Essential drug schemes in the Third World countries face many problems. These include dependency on imported drugs in the face of chronic shortages of foreign exchange, inadequate manpower and technical capability for selection and procurement of drugs, competition between generic and brand drugs, weak local drug procurement and distribution systems and inability to commence local manufacturing even in situations where there may exist comparative advantage. Many of these problems relate to each other and are compounded by the domination of the pharmaceutical industry by multinational firms. Third World countries are in a very weak position in the international pharmaceutical industry. It is suggested that the essential drug situation would improve in Third World countries if certain strategies and policies were adopted. These include: intensification of personnel training in pharmaceuticals, deliberate use of generic drugs rather than brand name drugs, the involvement of the public sector in the procurement and distribution of drugs, buying drugs in bulk, changing drug prescription and consumption practices through continuous education, changing or instituting regulations to guard against unfavourable patents and commencing domestic production of essential drugs where this is not in conflict with the principle of comparative advantage.

A model for the establishment of an integrated geodetic datum covering a region is treated. The integrated geodetic datum is understood here to comprise the geoid, the reference ellipsoid, and the positional coordinates. A comprehensive unified solution model including the three parameters comprising the datum is considered. The estimation model adopted rigorously incorporates determined prior information in the estimation of the datum parameters. Mathematical models together with the pertinent observation equations are presented, followed by a description of the procedure for the aetual setting up of the datum. The observational scheme is based on a system of modular traverses anchored on a trilateration of GPS baselines.

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A simple gas chromatographic assay utilising alkali flame ionisation detection is described for the estimation of cyclophosphamide as its trifluoroacetate derivative from plasma. Examination of five patients following intravenous cyclophosphamide gave values of 8.9 h (SD 2.7) for the half-life and 0.061 liters/h/kg (SD 0.011) for whole-body clearance of the drug.

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

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

SUMMARY
The total Dioxins (PCDD) and Furans (PCDF) release in Kenya is estimated to be 4,740 g TEQ per annum. The Uncontrolled Combustion Processes category generates 4,304 g TEQ which is the highest of all the categories that were identified, amounting to 91% of the total national release. Waste Incineration generated 249.4 g TEQ equivalent to 5% of the total national release, while Disposal/Landfilhng category has a notable contribution of 106 g TEQ which amounts to 2% of the total national release. Ferrous and non ferrous metal production contributes 12.8 g TEQ which is equivalent to 0.3% of the total national release. Releases from the remaining categories are not significant when compared to the ones already mentioned. However, this does not in anyway underrate their importance, especially in instances where total elimination by application of Best Available Technologies (BAT) and Best Environmental Practices (BEP) can be achieved. These results are summarised in Table Tl and Figures Fl and F2.
Uncontrolled domestic waste burning, a subcategory under the Uncontrolled Combustion Processes category, is the single most significant source of PCDD/PCDF. It generates 2168 g TEQ, which is equivalent to 45.7% of the total national releases. Landfill fires sub category is the second significant source of release, contributing 2126.3g TEQ which is equivalent to 44.8% of the total national release.
With regards to vectors, air receives the bulk of the PCDD/PCDF amounting to 3,103 g TEQ which is equivalent to 66% of the total national release. The bulk of this release comes from the Uncontrolled Combustion Processes, amounting to 2854g TEQ, which is equivalent to 92% of the total national release to air. Release to residues amounts to 1,614 g TEQ which is approximately 34% of the total national release, with the main contributor to this being Uncontrolled Combustion Processes, These results are summarised in Figure F2.
Uncontrolled Combustion Processes category therefore requires significant attention because of the great impact it may have in the country. Policies to govern the management of solid waste are necessary and would go along way in minimizing this impact. Similar efforts to address medical waste would also have a significant impact on the releases in the country. The release of PCDD/PCDF to water also needs to be addressed seriously considering the fact that a significant percentage of the country's population relies on surface water for domestic use.
There are no municipal waste incinerators in Kenya but there are isolated hazardous waste incinerators. However, the inventory has established that the medical waste accounts for the bulk of releases for this category. This is because majority of the government district hospitals and institutions operate the De Mont fort type incinerators. Only two major hospitals operate commercially acquired incinerators. However, most of the incinerators do not have effective air pollution control systems (APCs). To a large extent many of The medical facilities either openly bum their waste or have installations called incinerators which in effect are open burners. The total release from this category averages 249.4 g TEQ.
Hazardous wastes or waste oil are not currently used as fuel for firing cement kilns for fear of compromising on cement quality.

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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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Families in Kenya. In Handbook of World Families, edited by B.N. Adams and J. Trest. Sage Publication, 2005.

Ostriches of various ages, unhatched embryos and chicks found to have oedema during post-mortem examination are described here. Unhatched eggs and chicks originated from a commercial farm, where there was a complaint of poor hatchability of eggs and high chick mortality. Of 35 embryos examined, 29(82.9%) had severe subcutaneous oedema either generalized (23) or localized(6). Of 311 chicks, 232(74.6%) had oedema of varying degrees of severity. In 10 chicks, the oedema was subcutaneous and severe, in 5 it was only serous effusions in body cavities and in 217, it was manifested as wetness of subcutaneous tissues. Adult and juvenile ostriches originated from three farms, where they were kept as pets. Of 22 birds, 16(72.7%0 developed a general sickness and 10(62.3%) of them died. Post-mortem examination revealed emaciation and either subcutaneous oedema or serous effusion in body cavities. Additional lesions included combinations of steatites, haemorrhages and pneumonia. The sick birds responded to improved diets that were also supplemented with multivitamins and minerals.

Commercial ratite farming is rapidly becoming a desirable alternative source of profitable meat production among small holder farmers. However, ratite ranching particularly ostrich production is severely constrained by a very high chick mortality rate(up to 40%). To help rural farmers including those in the developed countries such as United States gain a successful foothold in this potentially lucrative farming enterprise, the causes of chick mortality must be identified and controlled. The present collaborative study was designed to characterize and compare disease causes of mortality in chicks in small holder ratite farms in Macon and adjoining Counties of Alabama and some selected localities in Kenya between 1997 and 2000, a four-year period. The study established that, in both Alabama[USA] and Kenya, ostrich farmers incur losses of considerable magnitude from a wide range of causes, some of which could not be established. Losses are experienced right from the embryonic stages whereby embryos may develop poorly causing death before hatching. In USA, hatchability was 72% while in Kenya, hatchability was 56% on average. In Kenya, a high mortality rate in the early weeks of life (<3 weeks) [27-40%] was noted. Pathogens isolated at post-mortem from inflamed tissues and septic yolk sacs were mainly common bacteria such as Enterobacter sp; Escherichia coli, Staphyloccocus sp, Streptococcus sp, Pseudomonas sp, Corynebacterium sp. and Clostridium sp. Other causes of death were impaction, dehydration, generalized oedema, joint infection and non-specific peritonitis. Limb deformities constituted the main cause of culling among chicks. Histopathological lesions were observed in virtually all organs examined including abdominal, thoracic and even the brain tissue. Lesions associated with circulatory disturbances were common. Bacteriological analysis of feeds in Kenya showed that bacterial contamination of feed was quite possibly a cause of infections and especially fish meals.

The purpose of this investigation was to establish the mastitis status in the dairy herd of 110 cows (genetically heterogeneous Bos Taurus breeds). All the cows were examined by physical inspection of the udder and California Mastitis Test (CMT) carried out on milk from the quarters of the 89 cows in milk. A total of 37 milk samples were collected from affected quarters of 36 cows, which had visibly abnormal secretion or tested positive on CMT, and taken for bacteriological culture and sensitivity tests. The outcome was a prevalence of 40.4 % based on the cows in milk and 18.4% based on their quarters. From the 37 samples that were cultured, 36 had abundant bacterial growth. Of the bacteria isolated, 45 % were Corynebacteria, 30.0 % Staphylococci, 22.5% Streptococci and 2.65% Pseudomonas. Of the twelve antibacterial compounds used in the sensitivity tests, the bacteria were most sensitive to ampi-clox and cefaclor at 98% and lest sensitive to sulphamethoxazole and cotrimoxazole both at 2%. Pseudomonas was only sensitive to gentamycin, norfloxacin and tetracycline. From this investigation the prevalence of mastitis in the herd is fairly high and there is need for a comprehensive monitoring and control program for udder health in this herd

Journal of Eastern African Literary and Cultural Studies

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JASPA Working Paper, ILO, Addis Ababa

{ 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%

{ 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%

Oyieke H.A. and Misra A.K:

Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

JASPA Working Paper, ILO, Addis Ababa

East African Publishers, Ltd.

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

JASPA Working Paper, ILO, Addis Ababa

JASPA Working Paper, ILO, Addis Ababa

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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Human Capital Externality and Returns to Education in Kenya

Kenya is a thriving country in East Africa: its economy is largely based on the natural environment that frames the tourism sector, mainly through safaris and holidays on the coast. The natural environment also underpins the second largest industry: agriculture. Kenya’s social, technological, and industrial developments are a reference for many neighboring countries. Kenya plays a leading role in Africa and attracts huge amounts of investments. Furthermore, the humanitarian community has made Nairobi its base for international headquarters and regional offices. This makes Kenya a possible model for development and investment in its widest sense. This book aims at updating the holistic view on Kenya’s natural environment and resources. It provides a sound scientific introduction to this country’s physical and socioeconomic setting and its evolution through time and will appeal to a broad audience of students – in Kenya and abroad – as well as those working in the development and humanitarian sectors and to international donors looking for a scientific compendium on Kenya’s environment. Its structure and references allow the reader to deepen his or her knowledge of every theme touched on in the book.

A simple gas chromatographic assay utilising alkali flame ionisation detection is described for the estimation of cyclophosphamide as its trifluoroacetate derivative from plasma. Examination of five patients following intravenous cyclophosphamide gave values of 8.9 h (SD 2.7) for the half-life and 0.061 liters/h/kg (SD 0.011) for whole-body clearance of the drug.

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Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

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

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

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

Differentiation of bloodstream-form trypanosomes into procyclic (midgut) forms is an important first step in the establishment of an infection within the tsetse fly. This complex process is mediated by a wide variety of factors, including those associated with the vector itself, the trypanosomes and the bloodmeal. As part of an on-going project in our laboratory, we recently isolated and characterized a bloodmeal-induced molecule with both lectin and trypsin activities from midguts of the tsetse fly, Glossina longipennis [Osir, E.O., Abubakar, L., Imbuga, M.O., 1995. Purification and characterization of a midgut lectin-trypsin complex from the tsetse fly, Glossina longipennis. Parasitol. Res. 81, 276-281]. The protein (lectin-trypsin complex) was found to be capable of stimulating differentiation of bloodstream trypanosomes in vitro. Using polyclonal antibodies to the complex, we screened a G. fuscipes fuscipes cDNA midgut expression library and identified a putative proteolytic lectin gene. The cDNA encodes a putative mature polypeptide with 274 amino acids (designated Glossina proteolytic lectin, Gpl). The deduced amino acid sequence includes a hydrophobic signal peptide and a highly conserved N-terminal sequence motif. The typical features of serine protease trypsin family of proteins found in the sequence include the His/Asp/Ser active site triad with the conserved residues surrounding it, three pairs of cysteine residues for disulfide bridges and an aspartate residue at the specificity pocket. Expression of the gene in a bacterial expression system yielded a protein (M(r) approximately 32,500). The recombinant protein (Gpl) bound d(+) glucosamine and agglutinated bloodstream-form trypanosomes and rabbit red blood cells. In addition, the protein was found to be capable of inducing transformation of bloodstream-form trypanosomes into procyclic forms in vitro. Antibodies raised against the recombinant protein showed cross-reactivity with the alpha subunit of the lectin-trypsin complex. These results support our earlier hypothesis that this molecule is involved in the establishment of trypanosome infections in tsetse flies.

Kenya: Reproductive Change Under Strain (with B. Egero); Lund University Press "Enhancing Better Natural Resource Use to prevent Conflict among pastoralist communities in Kenya" For Oxfam GB/Kenya Ref.jo/msaops

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Families in Kenya. In Handbook of World Families, edited by B.N. Adams and J. Trest. Sage Publication, 2005.

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Families in Kenya. In Handbook of World Families, edited by B.N. Adams and J. Trest. Sage Publication, 2005.

A simple gas chromatographic assay utilising alkali flame ionisation detection is described for the estimation of cyclophosphamide as its trifluoroacetate derivative from plasma. Examination of five patients following intravenous cyclophosphamide gave values of 8.9 h (SD 2.7) for the half-life and 0.061 liters/h/kg (SD 0.011) for whole-body clearance of the drug.

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Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.

This paper presents a development pro¬file of a sample of urban settlements in Kenya. Kenya is experiencing very rapid population growth, particularly in urban areas. The number and size of urban settlements has grown rapidly in the last 30-40 years, This rapid urbanization generates tremendous development potential and opportunities in the country. It has also generated serious social, economic and spatial challenges. The paper highlights the development potential and challenges facing urban settlements in Kenya. The development profile of the towns covers economic activities, housing, infrastructure and utilities, transport and governance issues. The paper then concludes by highlighting proposals on the way forward

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JASPA Working Paper, ILO, Addis Ababa

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The article sets out to investigate the question of the identity of Kenyan literature in the context of East Africa, Africa and the Commonwealth. It argues that this literature appears to reflect as it seeks to create and define a national culture because, despite Kenya being a mosaic of peoples and cultures, symbols of nationhood, defined boundaries and memories of the colonial experience continue to shape and mould its sense of national being. Its literature therefore needs to be discussed in the context of exploring its national sensibility, discussing how the nation produces it and how it narrates the nation. This discourse would assist the nation understand itself, unravel the aesthetic ideal the literature embodies, and, hopefully, galvanise the nation for a unity of purpose arising from yearnings for harmonious social relationships the aesthetic ideal embodies.

The Kenyan Maasai traditional built form in Kajiado District is changing. It is being replaced by the newly developed homesteads and houses which are inadequately planned, designed and lacking in symbolism. The latter are inconsistent with social arrangements and cultural needs of the contemporary Maasai lifestyle. It was the hypothesis of this study that the culture of the Maasai influences the architecture of their built forms. Multiple research tools were used in the collection of data. These included Observation, Focus Group Discussion, Questionnaires and Interviews. Among the techniques used in analysing the data are the chi-square statistics and qualitative analytical procedures based on the material collected through cluster sampling of 92 homesteads which were presented graphically. It is clear that the architectural conditions of Maasai buildings are a result of culture change variables identified as occupation, religion, rituals, education, family set-up and land tenure which have consistently evolved cultural values such as social status, independence, privacy and sedentary lifestyle. The study concludes that, in view of the changed culture of the maasai, the new built form is satifactory in the incorporating the emerging architectural design concepts such as nuclear family house, linearity, divisibility and permanence in response to emerging spaces and artifacts. These concepts symbolise the changing Maasai culture in the built form.

Over the past decade, the University of Nairobi (UoN) has increased the number of enrolled medical students threefold in response to the growing need for more doctors. This has resulted in a congested clinical training environment and limited opportunities for students to practice clinical skills at the tertiary teaching facility. To enhance the clinical experience, the UoN Medical Education Partnership Initiative Program Undertook training of medical students in non-tertiary hospitals around the country under the mentorship of consultant preceptors at these hospitals. This study focused on the evaluation of the pilot decentralized training rotation.

Department of Infectious Disease Epidemiology, Imperial College School of Medicine, London, UK. Previous attempts to determine the interactions between filariasis transmission intensity, infection and chronic disease have been limited by a lack of a theoretical framework that allows the explicit examination of mechanisms that may link these variables at the community level. Here, we show how deterministic mathematical models, in conjunction with analyses of standardized field data from communities with varying parasite transmission intensities, can provide a particularly powerful framework for investigating this topic. These models were based on adult worm population dynamics, worm initiated chronic disease and two major forms of acquired immunity (larval- versus adult-worm generated) explicitly linked to community transmission intensity as measured by the Annual Transmission Potential (ATP). They were then fitted to data from low, moderate and moderately high transmission communities from East Africa to determine the mechanistic relationships between transmission, infection and observed filarial morbidity. The results indicate a profound effect of transmission intensity on patent infection and chronic disease, and on the generation and impact of immunity on these variables. For infection, the analysis indicates that in areas of higher parasite transmission, community-specific microfilarial rates may increase proportionately with transmission intensity until moderated by the generation of herd immunity. This supports recent suggestions that acquired immunity in filariasis is transmission driven and may be significant only in areas of high transmission. In East Africa, this transmission threshold is likely to be higher than an ATP of at least 100. A new finding from the analysis of the disease data is that per capita worm pathogenicity could increase with transmission intensity such that the prevalences of both hydrocele and lymphoedema, even without immunopathological involvement, may increase disproportionately with transmission intensity. For lymphoedema, this rise may be further accelerated with the onset of immunopathology. An intriguing finding is that there may be at least two types of immunity operating in filariasis: one implicated in anti-infection immunity and generated by past experience of adult worms, the other involved in immune-mediated pathology and based on cumulative experience of infective larvae. If confirmed, these findings have important implications for the new global initiative to achieve control of this disease.

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Program in International Nutrition, University of California, Davis, CA 95616, USA.

Animal source foods (ASF) can provide micronutrients in greater amounts and more bioavailable forms compared to plant source foods, but their intake is low in many poor populations. However, the impact of ASF on micronutrient status of undernourished populations has not been assessed. Supplemental meat (60-85 g/d), milk (200-250 mL/d) or energy (isocaloric with the meat and milk, 240-300 kcal/d) were randomly assigned to 555 undernourished school children aged 5-14 y in a rural malaria-endemic area of Kenya, at one school meal daily for one school year. Blood and stool samples were collected at baseline and after 1 y to assess stool parasites, malaria, hemoglobin, serum or plasma C-reactive protein, ferritin, iron, zinc, copper, vitamin B-12, folate and retinol, and erythrocyte riboflavin. At baseline, there was a high prevalence of micronutrient deficiencies (iron, zinc, vitamins A and B-12 and riboflavin), yet plasma ferritin was low in few children, and none had low serum copper. At the end of the year of supplementation, plasma vitamin B-12 concentrations were significantly increased in children fed the Meat or Milk meal; prevalence of severe plus moderate deficiency fell from 80.7% at baseline to 64.1% in the Meat group and from 71.6 to 45.1% in the Milk group, respectively. No significant improvement was observed in the status of other micronutrients compared to the Energy and Control groups, although malaria and other infections may have obscured effects. Supplementation with small amounts of meat or milk reduced the high prevalence of vitamin B-12 deficiency in these children.

PMID: 14672298 [PubMed - indexed for MEDLINE]

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Presented here is a 16-year-old girl who was referred on 30th January 1996 with diagnosis of cord compression with spastic paraplegia with sensory level at T7/T8. CT scan myelogam confirmed soft tissue density mass displacing cord to the left with no dye being seen beyond T3. Thoracic spine decompressive laminectomy was performed on 1st January 1996 at Nairobi West Hospital extending from T3 to T6 level, which revealed a fibrous haemorrhagic tumour. Histology showed meningioma (mixed fibrous type and meningoepitheliomatous type) with many psammoma bodies. She had a stormy post-operative period, with infection and wound dehiscence. This was treated with appropriate antibiotics and wound care. She was eventually rehabilitated and was able to walk with the aid of a walking frame because of persistent spasticity of right leg. She was seen once as an outpatient by author on 6th July 1996, she was able to use the walking frame, but the right leg was still held in flexion deformity at the knee. She was thus referred to an orthopaedic surgeon for possible tenotomy. She was able to resume her studies at the University ambulating using a wheel chair and walking frame. She presented with worsening of symptoms in 2001 (five years after her first surgery). MRI scan thoracic spine revealed a left anterolateral intradural lesion extending from T3 to T5 vertebral body level compressing and displacing the spinal cord. She had a repeat surgery on 6th March 2001 at Kenyatta National Hospital; spastic paraparesis and urinary incontinenece persisted. She also developed bed sores and recurrent urinary tract infections. She was followed up by the author and other medical personnel in Mwea Mission Hospital where she eventually succumbed in 2005, nine years after her first surgery. This case is presented as a case of incompletely excised spinal meningioma to highlight some of the problems of managing spinal meningiomas when operating microscope and embolisation of tumours are not readily available. Also the family experienced financial constraint in bringing the patient for regular follow-up, and getting access to appropriate antibiotics, catheters and urine bags.

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There is a need to understand the factors that influence African women medical doctors to pursue international health research training because they remain under-represented in research fields but increasingly represented in medicine.