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.

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Department of Pharmacology and Toxicology, University of Nairobi, Kenya. The relative bioavailabilities of three carbamazepine tablet formulations available in the Kenyan market (Temporal(R), Taver(R) and Carbamazepine Lincoln) compared with the innovator formulation (Tegretol(R)) were evaluated in seven healthy African volunteers (5 males, two females; aged 22-36 years), according to a randomised fourway crossover study design, following oral administration of single 200 mg doses with a three week washout period. In vitro dissolution profiles of the tablets were also evaluated. Relative bioavailabilities ((F)rel) of Temporal(R), Taver(R) and Carbamazepine Linocoln were 101.2%, 82.2% and 71.6% respectively, compared with Tegretol(R). Percent drug content dissolved in vitro after I hour were 91.3%, 75.9% and 39.3% for Temporal(R), Taver(R) and Carbamazepine Lincoln, respectively. It was concluded that Temporal(R) was bioequivalent to Tegretol(R) while Taver(R) and Carbamazepin Lincoln were bioinequivalent to Tegretol(R). Administration of Taver(R) or Carbamazepine Lincoln might lead to poor control of epileptic seizures.

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.

Abstract Objectives: To evaluate after 2 years, the survival rate of glass ionomer cement (GIC) sealants placed in primary molars of 6-8 year-olds and as part of proximal ART restoration. Study design: A longitudinal clinical study. Setting: Matungulu/Kangundo rural divisions, Machakos district. Participants: A total of 804 six to eight year-olds from rural Kenya received sealants as part of proximal restorations placed in primary molars using the atraumatic restorative treatment (ART) approach. Trained operators, using the ART approach, placed the proximal restorations and the sealants using Fuji IX, Ketac Molar Easymix and Ketac Molar Aplicap, together with rubber dam and cotton roll tooth-isolation methods. Evaluation to determine the survival of the sealants was done soon after placement (within 2 hours of placing them) and after 2 years. The data were analyzed using SPSS 14.0 computer programme, and the survival results related to the materials and the isolation-methods used. Results: The 2-year cumulative survival of the sealants was 10.9%, and the survival of the sealants was not significantly affected by the GIC material brand and the tooth-isolation method used. However, slightly more sealants survived when Fuji IX and rubber dam tooth-isolation method were used. Conclusion: The two-year survival rate of the sealants was poor and was not significantly influenced by the GIC material or the tooth-isolation method used.

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

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

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Introduction: Despite the epidemiological data demonstrating a high need for palliative care in sub-Saharan Africa, systematic appraisal of the outcome evidence found a wealth of experience yet a dearth of evidence. This paradox offers an opportunity for ethical outcome evidence. A number of barriers to access for HIV palliative care have been identified, particularly in the assessment and management of HIV pain and drug availability in Africa for management of palliative care for people with HIV.There evidence from several studies in Europe, Africa and Latin America identifying those on ART to have a physical and psychological symptom burden equal to those not on treatment (even when controlling for CD4 and viral load). Research showed that around half of HIV outpatients would benefit from palliative care irrespective of their treatment status. Longitudinal studies conducted in East Africa have identified the palliative care-related needs among patients accessing outpatient care in the presence of ART. Barriers and lack of evidence have been identified and there is need for appropriateness of palliative care throughout the HIV disease trajectory and alongside ART. The aim of this study is to evaluate the efficacy in terms of patient outcomes of training HIV nurses in palliative care including an assessment tool, for adults taking ART in Kenya, using randomised controlled trial (RCT) designs.Materials and Method: The study consists of two independent Phase III clinical randomised controlled trials, in a comprehensive care centre in Kenya.Patients are randomly allocated to standard HIV care (including ART) or standard HIV care plus palliative care. The palliative care is delivered through the HIV clinic using an integrated model. The APCA African POS questionnaire is used in this study.The design is longitudinal, using repeated measures. Patient-centred outcomes are measured using quantitative questionnaires. This study aims to reject the null hypothesis that receipt of palliative care in addition to standard care does not affect pain compared to those receiving standard care alone.APCA African POS seeks to address: pain, symptoms, anxiety information, spirituality, communication, planning, family information, family ability to care and family anxietyConclusion: With palliative care being introduced in government hospitals in Kenya, the study aims to provide evidence for efficacy of palliative care in HIV management and to achieve greater access to palliative care for those on ART by enabling existing ART clinic staff to assess and provide palliative care rather than use alternative (potentially more costly) approaches that refer all palliative care need out to external providers.

Introduction: Despite the epidemiological data demonstrating a high need for palliative care in sub-Saharan Africa, systematic appraisal of the outcome evidence found a wealth of experience yet a dearth of evidence. This paradox offers an opportunity for ethical outcome evidence. A number of barriers to access for HIV palliative care have been identified, particularly in the assessment and management of HIV pain and drug availability in Africa for management of palliative care for people with HIV.There evidence from several studies in Europe, Africa and Latin America identifying those on ART to have a physical and psychological symptom burden equal to those not on treatment (even when controlling for CD4 and viral load). Research showed that around half of HIV outpatients would benefit from palliative care irrespective of their treatment status. Longitudinal studies conducted in East Africa have identified the palliative care-related needs among patients accessing outpatient care in the presence of ART. Barriers and lack of evidence have been identified and there is need for appropriateness of palliative care throughout the HIV disease trajectory and alongside ART. The aim of this study is to evaluate the efficacy in terms of patient outcomes of training HIV nurses in palliative care including an assessment tool, for adults taking ART in Kenya, using randomised controlled trial (RCT) designs.Materials and Method: The study consists of two independent Phase III clinical randomised controlled trials, in a comprehensive care centre in Kenya.Patients are randomly allocated to standard HIV care (including ART) or standard HIV care plus palliative care. The palliative care is delivered through the HIV clinic using an integrated model. The APCA African POS questionnaire is used in this study.The design is longitudinal, using repeated measures. Patient-centred outcomes are measured using quantitative questionnaires. This study aims to reject the null hypothesis that receipt of palliative care in addition to standard care does not affect pain compared to those receiving standard care alone.APCA African POS seeks to address: pain, symptoms, anxiety information, spirituality, communication, planning, family information, family ability to care and family anxietyConclusion: With palliative care being introduced in government hospitals in Kenya, the study aims to provide evidence for efficacy of palliative care in HIV management and to achieve greater access to palliative care for those on ART by enabling existing ART clinic staff to assess and provide palliative care rather than use alternative (potentially more costly) approaches that refer all palliative care need out to external providers.

The study was carried out between November 2008 and April 2009 to investigate the occurrence and pathology due to Echinostomum revolutum in free-range indigenous chickens. One hundred and fifty six (156) indigenous chickens were purchased from various farms and markets in A thorough post mortem examination was performed on each bird and the isolated worms from the ceaca, large intestines, cloaca and oviduct were identified and quantified.  Tissues were collected for histopathology, processed, examined and the severity of the lesions determined. Echinostoma revolutum was recovered in 3/156 (1.9 %) birds examined in the ceaca and large intestines but not in cloaca and oviduct. Affected birds originated from market birds in Kiambu. They caused heamorrhages and typhylo-enteritis in the affected birds. Other worms observed from these organs were Ascaridia galli, Heterakis gallinarum, Heterakis isolonche, Heterakis dispar, Subulura brumpti, Raillietina echinobothrida and Hymenolepis contaniana. The trematodes are reported in Kenya for the first time.

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

ABSTRACT The family Labiatae, commonly called the mint family, is one of the flowering group of plants that has been found to have great medicinal potential. In this study, at least twenty-eight (28) indigenous species which are popular among Kenyan herbalists have been collected from the Rift Valley and central parts of Kenya. Preliminary chemical analysis of the Ocimum genus has revealed several different components of essential oils. There is evidence that further and more intensive research on the medicinal aspects of the family is called for.

The decision to pay out earnings or retain dividends has been a subject of debate for many scholars. The effect of dividend on the firm value and cost of capital have been covered in attempt to resolve the dividend puzzle. This research paper tests the applicability of constant dividend model by companies listed at the Nairobi stock exchange. Data was collected from annual reports and share price schedules obtained from Nairobi stock exchange and Capital market Authority for a population of 20 companies that paid dividends consistently from 2002 to 2008. The data was then analyzed by re-computing the dividends that should have been paid if the dividend constant model was applied. This recomputed figure was later compared to the dividend as paid out by the companies thought the years of study. Paired sample t-test statistic was also performed to determine whether there is a significant difference between the two dividend figures. The findings of the research established that the dividend model was not employed by the companies listed at the Nairobi stock exchange. Most firms instead adopted stable and predictable policy where a specific amount of dividend per share each year was paid periodically. In some years there was a slight adjustment of the dividend paid after an increase in earnings, but only by a sustainable amount. The study shows that the relationship between the stock market prices and the dividend paid from the constant dividend model is uneven from one year to another and where there was a relationship it was insignificant. Though a share would be highly priced, a high dividend per share was not always declared.

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This paper investigates the impact of social capital on consumption expenditure of households in rural

This cross-sectional descriptive study was conducted among middle and functional level nurse managers at a National Referral Hospital with the aim of establishing their preparedness for computerization of nursing services, their attitudes towards computerization, their training needs, and their preferred mode of study. A purposive sample of all 112 nurse managers was obtained for this study. The response rate was 95.5 % (n=107). Data was collected using structured, selfadministered questionnaires. The study revealed that nurse managers had positive attitudes toward use of computers. Their attitudes toward use of computers were not significantly influenced by accessibility to computers or competence in computer use, but nursing experience and the age of the respondents had a negative influence on attitudes toward computerization of nursing services (p=0.05). Eighty-five percent of the respondents (n=91) did not have computer studies during their training in basic nursing; 51% (n=55) had sought training in computers after their basic training; 98% (n=105) desired to be trained in computer applications; and 69.1% (n

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

Ectoparasitism is an important factor associated with poor production of village indigenous chickens. A cross-sectional study was carried out to determine the prevalence of ectoparasites in free ranging indigenous chicken from two different agro-ecological zones: Lower highland 1 (LH1) in Embu District and Lower midland 5 (LM5) in Mbeere District, Kenya. A total of 144 chickens of matched age (chicks, growers and adults) and sex groups were examined for the presence of ectoparasites. Of these, 138 (95.8%) had one or more types of ectoparasites, namely; lice, mites, fleas and soft ticks. One thirty one birds had lice, 107 mites, 42 sticktight fleas and 8 had soft ticks. Of the 138 infested birds, 25 had single while 113 had mixed infestations. Lice were the most prevalent parasites. The study documents Epidermoptes species, Laminosioptes cysticola and Megninia species for the first time in Africa as well as Lipeurus caponis and Goniodes gigas in Kenya. All adult birds were infected with ectoparasites followed by 97.7% grower and 89.6% chicks. Both male and female birds had same prevalence (95.8%) of ectoparasites. Lower midland 5 had a slightly higher prevalence of ectoparasites (98.6%) compared to LH1 (93.1%) though not statistically significant. Parasite intensity was significantly different among age groups of chicken and between agro-ecological zones (p<0.05), but not between sexes of birds (p>0.05). Because of the high prevalence of ectoparasites revealed by this study, it is imperative that integrated control strategies need to be put in place to improve chicken productivity and enhance smallholder livelihood in these areas.

Ectoparasitism is an important factor associated with poor production of village indigenous chickens. A cross-sectional study was carried out to determine the prevalence of ectoparasites in free ranging indigenous chicken from two different agro-ecological zones: Lower highland 1 (LH1) in Embu District and Lower midland 5 (LM5) in Mbeere District, Kenya. A total of 144 chickens of matched age (chicks, growers and adults) and sex groups were examined for the presence of ectoparasites. Of these, 138 (95.8%) had one or more types of ectoparasites, namely; lice, mites, fleas and soft ticks. One thirty one birds had lice, 107 mites, 42 sticktight fleas and 8 had soft ticks. Of the 138 infested birds, 25 had single while 113 had mixed infestations. Lice were the most prevalent parasites. The study documents Epidermoptes species, Laminosioptes cysticola and Megninia species for the first time in Africa as well as Lipeurus caponis and Goniodes gigas in Kenya. All adult birds were infected with ectoparasites followed by 97.7% grower and 89.6% chicks. Both male and female birds had same prevalence (95.8%) of ectoparasites. Lower midland 5 had a slightly higher prevalence of ectoparasites (98.6%) compared to LH1 (93.1%) though not statistically significant. Parasite intensity was significantly different among age groups of chicken and between agro-ecological zones (p<0.05), but not between sexes of birds (p>0.05). Because of the high prevalence of ectoparasites revealed by this study, it is imperative that integrated control strategies need to be put in place to improve chicken productivity and enhance smallholder livelihood in these areas.

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Aim: This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. Methods: The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children had each one proximal cavity in a primary molar restored using the ART approach. During the restoration 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were randomly used by the operators. The restorations were then followed for a period of 2 years. Statistics: SPSS 14.0 was used to analyze and relate the data obtained to the method of isolation used. Results: After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. Conclusions: Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

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Land degradation is a major problem in the semi-arid environments of Sub-Saharan Africa. Fighting land degradation is essential to ensure the sustainable and long-term productivity of the habited semiarid lands. In Kenya, grass reseeding technology has been used to combat land degradation. However, despite the use of locally adapted perennial grass species namely Cenchrus ciliaris (African foxtail grass), Eragrostis superba (Maasai love grass) and Enteropogon macrostachyus (Bush rye) failure still abound. Therefore, more land is still being degraded. The aim of this study was to determine the main factors which contribute to failures in rehabilitating denuded patches in semi-arid lands of Kenya. A questionnaire was administered to capture farmer perceptions on failures on rangeland rehabilitation using grass reseeding technology. Rainfall data was collected during the study period. Moreover, rehabilitation trials using the three grasses were done under natural rainfall. Results from this study show that climatic factors mainly low amounts of rainfall to be the main contributor to rehabilitation failures. 92% of the respondents asserted that reseeding fails because of low rainfall amounts received in the area. The study area received a total of 324 mm of rainfall which was low compared to the average annual mean of 600mm. Reseeded trial plots also failed to establish due to the low amounts of rainfall received. This showed how low rainfall is unreliable for reseeding. Other factors namely destruction by the grazing animals, pests and rodents, flush floods, poor sowing time, poor seed quality, lack of enough seed and weeds also contribute to rehabilitation failures in semi-arid lands of Kenya.

Normal 0 21 false false false SW X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}   Experiments on animals play an important role in the study of noninfectious diseases, insulin development for diabetes treatment, kidney failure blood dialysis, transplantation techniques, and various types of surgery advancements. In this study hyperglycemia development in mice induced with alloxan monohydrate was determined using glycated hemoglobin and compared with blood glucose. Effective dose for making the mice hyperglycemic was first determined for alloxan monohydrate concentrations and found to be 300mg/kg body weight single dose. Ten mice were randomly selected, weighed and assigned into test and control groups  (5 per group). Test group was injected with 0.2ml of 300mg/kg alloxan while control group received 0.2ml of sterile water intraperitoneally. The blood glucose in the test group increased steadily from 3.7mmol/L (day1) to 8.4mmol/L (day 7).  Glycated hemoglobin in the test group mice increased marginally from 4.75% to 5.18% compared with the control group at 4.85% to 4.90% with glucose levels stabilizing at 5%. The experiment demonstrates that glycated hemoglobin testing can be used to detect sub-clinical diabetes mellitus and early initiation of treatment and management.

Ectoparasitism is an important factor associated with poor production of village indigenous chickens. A cross-sectional study was carried out to determine the prevalence of ectoparasites in free ranging indigenous chicken from two different agro-ecological zones: Lower highland 1 (LH1) in Embu District and Lower midland 5 (LM5) in Mbeere District, Kenya. A total of 144 chickens of matched age (chicks, growers and adults) and sex groups were examined for the presence of ectoparasites. Of these, 138 (95.8%) had one or more types of ectoparasites, namely; lice, mites, fleas and soft ticks. One thirty one birds had lice, 107 mites, 42 sticktight fleas and 8 had soft ticks. Of the 138 infested birds, 25 had single while 113 had mixed infestations. Lice were the most prevalent parasites. The study documents Epidermoptes species, Laminosioptes cysticola and Megninia species for the first time in Africa as well as Lipeurus caponis and Goniodes gigas in Kenya. All adult birds were infected with ectoparasites followed by 97.7% grower and 89.6% chicks. Both male and female birds had same prevalence (95.8%) of ectoparasites. Lower midland 5 had a slightly higher prevalence of ectoparasites (98.6%) compared to LH1 (93.1%) though not statistically significant. Parasite intensity was significantly different among age groups of chicken and between agro-ecological zones (p<0.05), but not between sexes of birds (p>0.05). Because of the high prevalence of ectoparasites revealed by this study, it is imperative that integrated control strategies need to be put in place to improve chicken productivity and enhance smallholder livelihood in these areas.

Normal 0 false false false EN-GB X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} Clematis brachiata Thunberg (Ranunculaceae) is used in Kenya for the management of headaches, malaria and other febrile illnesses, abdominal disorders, yaws and for skin disorders.  Old stems and leaves are chewed for the management of toothaches and sore throats.  Extracts of the plant were subjected to tests for antimalarial, antibacterial and antifungal activity.  The toxicity of the extracts was assessed using the brine shrimp lethality bioassay.   The root extract gave the highest in vitro antimalarial activity against a mulitidrug resistant strain, Plasmodium falciparum VI/S (IC50=39.24 mg/ml). The stem and leaf extracts had insignificant antiplasmodial activity.  The leaf, stem and root extracts had bacterial or fungal growth even at very high concentrations of 10 mg/ml. The LD50 values of the stem and leaf methanol extracts against the brine shrimp larvae was 365.60 and 66.5 mg/ml respectively. The in vitro anti malarial activity of the root extract in part supports the ethnobotanical use of the plant to manage malaria.  KEY WORDS Clematis, Ranunculaceae, antimalarial, brine shrimp, antimicrobial

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

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Introduction: To establish  a model for investigationg endometrics in vitro, we analyzed several immortalized endometrial and endometriotic cell lines for typical biological functions. Especially transforming growth factor (TGF)-betas were investigated, because TGF-betas are increased during menstrual and endometriosis and seem to modulate effects of progesterone on endometrial cells primarily on secretion of matrix metalloproteinases (MMPs).Methods: We used two stroma and one epithelial cell line from human endometrium and one stromal and three epithelial cell lines from endometrial patients. Protein secretion was quantitated with ELISAs and apoptosis determined with FACS analysis.Results: All cell lines secrete TGF-beta1, but interestingly the endometriotic cell lines secret considerably higher levels compared to normal endometrial cells. Of note,not the endometriotic cells secrete TGF-beta2. However, all cell lines only produce very slow levels of TGF-beta3. All cell lines could be stimulated by TGF-bata because they express high-affinity receptors TBR1 and TBR2. Treatment with TGF-betas reduced cell proliferation by innducing apoptosis, whereas TGF-beta1 more efficiently increased secretion of MMP2 compared to TGF0beta2. Progesterone reduced cell proliferation dose-dependent but induced secretion of TGF-beta1 and TGF-beta2. Interestingly TGF-beta3 was predominantly found in endothelial cells of patients with endometriosis.Conclusion: The results obtained with the endometrial and endometriotic celss lines are highly consistent with published data. For example TGF-beta1 is the predominant TGF-beta isoform in explant cultures as well as in endometriosis, followed by TGF-beta2 and very low levels of TGF-beta3. Our results convincingly demonstrate that cell lines are a suitable model for studying endometriosis.

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

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Ninety seven patients were examined for dental caries using two standard methods: (a) clinical examination based on WHO Basic Methods Oral Health surveys and (b) radiographic examination. Clinical examination method under records caries by upto 40%. Such under recording may give an impression of a decreasing caries prevalence in epidemiological studies.

The vision of the Government of Kenya is to facilitate ICT as a universal tool for education and training. In order to achieve this vision every educational institution, teacher, learner and the respective community should be equipped with appropriate ICT infrastructure, competencies and policies for usage and progress. It calls for recognition of the fact that ICT provides capabilities and skills needed for a knowledge-based economy. It also calls for transforming teaching and learning to incorporate new pedagogies that are appropriate for the 21st  century. The Ministry of Education�s (MOE) mission is to facilitate effective use of ICT to improve access, learning and administration in delivery education programmes and services. The principal objective will be to integrate ICT in the delivery of education and training curricula. XML:NAMESPACE PREFIX = O />  Although not exhaustive, the range of ICT that have been used in the delivery of education to improve access, teaching, learning, and administration includes: Electric Board, Audio Cassette, Radio for Interactive Radio Instructions (IRI), Video/TV-Learning, Computer, Integrated ICT infrastructure and Support Application Systems (SAS).These systems are in use, at various degrees, in most parts of Africa (Charp, 1998). This plan envisages use ofthese digital components to improve access and quality in the delivery of education in Kenya.  The major challenge in respect to this component is limited digital equipment at virtually all levels of education. While the average access rate is one computer to 15 students in most of the developed countries, the access rate in Kenya is approximately one computer to 150 students (EMIS, 2005). Whereas most secondary schools in Kenya have some computer equipment, only a small fraction is equipped with basic ICT infrastructure. In most cases equipment of schools with ICT infrastructure has been through initiatives supported by the parents, government, development agencies and the private sector, including the NEPAD E-Schools programme. Attempts to set up basic ICT infrastructure in primary schools are almost negligible.  According to ICTs in Education Options Paper, one of the main problems is limited penetration of the physical telecommunication infrastructure into rural and low-income areas. Specifically, the main challenge is limited access to dedicated phone lines and high-speed systems or connectivity to access e-mail and Internet resources. The EMIS Survey (2003/2004) indicated that over 70% of secondary schools and a much larger proportion of primary schools require functional telephones. Indeed, many parts of Kenya cannot easily get Internet services because of the poor telephone networks. About 90% of secondary schools need to establish standard Local Area Networks (LANs) in order to improve sharing of learning resources.  Alternative and appropriate technologies for access to Internet resources, including wireless systems remain quite expensive. Indeed, a small proportion of schools have direct access, through Internet Service Providers (ISPs), to high-speed data and communication systems. Furthermore, very few schools in the rural areas use wireless technology such as VSAT to access e-mail and Internet resources. Nearly all of the 6 NEPAD e-Schools are in rural areas and are expected to enjoy internet connectivity through VSAT technology.  While other countries have reported up to 41% of integration of ICT to teaching and learning, the proportion remains substantially low in Africa, Kenya included. Integration aims at the use ICT to support teaching and learning in the delivery of the various curricula to achieve improved education outcomes. Because ICT is interactive media, it facilitates students to develop diversified skills needed for industrialization and a knowledge-based economy. It also allows teachers and learners to proceed at different paces depending on the prevailing circumstances. As a first step, the Ministry of Education has initiated a major ICT project in Secondary schools meant to equip over 200 secondary schools with ICT infrastructure for integration of ICT in teaching/learning process ( KESSP, 2004). Three schools have been chosen in every district of Kenya.

The vision of the Government of Kenya is to facilitate ICT as a universal tool for education and training. In order to achieve this vision every educational institution, teacher, learner and the respective community should be equipped with appropriate ICT infrastructure, competencies and policies for usage and progress. It calls for recognition of the fact that ICT provides capabilities and skills needed for a knowledge-based economy. It also calls for transforming teaching and learning to incorporate new pedagogies that are appropriate for the 21st  century. The Ministry of Education�s (MOE) mission is to facilitate effective use of ICT to improve access, learning and administration in delivery education programmes and services. The principal objective will be to integrate ICT in the delivery of education and training curricula. XML:NAMESPACE PREFIX = O />  Although not exhaustive, the range of ICT that have been used in the delivery of education to improve access, teaching, learning, and administration includes: Electric Board, Audio Cassette, Radio for Interactive Radio Instructions (IRI), Video/TV-Learning, Computer, Integrated ICT infrastructure and Support Application Systems (SAS).These systems are in use, at various degrees, in most parts of Africa (Charp, 1998). This plan envisages use ofthese digital components to improve access and quality in the delivery of education in Kenya.  The major challenge in respect to this component is limited digital equipment at virtually all levels of education. While the average access rate is one computer to 15 students in most of the developed countries, the access rate in Kenya is approximately one computer to 150 students (EMIS, 2005). Whereas most secondary schools in Kenya have some computer equipment, only a small fraction is equipped with basic ICT infrastructure. In most cases equipment of schools with ICT infrastructure has been through initiatives supported by the parents, government, development agencies and the private sector, including the NEPAD E-Schools programme. Attempts to set up basic ICT infrastructure in primary schools are almost negligible.  According to ICTs in Education Options Paper, one of the main problems is limited penetration of the physical telecommunication infrastructure into rural and low-income areas. Specifically, the main challenge is limited access to dedicated phone lines and high-speed systems or connectivity to access e-mail and Internet resources. The EMIS Survey (2003/2004) indicated that over 70% of secondary schools and a much larger proportion of primary schools require functional telephones. Indeed, many parts of Kenya cannot easily get Internet services because of the poor telephone networks. About 90% of secondary schools need to establish standard Local Area Networks (LANs) in order to improve sharing of learning resources.  Alternative and appropriate technologies for access to Internet resources, including wireless systems remain quite expensive. Indeed, a small proportion of schools have direct access, through Internet Service Providers (ISPs), to high-speed data and communication systems. Furthermore, very few schools in the rural areas use wireless technology such as VSAT to access e-mail and Internet resources. Nearly all of the 6 NEPAD e-Schools are in rural areas and are expected to enjoy internet connectivity through VSAT technology.  While other countries have reported up to 41% of integration of ICT to teaching and learning, the proportion remains substantially low in Africa, Kenya included. Integration aims at the use ICT to support teaching and learning in the delivery of the various curricula to achieve improved education outcomes. Because ICT is interactive media, it facilitates students to develop diversified skills needed for industrialization and a knowledge-based economy. It also allows teachers and learners to proceed at different paces depending on the prevailing circumstances. As a first step, the Ministry of Education has initiated a major ICT project in Secondary schools meant to equip over 200 secondary schools with ICT infrastructure for integration of ICT in teaching/learning process ( KESSP, 2004). Three schools have been chosen in every district of Kenya.

{ Aim: To evaluate the survival rate of proximal ART restorations in relation to the sizes of their cavity preparations. Methods: In total, 804 children aged 6-8 years from a Kenyan rural population participated in the study. Trained operators and assistants restored, an equal number of proximal cavities in primary molars of the children, using only hand instruments. Fuji IX, Ketac Molar Easymix and Ketac Molar Aplicap glass ionomer cement-brands were randomly used to restore the cavities together with two tooth-isolation methods. The restorations were followed for two years. Results: After two years, 648 restorations were available for evaluation, with a cumulative survival of 30.8%. Restorations whose sizes were 2 to 3 mm (mesio-distal, bucco-lingual and depth) or volumes between 10.0 to 19.9 mm3 had the highest number of surviving restorations, that were statistically significant (Chi-square

{ Aim: To evaluate the survival rate of proximal ART restorations in relation to the sizes of their cavity preparations. Methods: In total, 804 children aged 6-8 years from a Kenyan rural population participated in the study. Trained operators and assistants restored, an equal number of proximal cavities in primary molars of the children, using only hand instruments. Fuji IX, Ketac Molar Easymix and Ketac Molar Aplicap glass ionomer cement-brands were randomly used to restore the cavities together with two tooth-isolation methods. The restorations were followed for two years. Results: After two years, 648 restorations were available for evaluation, with a cumulative survival of 30.8%. Restorations whose sizes were 2 to 3 mm (mesio-distal, bucco-lingual and depth) or volumes between 10.0 to 19.9 mm3 had the highest number of surviving restorations, that were statistically significant (Chi-square

Vertex epidural haematomas (VEDH) are rare and difficulties are encountered in diagnosis and management. This is a case report of a patient with a vertex epidural haematoma who presented with signs of severe head injury with upper limb decerebrate posture. We discuss the challenges of radiological investigation and neurosurgical management of VEDH.

The vision of the Government of Kenya is to facilitate ICT as a universal tool for education and training. In order to achieve this vision every educational institution, teacher, learner and the respective community should be equipped with appropriate ICT infrastructure, competencies and policies for usage and progress. It calls for recognition of the fact that ICT provides capabilities and skills needed for a knowledge-based economy. It also calls for transforming teaching and learning to incorporate new pedagogies that are appropriate for the 21st  century. The Ministry of Education�s (MOE) mission is to facilitate effective use of ICT to improve access, learning and administration in delivery education programmes and services. The principal objective will be to integrate ICT in the delivery of education and training curricula. XML:NAMESPACE PREFIX = O />  Although not exhaustive, the range of ICT that have been used in the delivery of education to improve access, teaching, learning, and administration includes: Electric Board, Audio Cassette, Radio for Interactive Radio Instructions (IRI), Video/TV-Learning, Computer, Integrated ICT infrastructure and Support Application Systems (SAS).These systems are in use, at various degrees, in most parts of Africa (Charp, 1998). This plan envisages use ofthese digital components to improve access and quality in the delivery of education in Kenya.  The major challenge in respect to this component is limited digital equipment at virtually all levels of education. While the average access rate is one computer to 15 students in most of the developed countries, the access rate in Kenya is approximately one computer to 150 students (EMIS, 2005). Whereas most secondary schools in Kenya have some computer equipment, only a small fraction is equipped with basic ICT infrastructure. In most cases equipment of schools with ICT infrastructure has been through initiatives supported by the parents, government, development agencies and the private sector, including the NEPAD E-Schools programme. Attempts to set up basic ICT infrastructure in primary schools are almost negligible.  According to ICTs in Education Options Paper, one of the main problems is limited penetration of the physical telecommunication infrastructure into rural and low-income areas. Specifically, the main challenge is limited access to dedicated phone lines and high-speed systems or connectivity to access e-mail and Internet resources. The EMIS Survey (2003/2004) indicated that over 70% of secondary schools and a much larger proportion of primary schools require functional telephones. Indeed, many parts of Kenya cannot easily get Internet services because of the poor telephone networks. About 90% of secondary schools need to establish standard Local Area Networks (LANs) in order to improve sharing of learning resources.  Alternative and appropriate technologies for access to Internet resources, including wireless systems remain quite expensive. Indeed, a small proportion of schools have direct access, through Internet Service Providers (ISPs), to high-speed data and communication systems. Furthermore, very few schools in the rural areas use wireless technology such as VSAT to access e-mail and Internet resources. Nearly all of the 6 NEPAD e-Schools are in rural areas and are expected to enjoy internet connectivity through VSAT technology.  While other countries have reported up to 41% of integration of ICT to teaching and learning, the proportion remains substantially low in Africa, Kenya included. Integration aims at the use ICT to support teaching and learning in the delivery of the various curricula to achieve improved education outcomes. Because ICT is interactive media, it facilitates students to develop diversified skills needed for industrialization and a knowledge-based economy. It also allows teachers and learners to proceed at different paces depending on the prevailing circumstances. As a first step, the Ministry of Education has initiated a major ICT project in Secondary schools meant to equip over 200 secondary schools with ICT infrastructure for integration of ICT in teaching/learning process ( KESSP, 2004). Three schools have been chosen in every district of Kenya.

This paper first defines what regional economic commuities are using economic theory as a point of reference. The Economic integration in Africa is also discussed at length and the various forms of integration in Africa such as the East African Community (EAC), the South African Customs Union (SACU), Common Market for East and Southern Africa (COMESA), the Southern African Development Community (SADC) and may others. Consequences of overlapping membership of various forms of integration and the constrainst of regional  integration in Africa are also discussed.

This article investigates the influence of social capital on consumption expenditure in rural Kenya. It uses primary data collected from a sample of 340 households in Nyeri district to demonstrate the linkage between social capital and rural livelihoods. Econometric methods (OLS) are used to explore the nexus between social capital and consumption expenditure. Results from econometric analysis show that social capital significantly affects total household expenditure. There is evidence in the study that social capital enables households to generate consumption expenditure sources that support non-monetary forms of exchange. This non-monetary exchange is presumed to reduce transactions demand for cash and facilitate household savings. Contrary to expectations, it is found that total household expenditure is negatively associated with aggregate social capital. This finding seems to indicate that social capital reduces welfare. Contrary to this simple interpretation, the finding suggests that households with large social capital endowments are able to meet their basic needs through non-cash transactions. Social capital can enable households to increase consumption without cash expenditures and relying on self-purchased goods. The article further shows that the welfare effects of various  forms of social capital differ, indicating that effects of social capital are not sufficiently measured using aggregate quantity of this variable. The findings of the study are used to suggest policies for promoting formation of social capital as a mechanism for improving conditions of rural households.

This article investigates the influence of social capital on consumption expenditure in rural Kenya. It uses primary data collected from a sample of 340 households in Nyeri district to demonstrate the linkage between social capital and rural livelihoods. Econometric methods (OLS) are used to explore the nexus between social capital and consumption expenditures. Results from econometric analysis show that social capital significantly affects total household expenditure. There is evidence in the study area that social capital enables households generate consumption expenditure sources that support non-monetary forms of exchange. This non-monetary exchange is presumed to reduce transactions demand for cash and facilitate household savings. Contrary to expectations, it is found that total household expenditure is negatively associated with aggregate social capital. This finding seems to indicate that social capital reduces household welfare. Contrary to this simple interpretation, the finding suggests that households with large social capital endowments are able to meet their basic needs through non-cash transactions. Social capital can enable households to increase consumption without cash expenditure and relying on self-purchased goods. The article further shows that the welfare effects of various forms of social capital differ, indicating that effects of social capital are not sufficientle measured using aggregate quantity of this variable. The findings of the study are used to suggest policies for promoting formation of social capital as a mechanism for improving living conditions of rural households.   

Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.

OBJECTIVES: Female sex workers (FSWs) form a core group at high risk of both sexual HIV acquisition and secondary transmission. The magnitude of these risks may vary by sexual risk taking, partner HIV prevalence, host immune factors and genital co-infections. We examined temporal trends in HIV prevalence and per-act incidence, adjusted for behavioral and other variables, in FSWs from Nairobi, Kenya. METHODS: An open cohort of FSWs followed since 1985. Behavioral and clinical data were collected six monthly from 1985 to 2005, and sexually transmitted infection (STI) diagnostics and HIV serology performed. A Cox proportional hazards model with time-dependent covariables was used to estimate infection risk as a function of calendar time. RESULTS: HIV prevalence in new FSW enrollees peaked at 81% in 1986, and was consistently below 50% after 1997. Initially uninfected FSWs remained at high risk of acquiring HIV throughout the study period, but the rate of HIV acquisition during unprotected sex with a casual client declined by over four-fold. This reduction correlated closely with decreases in gonorrhea prevalence, and predated reductions in the Kenyan HIV population prevalence by over a decade. CONCLUSIONS: The per-act rate of HIV acquisition in high-risk Nairobi FSWs fell dramatically between 1985 and 2005. This decline may represent the impact of improved STI prevention/therapy, immunogenetic shifts in at-risk women, or changes in the proportion of HIV exposures occurring with clients who had acute HIV infection. Declining HIV incidence in high-risk cohorts may predict and/or be causally related to future reductions in population prevalence.

Background
Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya.
Design
A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.
Discussion
Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.

Background
Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya.
Design
A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions.
Discussion
Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa.

Introduction. Male circumcision is being promoted for HIV prevention in high-risk heterosexual populations. However, there is a concern that circumcision may impair sexual function. Aim. To assess adult male circumcision's effect on men's sexual function and pleasure. Methods. Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya were uncircumcised, HIV negative, sexually active men, aged 18-24 years, with a hemoglobin >/=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans, a condition that might unduly increase surgical risks, or a medical indication for circumcision. Participants were randomized 1:1 to either immediate circumcision or delayed circumcision after 2 years (control group). Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months. Main Outcome Measures. (i) Sexual function between circumcised and uncircumcised men; and (ii) sexual satisfaction and pleasure over time following circumcision. Results. Between February 2002 and September 2005, 2,784 participants were randomized, including the 100 excluded from this analysis because they crossed over, were not circumcised within 30 days of randomization, did not complete baseline interviews, or were outside the age range. For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24. Changes over time were not associated with circumcision status. Compared to before they were circumcised, 64.0% of circumcised men reported their penis was "much more sensitive," and 54.5% rated their ease of reaching orgasm as "much more" at month 24. Conclusions. Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm. These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function.

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OBJECTIVE: To assess the causes and pattern of hand injuries in patients with isolated unilateral acute hand injuries managed at the Kenyatta National Hospital (KNH). Design: A prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, Nairobi, Kenya, between May and August 2006. SUBJECTS: All patients with isolated unilateral acute hand injuries who presented at the casualty department. RESULTS: A total of 99 patients were recruited. The mean age was 28.2 years with the modal age being 21-30 years. More males were injured than females. Occupational injuries and assaults were the most prevalent causes of hand injury. Majority of the injuries included lacerations, fractures and tendon injuries. The distal phalanges of the ring and long fingers were the most common sites of injury on the digits. CONCLUSION: Occupational hand injuries, a largely preventable problem, are the most prevalent cause of hand injury. This offers opportunity for strategies in preventing a large number of hand injuries by initiating safety measures at the work place.

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Objective: To determine the prevalence and pattern of eye diseases and visual impairment in the Nairobi Comprehensive Eye Care Services (NCES) Project; the catchment area of the Mbagathi District Eye Unit of Nairobi. Design: Community based survey conducted from October 15th to 31st 2007 Setting: Kibera and Dagoreti divisions of Nairobi City Subjects: 4200 people of all ages were randomly selected; 4056 were examined (96.6% response rate). 122 (2.9%) were not available and 15 (0.4%) declined to be examined. Results: Females: 54.2%, Males: 45.8%. Mean age; 22.4 years, SD; 16.5. Only 241(5.9%) aged >50years old. The leading eye disorders in Kibera and Dagoretti divisions are conjunctival disorders including allergic conjunctivitis and conjunctival growths. This was found to affect 7.6% of the subjects. This was followed by refractive errors found in 5.3% of the subjects. Cataract was found in 30 subjects (0.7%). Disorders of the retina and the optic nerve were found in 1.1% of the subjects and corneal disorders in 0.5%. The prevalence of visual impairment was 0.6%, severe visual impairment was 0.05% and blindness was 0.1%. This indicates that most of the ocular disorders encountered were not visually threatening. The main cause of visual impairment is refractive errors and the causes of severe visual impairment and blindness are cataract, corneal opacity and glaucoma. Conclusion: The population of the NCES is relatively young and the prevalence of blindness and visual impairment is low. The main cause of visual impairment was refractive errors and the causes of severe visual impairment and blindness were cataract, corneal opacity and glaucoma. Recommendations: The level of blindness in NCES is low and the project should focus more on rendering eye care and not treatment of blindness. There is need to address the issue of refractive errors as this was one of the main ocular problems encountered. In this survey, it was not possible to perform detailed refraction and hence it was recommend that a refractive error survey be conducted; especially in school going children.