage of labour at peripheral levels of health care.

OBJECTIVE:
The primary objective is to determine whether the simplified package of oxytocin 10 IU IM/IV is not less effective than the full AMTSL package.

METHODS:
A hospital-based, multicentre, individually randomized controlled trial is proposed. The hypothesis tested will be a non-inferiority hypothesis. The aim will be to determine whether the simplified package without CCT, with the advantage of not requiring training to acquire the manual skill to perform this task, is not less effective than the full AMTSL package with regard to reducing blood loss in the third stage of labour.The simplified package will include uterotonic (oxytocin 10 IU IM) injection after delivery of the baby and cord clamping and cutting at approximately 3 minutes after birth. The full package will include the uterotonic injection (oxytocin 10 IU IM), controlled cord traction following observation of uterine contraction and cord clamping and cutting at approximately 3 minutes after birth. The primary outcome measure is blood loss of 1000 ml or more at one hour and up to two hours for women who continue to bleed after one hour. The secondary outcomes are blood transfusion, the use of additional uterotonics and measure of severe morbidity and maternal death.We aim to recruit 25,000 women delivering vaginally in health facilities in eight countries within a 12 month recruitment period.

MANAGEMENT:
Overall trial management will be from HRP/RHR in Geneva. There will be eight centres located in Argentina, Egypt, India, Kenya, Philippines, South Africa, Thailand and Uganda. There will be an online data entry system managed from HRP/RHR. The trial protocol was developed following a technical consultation with international organizations and leading researchers in the field. EXPECTED OUTCOMES: The main objective of this trial is to investigate whether a simplified package of third stage management can be recommended without increasing the risk of PPH. By avoiding the need for a manual procedure that requires training, the third stage management can be implemented in a more widespread and cost-effective way around the world even at the most peripheral levels of the health care system. This trial forms part of the programme of work to reduce maternal deaths due to postpartum haemorrhage within the RHR department in collaboration with other research groups and organizations active in the field.

TRIAL REGISTRATION:
ACTRN12608000434392

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No abstract available. PMID: 163952 [PubMed - indexed for MEDLINE]

Antibody responses to a conventional rabies preexposure regimen of a new purified Vero cell rabies vaccine (PVRV) and a human diploid cell vaccine (HDCV) were compared in 80 healthy Kenyan veterinary students. Forty-three of the students received the PVRV and 37 received the HDCV on days 0, 7, and 28. Antibody responses were monitored using the rapid fluorescent-focus inhibition test (RFFIT) and an inhibition enzyme immunoassay (INH EIA) on days 0, 7, 28, and 49. Both vaccines elicited a rapid antibody response. A good correlation between the RFFIT titers and the INH EIA titers was obtained (r = 0.90). Our results also showed that the INH EIA was more reproducible and might therefore be a suitable substitute for the more expensive and less reproducible RFFIT. The geometric mean titers determined by both tests in the two groups of students were statistically similar during the test period. The RFFIT and the INH EIA gave comparable geometric mean titers, which differed significantly only on day 28 in the PVRV group. The effect of the new PVRV is comparable to that of the more expensive HDCV, as determined by the present test systems. The PVRV could therefore be the vaccine of choice, especially in tropical rabies-endemic areas, where the high cost of the HDCV has confined its use to a privileged few.

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

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

One of the most remarkable features of the developing brain is its ability to undergo structural change in response to experience. Among the cellular elements that show this kind of plasticity are dendrites, which are the components that receive and process synaptic information. Recent observations indicate that calcium signalling in neurons can regulate dendritic growth and remodelling by several mechanisms, and these mechanisms are likely to be key mediators of structural plasticity in the developing brain.

Activity plays critical roles in development and maintenance of the olfactory system, which undergoes considerable neurogenesis throughout life. In the mouse olfactory epithelium, each olfactory sensory neuron (OSN) stably expresses a single odorant receptor (OR) type out of a repertoire of ∼1200 and the OSNs with the same OR identity are distributed within one of the few broadly-defined zones. However, it remains elusive whether and how activity modulates such OR expression patterns. Here we addressed this question by investigating OR gene expression via in situ hybridization when sensory experience or neuronal excitability is manipulated. We first examined the expression patterns of fifteen OR genes in mice which underwent neonatal, unilateral naris closure. After four-week occlusion, the cell density in the closed (sensory-deprived) side was significantly lower (for four ORs), similar (for three ORs), or significantly higher (for eight ORs) as compared to that in the open (over-stimulated) side, suggesting that sensory inputs have differential effects on OSNs expressing different OR genes. We next examined the expression patterns of seven OR genes in transgenic mice in which mature OSNs had reduced neuronal excitability. Neuronal silencing led to a significant reduction in the cell density for most OR genes tested and thinner olfactory epithelium with an increased density of apoptotic cells. These results suggest that sensory experience plays important roles in shaping OR gene expression patterns and the neuronal activity is critical for survival of OSNs.

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{ OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers. METHODS: A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994. RESULTS: With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, had similar feeding practices and similar growth status and patterns. However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their husband's first wife (79% vs. 91%

Acute acalculous cholecystitis (AAC) typically affects hospitalized patients with critical illness. Outpatient AAC is reported to occur in elderly males with cardiovascular comorbidities. We report the presentation of acute acalculous cholecystitis in two young African men admitted for the first time within days of each other. They reported short histories of right upper abdominal pain and had tender gallbladders. Sonography revealed gallbladder wall thickening. Open cholecystectomy and histology confirmed AAC.The postoperative outcome was excellent. Recognition of AAC in a subset of young male patients presenting de novo with right upper quadrant pain is stressed. Cholecystectomy has good prognosis in these cases.

Acute acalculous cholecystitis (AAC) typically affects hospitalized patients with critical illness. Outpatient AAC is reported to occur in elderly males with cardiovascular comorbidities. We report the presentation of acute acalculous cholecystitis in two young African men admitted for the first time within days of each other. They reported short histories of right upper abdominal pain and had tender gallbladders. Sonography revealed gallbladder wall thickening. Open cholecystectomy and histology confirmed AAC.The postoperative outcome was excellent. Recognition of AAC in a subset of young male patients presenting de novo with right upper quadrant pain is stressed. Cholecystectomy has good prognosis in these cases.

The objective of this presentation is to document the salient clinical findings in a case of aflatoxicosis and to review the literature on the same so as to increase the index of suspicion, enhance early diagnosis and improve management. The case was a 17-year-old schoolboy presenting with vomiting, features of infection and gastrointestinal tract symptoms. Examination revealed a very ill looking pale patient with abdominal distension, tenderness and rectal bleeding and easy bruisability. Investigations showed abnormal liver function tests, pancytopenia and elevated serum levels of aflatoxins. Management consisted of supportive care including antibiotics and antifungal therapy, transfusion of red blood cells and fresh frozen plasma. His recovery was uneventful. The literature on human aflatoxicosis shows that the presentation may be acute, subacute and chronic. The degree of emanating clinical events also conforms to status of the aflatoxicosis. Overall, the features are protean and may masquerade many other forms of toxaemias. In conclusion, the diagnosis of aflatoxicosis takes cognisance of geographical location, past events, staple diet and clinical features to exclude other infections. Also required are high index of suspicion and importantly serum levels of aflatoxin. Treatment strategies involved use of antimicrobials and supporting the damaged multi-organs.

The objective of this presentation is to document the salient clinical findings in a case of aflatoxicosis and to review the literature on the same so as to increase the index of suspicion, enhance early diagnosis and improve management. The case was a 17-year-old schoolboy presenting with vomiting, features of infection and gastrointestinal tract symptoms. Examination revealed a very ill looking pale patient with abdominal distension, tenderness and rectal bleeding and easy bruisability. Investigations showed abnormal liver function tests, pancytopenia and elevated serum levels of aflatoxins. Management consisted of supportive care including antibiotics and antifungal therapy, transfusion of red blood cells and fresh frozen plasma. His recovery was uneventful. The literature on human aflatoxicosis shows that the presentation may be acute, subacute and chronic. The degree of emanating clinical events also conforms to status of the aflatoxicosis. Overall, the features are protean and may masquerade many other forms of toxaemias. In conclusion, the diagnosis of aflatoxicosis takes cognisance of geographical location, past events, staple diet and clinical features to exclude other infections. Also required are high index of suspicion and importantly serum levels of aflatoxin. Treatment strategies involved use of antimicrobials and supporting the damaged multi-organs.

The plant Nicandra physaloides (L) Gaertn, commonly known as the' apple of Peru' is a member of the solaneceae family. It has been widely associated with livestock poisoning in Kenya and elsewhere. The clinical signs reportedly associated with its poisoning are circling, tremors of the hind limbs, tachycardia, bloat, convulsions, coma and death. In the current study the acute toxicity was determined by intra-peritoneal injections of the aqueous extracts from different plant parts in a total of one hundred and fifty (150) white Swiss mice aged between to and 12 weeks and divided in groups of six (3 males and 3 females) for each dosage level. The median lethal dose (LDso) was then calculated by the method of Reed and Muench (1938). The subacute toxicity was determined by feeding five groups of two male Friesian calves each, aged between 8 and 10 months, at 0 (control), 4, 8, 16 and 32% levels of dried ground whole plant material in wheat bran for 14 weeks. The physiological parameters of rectal temperature, respiration, heart rate and ruminal motility were taken from all the calves every morning for the whole period of the experiment. The blood for hematology (5ml in EDTA) and biochemistry (l5ml without anticoagulant) was collected weekly via the jugular vene-puncture after thorough disinfection of the site with surgical spirit. LDso values for the leaf, fruit and whole plant extracts were 1.82, 2.58 and 3.62 g/kg body weight respectively, therefore, classifying the plant as slightly toxic according to Loomis (1978). The clinical signs showed by the mice were starry coat, slowed movements, fast respiration, gasping for air and leaping into the air before collapsing. The treated calves transiently exhibited muzzle drying, heart beat irregularity, loose feces, staggering gaits and lower growth rate than the control group. The activity of the enzyme gammaglutamyltransferase (GGT) and the mean corpuscular volume (MeV) were significantly lower (P0.05) between the treated and control groups in respect of the other assayed hematological (total protein. hemoglobin, red blood cells, packed cell volume, mean corpuscular hemoglobin concentration, white blood cells, lymphocytes and neutrophils) and biochemical (aspartate aminotransferase, creatinine and blood urea nitrogen) parameters. There were no mortalities, no gross or histopathological lesions in all the groups. The possible reasons for the difference in behaviour between the calves in this experiment and the suspected natural cases were thought to be due to the variations in animal susceptibility or even plant toxin content. It is concluded that the plant Nicandra physaloides growing around the Kabete areas of Kenya may contain toxic phytochemicals that may cause poisoning in livestock if consumed. Nicandra physaloides is known to contain glycosides, steroids and alkaloids from earlier studies. More studies are necessary to determine the nature of these phytotoxins and their exact mode of action. Meanwhile livestock keepers are advised to control this plant in their pastures and avoid its consumption by animals.

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A 6-year-old boy presented with diffuse abdominal pain, nausea and vomiting followed by features of acute scrotum. Laboratory and radiological evaluation suggested presence of infective pathology in the inguinoscrotal region. Surgical exploration revealed patent right processus vaginalis with purulent collection resulting from the presence of perforated tip of appendix in the hernial sac. Appendectomy with drainage of scrotal collection and ligation of hernial sac resulted in satisfactory recovery.

OBJECTIVE: To determine the prevalence of acute coronary syndromes among type 2 diabetic patients presenting to Accident and Emergency department. DESIGN: Prospective cross-sectional study. SETTING: Kenyatta National Hospital, a tertiary teaching and referral hospital. SUBJECTS: Type 2 diabetic patients with ischaemic electrocardiograms (ECG). MAIN OUTCOME MEASURES: Demographics, clinical symptoms, cardiovascular status and risk factors--central obesity, hypertension, dyslipidaemia, smoking. RESULTS: From 12,307 accident and emergency attendees, 400 (33%) diabetics aged > OR =30 years were screened with a resting ECG and 95 (24%) with ischaemic ECG were recruited; age range 41-87 years, 60% were male; diabetes duration ranged 0-30 years with 8.4% being newly diagnosed. The commonest enrolling ECG feature was nonspecific ST-T changes. The commonest presenting complaint were fatigue and dyspnoea. Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevated LDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulin and OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) were classified as acute coronary syndrome (ACS); 29 (30.5%) acute myocardial infarction (ACS-AMI) and five (5.2%) unstable angina (ACS-UA). Majority (79.4%) of the ACS presented more than six hours after symptom onset and majority had features of acute left ventricular failure. CONCLUSIONS: Acute coronary syndrome accounted for 35% of the morbidity in type 2 diabetics with ischaemic ECG's presenting to KNH accident and emergency department; patients presented late and 80% were not on CAD prophylactic therapy.

Objective: Cytomegalovirus (CMV) coinfection may influence HIV-1 disease progression
during infancy. Our aim was to describe the incidence of CMV infection
and the kinetics of viral replication in Kenyan HIV-infected and HIV-exposed uninfected
infants.
Methods: HIV-1 and CMV plasma viral loads were serially measured in 20 HIVexposed
uninfected and 44 HIV-infected infants born to HIV-infected mothers.
HIV-infected children were studied for the first 2 years of life, and HIV-exposed
uninfected infants were studied for 1 year.
Results: CMVDNAwas detected frequently during the firstmonths of life; by 3months of
age,CMVDNAwasdetectedin90%ofHIV-exposeduninfectedinfantsand93%of infants
whohadacquiredHIV-1inutero.CMVviral loadswerehighest inthe1–3monthsfollowing
the first detection of virus and declined rapidly thereafter. CMV peak viral loads were
significantlyhigher in theHIV-infectedinfantscomparedwith theHIV-exposeduninfected
infants (mean3.2versus2.7 log10CMVDNAcopies/ml, respectively,P¼0.03).Thedetection
of CMV DNA persisted to 7–9 months post-CMV infection in both the HIV-exposed
uninfected (8/17, 47%) and HIV-infected (13/18, 72%, P¼0.2) children. Among HIVinfected
children, CMV DNA was detected in three of the seven (43%) surviving infants
tested between 19 and 21 months post-CMV infection. Finally, a strong correlation was
found between peak CMV and HIV-1 viral loads (r¼0.40, P¼0.008).
Conclusion: Acute CMV coinfection is common in HIV-infected Kenyan infants. HIV-1
infection was associated with impaired containment of CMV replication.

Cytomegalovirus (CMV) coinfection is associated with infant HIV-1 disease progression and mortality. In a cohort of Kenyan HIV-infected infants, the frequencies of activated (CD38(+) HLA-DR(+)) and apoptosis-vulnerable (CD95(+) Bcl-2(-)) CD4(+) and CD8(+) T cells increased substantially during acute CMV infection. The frequency of activated CD4(+) T cells was strongly associated with both concurrent CMV coinfection (P = 0.001) and HIV-1 viral load (P = 0.05). The frequency of apoptosis-vulnerable cells was also associated with CMV coinfection in the CD4 (P = 0.02) and CD8 (P < 0.001) T cell subsets. Similar observations were made in HIV-exposed uninfected infants. CMV-induced increases in T cell activation and apoptosis may contribute to the rapid disease progression in coinfected infants.

Hypophosphatemia in diabetic ketoacidosis is well recognized, but is believed to be usually of moderate severity. We describe 2 patients in whom acute hemolytic anemia secondary to severe (0.19-0.35 mmol/l) hypophosphatemia has developed 1-2 days following treatment for diabetic ketoacidosis. Our experience indicates that severe hypophosphatemia requiring phosphate supplementation does occur in diabetic patients, and calls for increased awareness for the clinical and laboratory manifestations of this complication of diabetic ketoacidosis.

BACKGROUND:
Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized.
METHODS:
Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (<2 months vs. >or=2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection.
RESULTS:
There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05).
CONCLUSIONS:
Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.

Department of Biostatistics, University of Washington, Seattle, Washington, USA. BACKGROUND: Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized. METHODS: Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (<2 months vs. >or=2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection. RESULTS: There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05). CONCLUSIONS: Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants. PMID: 18171265 [PubMed - indexed for MEDLINE]

PMID: 7215256 [PubMed - indexed for MEDLINE]

Acute liver failure (ALF) is defined as liver failure occurring within one month of the occurrence of jaundice. The disease has a grim prognosis, with a mortality of 65% to 85%. The management of ALF has till recently been conservative, and newer therapeutic modalities like bioartificial liver, hepatocyte transplant, and extracorporeal liver assist devices have not yet been proven to be successful. Liver transplant has changed the gloomy outlook of the disease, and post-transplant survival rates of 60%-70% have been reported from most centers. However liver transplant is expensive, necessitates life-long immunosupression, and is limited by a global shortage of available organs. It is thus necessary to select patients who are at greatest risk of death for liver transplantation. Prognostic criteria are based primarily either on clinical and laboratory (coagulation tests, serum bilirubin) parameters, or on other parameters like liver volume. Prognostic criteria have been developed both from the East and the West; these are essentially similar except that the Western criteria take into account etiology (drug overdose being the main cause of ALF there) as well as jaundice-encephalopathy interval as factors for prognostication. The King's College criteria were one of the first prognostic systems; it has two parts for both paracetamol as well as non paracetamol ALF. The criteria from our institute found prothrombin time >25 s, serum bilirubin >15 mg/dL, age >40 years, and cerebral edema to be bad prognostic markers. Criteria from the PGIMER, Chandigarh found age >50 years, raised intracranial pressure, prothrombin time >100 s, and onset of HE more than seven days after the jaundice as poor prognostic markers. All these clinical criteria have similar sensitivity and specificity.

OBJECTIVE:
To determine the prevalence of childhood preventable and treatable medical conditions and the parent's/guardian's knowledge about the conditions and their management.
DESIGN:
A descriptive cross-sectional study.
SETTING:
Paediatric medical wards at Kenyatta National hospital
SUBJECTS:
All children aged 0-60 months with preventable conditions (that included pneumonia, malaria, diarrhoea/dehydration, meningitis and malnutrition) in paediatric wards who had stayed in the ward for 24 to 48 hours.
RESULTS:
Two hundred and fifty six parents/guardians staying with their children were recruited into the study. The vast majority (85.5%) of the children were aged less than two years. The prevalence of the acute treatable and preventable medical conditions was 88.6% over a one month period. The leading cause of admission for most children was pneumonia (31.6%) followed by malnutrition (16.8%) and gastro-enteritis (16%). Other conditions included neonatal sepsis (9.1%), measles (6%) and malaria (4.8%). The parents'/guardians' mean and median age was 26 years and the majority (89.8%) were mothers. A great proportion (46.5%) of the parents/guardians had attained at least some primary education. More than 70% of the parents/guardians were found to lack knowledge about their children's health problems and the drugs they were using. This was regardless of the parent's/guardians level of education and the frequency of admission of the child.
CONCLUSION:
Acute preventable and treatable medical conditions at KNH are highly prevalent, and the leading conditions include pneumonia, malnutrition and gastroenteritis. Most parents/guardians did not understand their children's health problems regardless of their level of education.

This paper gives general information on the location of Kenya, its demography, economy, organisation of health services, general health policy, health financing, oral health infrastructure, problems that hamper health financing and proposals on how to solve these problems. Further, a summary of health status of the Kenyan people is given based on the results of studies. The mean DMFT for the rural and urban populations is low and there is no evidence of an increase or decrease. Similarly, the prevalence of periodontitis is low (1-10%), with no increase. Ulcerative lesions are rare (0.12%). The most common birth defects are cleft lip and palate. Oral cancer is very low, accounting for 2% of all malignancies. Comparative studies have not demonstrated any dramatic change in the frequency of oral cancer for the last 25 years. Oral candidiasis is the most prevalent oral lesion amongst HIV/AIDS patients. In June 2003, Kenya formulated a National Oral Health Policy, which gives direction on how to improve the oral health status of the citizens.

Mice infected with Trypanosoma congolense developed a severe anaemia 1 week after infection, which persisted till treatment with diminazine aceturate when the packed cell volume (PCV) recovered to pre-infection levels. This was accompanied by a marked increase in the plasma levels of the acute phase proteins (APP), serum amyloid P-component (SAP) and haptoglobin (Hp). The initial peak levels of Hp and SAP were attained 7 and 12 days post-infection (DPI), respectively. Thereafter SAP levels decreased significantly to near pre-infection levels, but later increased even after treatment to give a second peak 34 DPI after which there was a decline till the study was terminated. The Hp levels on the other hand decreased to an intermediate level after the initial peak increasing to a second peak 22 DPI. Thereafter Hp decreased significantly following diminazine aceturate treatment to reach pre-infection levels within 5 days post-treatment. This indicates that T. congolense-infected mice develop severe anaemia accompanied by an acute phase response leading to an increase in SAP and Hp but that following treatment divergent responses occurred indicating differences in the pathways for stimulation of the APP. Haptoglobin was shown to be an earlier indicator of infection and a better marker in monitoring the response to treatment.

Mice infected with Trypanosoma congolense developed a severe anaemia 1 week after infection, which persisted till treatment with diminazine aceturate when the packed cell volume (PCV) recovered to pre-infection levels. This was accompanied by a marked increase in the plasma levels of the acute phase proteins (APP), serum amyloid P-component (SAP) and haptoglobin (Hp). The initial peak levels of Hp and SAP were attained 7 and 12 days post-infection (DPI), respectively. Thereafter SAP levels decreased significantly to near pre-infection levels, but later increased even after treatment to give a second peak 34 DPI after which there was a decline till the study was terminated. The Hp levels on the other hand decreased to an intermediate level after the initial peak increasing to a second peak 22 DPI. Thereafter Hp decreased significantly following diminazine aceturate treatment to reach pre-infection levels within 5 days post-treatment. This indicates that T. congolense-infected mice develop severe anaemia accompanied by an acute phase response leading to an increase in SAP and Hp but that following treatment divergent responses occurred indicating differences in the pathways for stimulation of the APP. Haptoglobin was shown to be an earlier indicator of infection and a better marker in monitoring the response to treatment.

PIP: In 1990, the annual population growth rate in Kenya was 3.8%, among the highest rates world wide. The ever growing adolescent fertility rate (111-152/1000 from 1969-1989) contributed to this rapid growth. Further repeat pregnancies among adolescents remained high in the 1980's and ranged from 20%-28.6%, depending on the survey. Even though overall prevalence of pregnancy fell 15.4% between 1978-1984, it remained the same for the 15-19 year old group. Teenage births have made up at least 35% of total deliveries. 1985 data revealed that even though adolescents represent 11-35% of the total obstetric population, problems ranked high among them: 38% of all eclampsia cases and high maternal mortality (102/100,000 vs. 57/100,000 older mothers). Studies showed that adolescents are sexually active, are ignorant about contraception, and do not use contraception. Yet contraceptive and family planning services are free in Kenya. Nevertheless the teenagers are at high risk of an unwanted pregnancy, sexually transmitted diseases (STDs), and AIDS. In the early 1980s, Kenyatta National Hospital reported 53% of 74.1% of septic abortion cases being single women were between 14-20 years old. Similar results emerged from other studies. Health professionals believed these results to be underestimated, however. In the 1980s, 33% of all adolescents between 13-15 years old in a rural area had gonorrhea. In Kenyatta, 36% of pregnant 15-24 year olds had at least 1 STD while,e only 16% of those 24 years old did. Further, teenagers are especially vulnerable to psychological problems when they 1st learn of their pregnancy. Health services should be geared to meet the specific needs of adolescents, such as contraception education and antenatal services. PMID: 12316815 [PubMed - indexed for MEDLINE]

Forty seven patients with acute renal failure were studied prospectively over a two-year period at the Kenyatta National Hospital. There were 20 males and 27 females. The mortality rate was 40.4%. Most patients had medically oriented problems. Complications that were associated with a high mortality were infections and the presence of neuropsychiatric manifestations.

Abstract: A case of acute respiratory distress syndrome due to babesiosis is reported in a 5 years old male Japanese sptiz. The patient was noticed to have developed sudden dyspnoea. The main presenting clinical signs included laboured breathing, broad-base stance but preferred recumbency, pallour and seizures. Blood smears from the ear tips revealed presence of multiple Babesia parasites in the erythrocytes. Hematology results showed slight leucocytosis, severe anemia and thrombocytopenia. Additionally, urinalysis revealed renal pathology and presence of leucocytes in urine. Despite aggressive measures to stabilize the patient, it died within an hour. Autopsy results also confirmed Babesiosis with generalized icterus.

Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

Description: This book describes four types of indigenous water retention structures used in East Africa. These structures are the Berkad tank, the Charco dam, sand wiers and hillside water retention ditches.

Abstract: A case of acute respiratory distress syndrome due to babesiosis is reported in a 5 years old male Japanese sptiz. The patient was noticed to have developed sudden dyspnoea. The main presenting clinical signs included laboured breathing, broad-base stance but preferred recumbency, pallour and seizures. Blood smears from the ear tips revealed presence of multiple Babesia parasites in the erythrocytes. Hematology results showed slight leucocytosis, severe anemia and thrombocytopenia. Additionally, urinalysis revealed renal pathology and presence of leucocytes in urine. Despite aggressive measures to stabilize the patient, it died within an hour. Autopsy results also confirmed Babesiosis with generalized icterus.

Abstract: A case of acute respiratory distress syndrome due to babesiosis is reported in a 5 years old male Japanese sptiz. The patient was noticed to have developed sudden dyspnoea. The main presenting clinical signs included laboured breathing, broad-base stance but preferred recumbency, pallour and seizures. Blood smears from the ear tips revealed presence of multiple Babesia parasites in the erythrocytes. Hematology results showed slight leucocytosis, severe anemia and thrombocytopenia. Additionally, urinalysis revealed renal pathology and presence of leucocytes in urine. Despite aggressive measures to stabilize the patient, it died within an hour. Autopsy results also confirmed Babesiosis with generalized icterus.

Abstract: A case of acute respiratory distress syndrome due to babesiosis is reported in a 5 years old male Japanese sptiz. The patient was noticed to have developed sudden dyspnoea. The main presenting clinical signs included laboured breathing, broad-base stance but preferred recumbency, pallour and seizures. Blood smears from the ear tips revealed presence of multiple Babesia parasites in the erythrocytes. Hematology results showed slight leucocytosis, severe anemia and thrombocytopenia. Additionally, urinalysis revealed renal pathology and presence of leucocytes in urine. Despite aggressive measures to stabilize the patient, it died within an hour. Autopsy results also confirmed Babesiosis with generalized icterus.

No abstract available.

A nine-month study was done on children with acute septic arthritis admitted to the Paediatric Orthopaedic and general paediatric wards. The aims of the study were to elucidate the clinical characteristics and aetiological agents of septic arthritis in children admitted to Kenyatta National Hospital. Thirty one children were recruited into the study and of these 58% were infants and 32.3% were school age children. There was a striking male predominance in the school age children - 9:1 while male/female ratio was 1.2:1 in the
younger children. Knees and shoulders were the most frequently affected by septic arthritis and together were responsible for
71% of the septic joints. It is of interest that all the septic

shoulder joints occurred in infancy. Non-typhoidal salmonella species especially Salmonella typhimurium, Klebsiella species and Staphylococcus aureus were the most frequently isolated bacteria.

The rate of bacterial isolation was as high as 72.2% when both blood cultures and joint aspirate cultures were done. Salmonella species had 75% sensitivity to the aminoglycosides (Gentamicin,Kanamycin) and Chloramphenicol while only two thirds of the Klebsiella species were sensitive to the same antibiotics. Staphylococcus aureus isolated in this study were sensitive to Erythromycin and uniformly resistant to
Ampicillin,.Cloxacillin and Cotrimoxazole. There was full

recovery in 63.7% of the patients while 23% went home without appropriate follow-up.

The author recommends that blood and joint aspirate cultures should be done in all patients suspected to have septic arthritis. Antibiotic sensitivity testing should be done r~gularly to facilitate appropriate drug therapy. Clinicians should ensure adequate follow-up of patients following discharge from hospital.

J Infect Dis. 2000 Aug;182(2):459-66. Epub 2000 Jul 12.
Acute sexually transmitted infections increase human immunodeficiency virus type 1 plasma viremia, increase plasma type 2 cytokines, and decrease CD4 cell counts.
Anzala AO, Simonsen JN, Kimani J, Ball TB, Nagelkerke NJ, Rutherford J, Ngugi EN, Bwayo JJ, Plummer FA.
Source
Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
Abstract
In Kenya, the median incubation time to AIDS in seroconverting sex workers is 4 years; this incubation time is specific to female sex workers. We studied the influence of acute sexually transmitted infections (STIs) on several immunologic parameters in 32 human immunodeficiency virus type 1 (HIV-1)-positive and 10 HIV-1-negative women sex workers who were followed for 1-5 months. Plasma cytokines, soluble cytokine receptors, CD4 and CD8 T cell counts, and HIV-1 plasma viremia were quantitated before, during, and after episodes of STI. Increases in interleukin (IL)-4, IL-6, IL-10, soluble tumor necrosis factor (TNF)-alpha, and viremia and a decline in CD4(+) T cell counts occurred during gonococcal cervicitis and returned to baseline after treatment. Increases in viremia correlated with increased IL-4 and decreased IL-6 concentrations. Similar changes were seen among women with acute pelvic inflammatory disease. Acute bacterial STI resulted in increased HIV-1 viremia. This may be mediated through increased inflammatory cytokines or through modulation of immune responses that control HIV-1 viremia.
PMID:
10915076
[PubMed - indexed for MEDLINE]
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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.

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.

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

Nicandra physaloides (L) Gaertn (Solanaceae), commonly known as the ‘apple of Peru’ is widely associated with livestock poisoning. The clinical signs associated with its poisoning in ruminants appear within 6 hours of ingestion and are circling, tremors of the hind limbs, tachycardia, bloat, convulsions, coma and death. However, there is no published information on the toxicology of this plant in Kenya. This study documents Nicandra physaloides toxicity in two different zero-grazed dairy cattle herds that were inadvertently fed on Napier grass contaminated with Nicandra physaloides. In addition to the case studies, the toxicity of the aqueous extracts from the different parts of Nicandra physaloides was studied under experimental conditions in mice. The 24 hour median lethal dose (LD50) was determined after intra-peritoneal injection (i.p.) of the aqueous extracts of the plant into white Swiss mice and found to be 1820, 2580 and 3620 mg/kg body weight for the leaves, fruits and whole plant respectively. The clinical signs in mice appeared within 30 minutes of inoculation and included coat, decreased locomotor activity, increased respiratory rate, gasping for air and leaping into the air before collapsing into coma and death. There were similarities in the symptoms of the spontaneous poisoning in cattle and in the experimentally induced poisoning in mice.

Fresh blood lymphocytes from nine health donors have been compared with samples from the same donors, recovered after period of 2 to 21 months storage in liquid nitrogen, for the capacity to respond to a range of mitogens in vitro. A microculture assay was used, requireing aliquots of only 25,000 cells. The mean levels of 14C-thymidine uptake for fresh and frozen samples were closely comparable when the cells had been stimulated by PHA, Pokeweed or mitomycin-C-treated allogeneic lymphoblastoid cells. Lymphocytes from six East African donors, frozen by a very simple technique, were recovered after 3 or more years storage in liquid nitrogen. Five of the samples were in good condition as judged by cell viability and the capacity to form spontaneous 'E' rosettes with sheep erythrocytes. These five samples also responded extremely well to PHA, PWM and mitomycin-C-treated allogeneic lymphoblastoid cells using the microculture assay. This study extends the range of applications of cell banks in which small aliquots of blood lymphocytes are stored in liquid nitrogen for periods of several years.

A study was carried out to determine the toxicity of unripe fruits of Solanum incanum L in sheep. The sheep were orally drenched with dried unripe fruits powder of S. incanum L at dose rates varying from 1,200mg to 3,600 mg/Kg /day for 9 weeks. Clinical signs were observed daily while blood with and without anticoagulant was taken weekly for haematological and biochemical analysis. Clinical signs started on day two with bloat. All sheep groups showed bloat and coughing. Signs of cerebellar hyperplasia were manifested in 25%, 75% and 25% of sheep in groups 2, 3, and 4 respectively, manifested by staggering gait, lateral recumbency, leg paddling movements, coma and death. The mortality rate was 25% for group 2 and 100% for groups 3 and 4. All sheep groups had pneumonia, froth in the bronchi, lung emphysema and congestion in the brain, liver and kidneys while groups 3 and 5 had hemorrhagic ulcers on distal abomasum to proximal duodenum and hemorrhagic enteritis from duodenum to colon. On histology, all sheep showed necrosis of the Purkinje cells of the cerebellum and Wallerian degeneration of neurons; lung emphysema and interstitial pneumonia, hemorrhagic enteritis, tubular necrosis in the kidneys and hepatocyte necrosis. The results indicate that S. incanum L is highly toxic to sheep and allowing sheep to graze on the plant is dangerous to their health.

A study was carried out to determine the toxicity of unripe fruits of Solanum incanum L in sheep. The sheep were orally drenched with dried unripe fruits powder of S. incanum L at dose rates varying from 1,200mg to 3,600 mg/Kg /day for 9 weeks. Clinical signs were observed daily while blood with and without anticoagulant was taken weekly for haematological and biochemical analysis. Clinical signs started on day two with bloat. All sheep groups showed bloat and coughing. Signs of cerebellar hyperplasia were manifested in 25%, 75% and 25% of sheep in groups 2, 3, and 4 respectively, manifested by staggering gait, lateral recumbency, leg paddling movements, coma and death. The mortality rate was 25% for group 2 and 100% for groups 3 and 4. All sheep groups had pneumonia, froth in the bronchi, lung emphysema and congestion in the brain, liver and kidneys while groups 3 and 5 had hemorrhagic ulcers on distal abomasum to proximal duodenum and hemorrhagic enteritis from duodenum to colon. On histology, all sheep showed necrosis of the Purkinje cells of the cerebellum and Wallerian degeneration of neurons; lung emphysema and interstitial pneumonia, hemorrhagic enteritis, tubular necrosis in the kidneys and hepatocyte necrosis. The results indicate that S. incanum L is highly toxic to sheep and allowing sheep to graze on the plant is dangerous to their health.

n/a

From the dried bark of Ekebergia capensis, two novel acyclic triterpenoids, 2,3,22,23-tetrahydroxy-2,6,10,15,19,23-hexamethyl-6,10,14,18-tetracosatetraene and 2-hydroxymethyl-2,3,22,23-tetrahydroxy-6,10,15,19,23-pentamethyl-6,10,14,18-tetracosatetraene were isolated, along with known cyclic triterpenoids. The structures of these two new triterpenoids were determined by spectroscopic and chemical methods.

Most persons who are infected with human immunodeficiency virus type 1 (HIV-1)
are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated
and is associated with increased plasma and genital levels of HIV-1. Therapy to
suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels,
suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV Daily acyclovir therapy did not reduce the risk of transmission of HIV-1, despite a reduction
in plasma HIV-1 RNA of 0.25 log10 copies per milliliter and a 73% reduction in the
occurrence of genital ulcers due to HSV-2. (ClinicalTrials.gov number, NCT00194519

Most persons who are infected with human immunodeficiency virus type 1 (HIV-1) are also infected with herpes simplex virus type 2 (HSV-2), which is frequently reactivated and is associated with increased plasma and genital levels of HIV-1. Therapy to suppress HSV-2 reduces the frequency of reactivation of HSV-2 as well as HIV-1 levels, suggesting that suppression of HSV-2 may reduce the risk of transmission of HIV-1.

We studied 506 consecutive adult acute medical admissions to hospital in Nairobi; 95 (18.8%) were seropositive for HIV-1, and 43 new cases of active tuberculosis (TB) were identified. TB was clearly associated with HIV infection, occurring in 17.9% of seropositive patients compared with 6.3% of seronegatives [odds ratio (OR) 3.2; 95% confidence limits (CL) 1.6-6.5]. Extrapulmonary disease was more common in seropositive than seronegative TB patients (nine out of 17 versus five out of 26; OR 4.7; 95% CL 1.01-23.6); this accounted for most of the excess cases of TB seen in seropositive patients. Mycobacteraemia was demonstrated in two of eight seropositive TB patients but in none of 11 seronegative TB patients. No atypical mycobacteria were isolated. The World Health Organization (WHO) clinical case definition for African AIDS did not discriminate well between seropositive and seronegative TB cases. Five out of seven seropositive women with active tuberculosis had delivered children in the preceding 6 months and were lactating, compared with only one out of eight seronegative tuberculous women. An association between recent childbirth, HIV immunosuppression and the development of TB is suggested

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

One hundred normal lateral skull radiographs were studied and those of ten patients with basilar impression attending Kenyatta Hospital, Nairobi. The mean shortest distance of the odontoid tip to McGregor's basal line was 1.2 +/- 2.28 mm below the basal line (range 6 mm below to 3 mm above basal line), in normals and 9 +/- 2.7 mm (6-14 mm) above basal line in patients. The mean basal angle was 113 degrees +/- 7 degrees (102 degrees-133 degrees) in normals and 122 degrees +/- 6 degrees (113 degrees-125 degrees) in patients. The mean nasion-basion-opisthion angle was 162 degrees +/- 4 degrees (154 degrees-169 degrees) in normals and 178 degrees +/- 5 degrees (173 degrees-185 degrees) in patients. The mean total length of clivus was 48 +/- 3.7 mm (43-56 mm) in normals and 44 +/- 6.6 (36-48 mm) in patients group. The mean median diameter of the foramen magnum was 39 +/- 5 mm (30-48 mm), atlas 21 +/- 3 mm (18-25 mm) axis 18 +/- 3 mm (14-23 mm), third cervical vertebra 16 +/- 2 mm (13-22 mm) in normals and in patients: 39 +/- 4 mm (36-45 mm), atlas 23 +/- 6 (15-30 mm) axis 19 +/- 4 mm (16-25 mm), third cervical vertebra 16 +/- 3 (14-20). There was a significant difference in the position of the odontoid tip and the nasion-basion-opisthion angle between the normal and patient groups. All the other parameters measured in this work did not differ significantly between the two groups.

An 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya.

An 18 year female sickler (HbSS) presented with repeated history of epistaxis and bleeding gums. Features consistent with pseudoxanthoma elasticum were observed, such as hyper-extensile redundant skin folds in the neck, axilla, inguinal areas and abdomen. The skin biopsy showed swollen, clumped and fragmented elastic fibres and calcium deposits in the deep and mid reticular dermis, consistent with pseudoxanthoma elasticum. This is a well recognised complication of sickle cell disease which has not been described in Kenya.

Aminoglutethimide (AG) 500 mg was administered orally to four normal volunteers and eight patients undergoing treatment for metastatic breast cancer. In each subject the acetylator phenotype was established from the monoacetyldapsone (MADDS)/dapsone (DDS) ratio. Acetylaminoglutethimide (acetylAG) rapidly appeared in the plasma and its disposition paralleled that of AG. A close relationship (P less than 0.01) was observed between the acetyl AG/AG and MADDS/DDS ratio suggesting that AG may undergo polymorphic acetylation like DDS. AG half-life was 19.5 +/- 7.7 h in seven fast acetylators of DDS and 12.6 +/- 2.3 h in five slow acetylators and its apparent metabolic clearance was significantly (P less than 0.01) related to the acetylAG/AG ratio. Over 48 h the fast acetylators excreted 7.7 +/- 4.4% of the administered AG dose in the urine as unchanged AG as compared to 12.4 +/- 2.8% in slow acetylators. A much smaller fraction of the dose was excreted as acetylAG: 3.6 +/- 1.5% by fast and 1.9 +/- 1.0% by slow acetylators respectively. After 7 days treatment with AG at an accepted clinical dose regimen to the eight patients there were significant reductions in the half-lives of AG (P less than 0.01) and acetylAG (P less than 0.01) and a trend (0.1 greater than P greater than 0.05) towards reduction of the acetylAG/AG ratio which became significant (P less than 0.05) if the one patient on a known enzyme inducer was omitted. The mean apparent volume of distribution was not significantly (P greater than 0.1) altered but the mean apparent systemic clearance of AG was increased (P less than 0.05). These changes are attributed to auto-induction of oxidative enzymes involved in AG metabolism.

OBJECTIVE: To find out if there is any association between serum uric acid level and positional vertigo. DESIGN: A prospective, case controlled study. SETTING: A private neurological clinic. SUBJECTS: All patients presenting with vertigo. RESULTS: Ninety patients were seen in this period with 78 males and 19 females. Mean age was 47 +/- 3 years (at 95% confidence level) with a standard deviation of 12.4. Their mean uric acid level was 442 +/- 16 (at 95% confidence level) with a standard deviation of 79.6 umol/l as compared to 291 +/- 17 (at 95% confidence level) with a standard deviation of 79.7 umol/l in the control group. The P-value was less than 0.001. CONCLUSION: That there is a significant association between high uric acid and benign positional vertigo.

OBJECTIVE: To find out if there is any association between serum uric acid level and positional vertigo. DESIGN: A prospective, case controlled study. SETTING: A private neurological clinic. SUBJECTS: All patients presenting with vertigo. RESULTS: Ninety patients were seen in this period with 78 males and 19 females. Mean age was 47 +/- 3 years (at 95% confidence level) with a standard deviation of 12.4. Their mean uric acid level was 442 +/- 16 (at 95% confidence level) with a standard deviation of 79.6 umol/l as compared to 291 +/- 17 (at 95% confidence level) with a standard deviation of 79.7 umol/l in the control group. The P-value was less than 0.001. CONCLUSION: That there is a significant association between high uric acid and benign positional vertigo.

Jatropha curcas L. has the potential for becoming an important feedstock for biodiesel and bioenergy in Kenya. The objective of this study was to evaluate the e"ects of genotype X` environment interaction and to determine the stability of performance of the currently grown genotypes. Methodology:A field trial consisting of 49 genotypes was laid out in a lattice design of two replications in two contrasting agroecological environments, namely Thika and Kibwezi, for 2 years. The Eberhart and Russell stability method was used to measure the performance of yield components of the 49 genotypes. Results: Environmental variance in%uenced the performance of genotypes for all the traits measured and genotype#×#environment interactions were important in determining their performance.

Jatropha curcas L. has the potential for becoming an important feedstock for biodiesel and bioenergy in Kenya. The objective of this study was to evaluate the e"ects of genotype X` environment interaction and to determine the stability of performance of the currently grown genotypes. Methodology:A field trial consisting of 49 genotypes was laid out in a lattice design of two replications in two contrasting agroecological environments, namely Thika and Kibwezi, for 2 years. The Eberhart and Russell stability method was used to measure the performance of yield components of the 49 genotypes. Results: Environmental variance in%uenced the performance of genotypes for all the traits measured and genotype#×#environment interactions were important in determining their performance.

AIACC Working Papers, published on-line by Assessments of Impacts and Adaptations to Climate Change (AIACC), is a series of papers and paper abstracts written by researchers participating in the AIACC project. Papers published in AIACC Working Papers have been peer reviewed and accepted for publication in the on-line series as being (i) fundamentally sound in their methods and implementation, (ii) informative about the methods and/or findings of new research, and (iii) clearly written for a broad, multi-disciplinary audience. The purpose of the series is to circulate results and descriptions of methodologies from the AIACC project and elicit feedback to the authors. The AIACC project is funded by the Global Environment Facility, the Canadian International Development Agency, the U.S. Agency for International Development, and the U.S. Environmental Protection Agency. The project is co-executed on behalf of the United Nations Environment Programme by the global change SysTem for Analysis Research and Training (START) and The Academy of Sciences for the Developing World (TWAS).

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Abstract
AIACC Working Papers, published on-line by Assessments of Impacts and Adaptations to Climate Change (AIACC), is a series of papers and paper abstracts written by researchers participating in the AIACC project. Papers published in AIACC Working Papers have been peer reviewed and accepted for publication in the on-line series as being (i) fundamentally sound in their methods and implementation, (ii) informative about the methods and/or findings of new research, and (iii) clearly written for a broad, multi-disciplinary audience. The purpose of the series is to circulate results and descriptions of methodologies from the AIACC project and elicit feedback to the authors. The AIACC project is funded by the Global Environment Facility, the Canadian International Development Agency, the U.S. Agency for International Development, and the U.S. Environmental Protection Agency. The project is co-executed on behalf of the United Nations Environment Programme by the global change SysTem for Analysis Research and Training (START) and The Academy of Sciences for the Developing World (TWAS).

Global climate change and its interactive components, such as water availability, related vulnerability of natural and socio-economic systems and health, changes in land use, as well as availability, quality, quantity of water and related policies, affects human wellbeing. The apparent correlation between disease outbreaks, such as malaria, cholera, rift valley fever, and meningitis—all of which are sensitive to climate variability (McCarthy et al., 2001)—and the strong El Niño years, e.g., 1982–1983 and the 1997–1998 events indicates a causal link between climate and health. Integrated climate-disease models show that rates of infections can be affected by climatic anomalies.

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To adapt a validated instrument that quantitatively measures stigma among English/Swahili speaking TB (tuberculosis) patients in Kenya, a high burden TB country.

The aim of this study was to determine suitability zones of future banana growth under a changing climate to guide the design of future adaptation options in the banana sub-sector of Uganda. The study used high resolution (~1 km) data on combined bioclimatic variables (rainfall and temperature) to map suitability zones of the banana crop while the Providing Regional Climate for Impacts Studies (PRECIS) regional climate model temperature simulations were used to estimate the effect of rising temperature on banana growth assuming other factors constant. The downscaled future climate projections were based on the Intergovernmental Panel on Climate Change (IPCC) Representative Concentration Pathways (RCPs, 2.6, 4.5, 6.0 and 8.5) and Special Report on Emission Scenarios (SRES, A1B and A2) across the period 2011–2090. The methodology involved identification of banana-climate growth thresholds and developing suitability indices for banana production under the high mitigation (RCP 2.6, less adaptation), medium mitigation (RCP 4.5 and RCP 6.0, medium adaptation), no mitigation (RCP 8.5, very high adaptation) scenarios, SRES A1B and A2 scenarios. The FAO ECO-Crop tool was used to determine and map future suitability of banana growth. Banana production indices were determined using a suitability model in the Geographical Information System (GIS) spatial analyst tool. The non-linear banana-temperature regression model was used to assess the impact of future changes in temperature on banana growth. The results revealed unique and distinct banana production suitability and growth patterns for each climate scenario in the sub-periods. RCPs 2.6 and 6.5 are likely to be associated with higher levels of banana production than RCPs 4.5 and 8.5. The results further showed that projected temperature increase under SRES A1B will promote banana growth. In contrast, expected increases in temperatures under SRES A2 are likely to retard banana growth due to high moisture deficits. There is need to develop adaptation option for farming communities to maximize their agricultural production and incomes. The effectiveness of adaptation options needed to combat the impacts will be influenced by the magnitude of the expected climatic changes associated with each scenario, the timing of expected climate change extremes and sensitivity of the crop to climate. This study has provided critical information that will be useful for planning integrated adaptation practices in the banana farming subsector to promote productivity.