Critically examined in this paper are the current sources of water for human consumption in Z Kenya. The various treatment methods and their effectiveness are highlighted. The quality control methods and the statutory regulatory bodies in place are mentioned. Water standards in use are compared with those World Health Organization (WHO). The question whether water supply and quality control should continue to be the domain of the civic/municipal authorities and whether they treat their water properly is discussed.

Critically examined in this paper are the current sources of water for human consumption in Z Kenya. The various treatment methods and their effectiveness are highlighted. The quality control methods and the statutory regulatory bodies in place are mentioned. Water standards in use are compared with those World Health Organization (WHO). The question whether water supply and quality control should continue to be the domain of the civic/municipal authorities and whether they treat their water properly is discussed.

Critically examined in this paper are the current sources of water for human consumption in Z Kenya. The various treatment methods and their effectiveness are highlighted. The quality control methods and the statutory regulatory bodies in place are mentioned. Water standards in use are compared with those World Health Organization (WHO). The question whether water supply and quality control should continue to be the domain of the civic/municipal authorities and whether they treat their water properly is discussed.

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Scientific paper presented during the FIFTH ANNUAL REGIONAL WORKSHOP  ON THE THEME;`` WATER IS LIFE``. Abstract: The paper illustrates the health status of water in the human body in health and in disease situations and how body water content depends on many variables including age, sex, fat content,leaness of muscles ,the internal environment of body cells and the external envronmental air and  temperature.

Introduction
The use of free ranging mammals in monitoring ecosys-tem health has been suggested (Costanza, Norton & Haskell, 1992). In Lake Nakuru National Park of Kenya, a high frequency of dental abnormalities has been reported in the waterbuck (Foley & Atkinson, 1984). This was attributed to inbreeding and increased homozyg-osity, which led to a higher frequency of genetic abnor¬malities. It was also noted that waterbuck in the north¬eastern part were in poorer body condition than in other parts of the park (Kock et al, 1994). Maskall & Thornton (1989) carried out a study of the mineral status of soils in the park, which showed some def¬iciencies. Because the waterbuck is territorial and has a small feeding range, an environmental factor, amongst others, might also play a role in the poor health status of the antelope in the north-eastern part of the park.
The purpose of the present study was to correlate the mineral status of the waterbuck to its health status in lake Nakuru National Park. A comparison was also made with waterbuck around Lakes Elementaita and Naivasha, which are located in the same region. Furthermore the study would be useful in assessing the suitability of Lake Nakuru National Park for rearing endangered species.

Over the past three decades, agricultural watersheds in semi-arid Kenya have experienced some rapid decline in soil and crop productivity due to severe soil erosion, low soil water, low soil fertility and high soil crusting and compaction. Thus, the management of these watersheds requires some good understanding of agricultural drought, stratification of production zones according to slope, and suitable conservation options that include in-situ water conservation and runoff utilization. The planning of watershed conservation requires the application of runoff models in the selection of interventions that reduce upstream flood magnitude and downstream sedimentation. Successful interventions can be introduced under enabling conditions to farmers at various hierarchical policy levels. A few of these enabling conditions that are elaborated upon include agricultural policy, focus on smallholder agriculture and public¬community partnerships.

Over the past three decades, agricultural watersheds in semi-arid Kenya have experienced some rapid decline in soil and crop productivity due to severe soil erosion, low soil water, low soil fertility and high soil crusting and compaction. Thus, the management of these watersheds requires some good understanding of agricultural drought, stratification of production zones according to slope, and suitable conservation options that include in-situ water conservation and runoff utilization. The planning of watershed conservation requires the application of runoff models in the selection of interventions that reduce upstream flood magnitude and downstream sedimentation. Successful interventions can be introduced under enabling conditions to farmers at various hierarchical policy levels. A few of these enabling conditions that are elaborated upon include agricultural policy, focus on smallholder agriculture and public¬community partnerships.

There are four hypotheses which have been advanced to explain the pathophysiology of severe and complicated malaria such as cerebral malaria. However, none of them adequately explains all the features of cerebral malaria in man. One such hypotheses is Disseminated Intravascular Coagulation (DIC). To determine whether this condition occurs in patients with uncomplicated malaria, the authors conducted a study on fibrinogen and its degradation products, euglobulin lysis time and parasite counts in 30 cases of uncomplicated malaria. By spectrophotometric method, plasma fibrinogen in patients with uncomplicated malaria was found to be normal as compared to normal healthy adults. There were no fibrinogen degradation production (FDP) detected in either patients or healthy controls, using latex agglutination tests at a dilution of 1:5. This method for FDP estimation is significant in that a serum agglutination with 1:5 dilution indicates a concentration of FDP in the original serum in excess of 10g/ml, designated as positive results of experiment. High values of euglobulin lysis time (ELT) were noted in patients with low parasitaemia. Analysis of these results showed that disseminated intravascular coagulation did not occur in uncomplicated cases of malaria. In this study on cases of uncomplicated malaria and low parasitaemia the biochemical parameters relating to to DIC have been essentially normal, although DIC is thought to be a primary stage in the development of cerebral malaria. According to Reid, DIC is an important intermediate mechanism in the pathophysiology of severe and complicated malaria such as cerebral malaria.

OBJECTIVES: Marginal integrity is a major clinical problem in restorative dentistry. The aim of this study was to evaluate the applicability of an edge strength measurement device in an in vitro test to determine the force required to fracture flakes of material by a Vickers indentation at progressively increasing distances from an interface edge of bulk material. METHODS: Five representative resin-composites were investigated. Fourteen disks of specimens (12mm diameter x 2.5mm thick) were prepared for each material. These were divided into seven sub-groups corresponding to different edge-distances (0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 1.0mm). An edge strength measurement device (CK10) (Engineering Systems, Nottingham, UK) was used. The mode of the failure of each specimen was examined under the integral microscope of the CK10. RESULTS: The force (N)-to-fracture at a distance of 0.5mm from the edge was defined as the edge strength. The highest failure force (edge strength) was observed for Tetric Ceram (174.2N) and the lowest for Filtek Supreme (enamel) (87.0N). Correlations between the failure-forces to fracture materials with edge-distance were regression analyzed giving coefficients (r) ranging from 0.94 (p=0.02) to 0.99 (p=0.01). Two modes of failure were observed: chipping and–generally at greater distances–cracking. SIGNIFICANCE: Edge strength is a definable and potentially useful parameter to characterize this aspect of clinically related behavior. A standardized distance of 0.5mm from the specimen's edge, when chipping failure prevails, is suitable and convenient as a reference point.

OBJECTIVES: Marginal integrity is a major clinical problem in restorative dentistry. The aim of this study was to evaluate the applicability of an edge strength measurement device in an in vitro test to determine the force required to fracture flakes of material by a Vickers indentation at progressively increasing distances from an interface edge of bulk material. METHODS: Five representative resin-composites were investigated. Fourteen disks of specimens (12mm diameter x 2.5mm thick) were prepared for each material. These were divided into seven sub-groups corresponding to different edge-distances (0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 1.0mm). An edge strength measurement device (CK10) (Engineering Systems, Nottingham, UK) was used. The mode of the failure of each specimen was examined under the integral microscope of the CK10. RESULTS: The force (N)-to-fracture at a distance of 0.5mm from the edge was defined as the edge strength. The highest failure force (edge strength) was observed for Tetric Ceram (174.2N) and the lowest for Filtek Supreme (enamel) (87.0N). Correlations between the failure-forces to fracture materials with edge-distance were regression analyzed giving coefficients (r) ranging from 0.94 (p=0.02) to 0.99 (p=0.01). Two modes of failure were observed: chipping and–generally at greater distances–cracking. SIGNIFICANCE: Edge strength is a definable and potentially useful parameter to characterize this aspect of clinically related behavior. A standardized distance of 0.5mm from the specimen's edge, when chipping failure prevails, is suitable and convenient as a reference point.

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This paper examines the influence of multisensor data fusion on the automatic extraction of topographic objects from SPOT panchromatic imagery. The suitability of various grey level co-occurence based texture measures, as well as different pixel windows is also investigated. It is observed that best results are obtained with a 3x3 pixel window and the texture measure homogeneity. The synthetic texture image derived together with a Landsat TM imagery are then fused with the SPOT data using the additional channel concept. The object feature base is expanded to include both spectral and spatial features. A maximum likelihood classification approach is then applied. It is demonstrated that the segmentation of topographic objects is significantly improved by fusing the multispectral and texture information.

This paper examines the influence of multisensor data fusion on the automatic extraction of topographic objects from SPOT panchromatic imagery. The suitability of various grey level co-occurence based texture measures, as well as different pixel windows is also investigated. It is observed that best results are obtained with a 3x3 pixel window and the texture measure homogeneity. The synthetic texture image derived together with a Landsat TM imagery are then fused with the SPOT data using the additional channel concept. The object feature base is expanded to include both spectral and spatial features. A maximum likelihood classification approach is then applied. It is demonstrated that the segmentation of topographic objects is significantly improved by fusing the multispectral and texture information.

This paper examines the influence of multisensor data fusion on the automatic extraction of topographic objects from SPOT panchromatic imagery. The suitability of various grey level co-occurence based texture measures, as well as different pixel windows is also investigated. It is observed that best results are obtained with a 3x3 pixel window and the texture measure homogeneity. The synthetic texture image derived together with a Landsat TM imagery are then fused with the SPOT data using the additional channel concept. The object feature base is expanded to include both spectral and spatial features. A maximum likelihood classification approach is then applied. It is demonstrated that the segmentation of topographic objects is significantly improved by fusing the multispectral and texture information.

Information and communication technologies (ICTs) have become common place entities in all aspects of life. Over the past twenty years the use of ICT has fundamentally changed the practices and procedures of nearly all forms of endeavour within business and governance. Within education, ICT has begun to have a presence but the impact has not been as extensive as in other fields both globally and locally within Africa as well as in Kenya. In this study, the researcher sought to find out how the use of ICT in education lends itself to more student-centered learning settings. The study seeks to determine the various impacts of ICT on contemporary secondary education in Kenya as well as potential challenges. The study was conducted through survey method. The researcher sought permission from the Ministry of Education in Kenya to collect research data from the sampled schools since all of them were public secondary schools. The researcher constructed questionnaires which were used to collect data from various respondents in the sampled Nepad e-schools in Kenya. The researcher used three categories of respondents in each school namely; the administrators, the teachers and the students. The completed questionnaires were then coded, entered into the computer using Statistical Package for Social Scientists (SPSS) and then analyzed. The study revealed that both students and teachers have developed a positive attitude towards the use ICTs and related accessories in the teaching/learning process. This was reflected by the frequency of use of the facilities and the interest as indicated by the respondents. The study also found out that the schools under study were already using educational management software for various processes carried out in the schools. The study also revealed some challenges faced by the schools. Notable challenges included lack of funding to support the purchase of the infrastructure to improve access to educational materials, lack of training for teachers to adopt ICT as a teaching tool and lack suitable e-content for various subjects.Information and communication technologies (ICTs) have become common place entities in all aspects of life. Over the past twenty years the use of ICT has fundamentally changed the practices and procedures of nearly all forms of endeavour within business and governance. Within education, ICT has begun to have a presence but the impact has not been as extensive as in other fields both globally and locally within Africa as well as in Kenya. In this study, the researcher sought to find out how the use of ICT in education lends itself to more student-centered learning settings. The study seeks to determine the various impacts of ICT on contemporary secondary education in Kenya as well as potential challenges. The study was conducted through survey method. The researcher sought permission from the Ministry of Education in Kenya to collect research data from the sampled schools since all of them were public secondary schools. The researcher constructed questionnaires which were used to collect data from various respondents in the sampled Nepad e-schools in Kenya. The researcher used three categories of respondents in each school namely; the administrators, the teachers and the students. The completed questionnaires were then coded, entered into the computer using Statistical Package for Social Scientists (SPSS) and then analyzed. The study revealed that both students and teachers have developed a positive attitude towards the use ICTs and related accessories in the teaching/learning process. This was reflected by the frequency of use of the facilities and the interest as indicated by the respondents. The study also found out that the schools under study were already using educational management software for various processes carried out in the schools. The study also revealed some challenges faced by the schools. Notable challenges included lack of funding to support the purchase of the infrastructure to improve access to educational materials, lack of training for teachers to adopt ICT as a teaching tool and lack suitable e-content for various subjects.

The civil engineering teaching involves provision of sound professional education so that upon graduation the student is able to fit into the various disciplines of civil engineering. These disciplines can be broadly described as transportation, structural, water and waste water engineering. This paper suggests that besides instilling the core engineering knowledge, the teaching of civil engineering should include other subjects which have a big impact in the work of civil engineers. These areas include entrepreneurship, environmental, and social studies. Additionally a study abroad is recommended for those students who are likely to work outside their counties of birth.

Any displacement of abdominal contents through "unnatural" openings in any part of the abdominal wall is termed a ventral hernia (Frank 1970; Keown 1976; Tirgari 1979; McIlwraith 1984). Ventral hernia is an acquired type of hernia whose main cause is trauma inflicted by violent, blunt force such as kicks, blows, horn thrusts and falling objects (Frank 1970; Keown, 1976; McIlwraith, 1984). Previous abdominal wall surgery, abscesses, or degenerative causes may lead to muscular weakness. The stress of pregnancy and parturition then causes the weakened part of the abdominal wall to give way (Oehme 1965; McIlwraith 1984). Muscular tear follows the pathway of least resistance and in most cases it is in the direction of the fibres of the external oblique muscle (Meek et aI1977; Tirgari 1979). Housing and type of management could be contributory predisposing factors that are not well defined.

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

Journal of the Institute of Certified Public Accountants of Kenya. (pages 13-15)

The establishment of Christian missionary stations and the spread of Christianity, Western education and medical services were possible due to concerted efforts of the White missionaries and African teachers, evangelists and ‘dispensers’. However, role played by the pioneering hospital dressers and nurses in this endeavor has received little attention from scholars. The African nurses and dressers in the Church of Scotland Mission (CSM) now Presbyterian Church of East Africa, contributed a lot to the establishment and growth of not only the medical wing of CSM but to the expansion of education and Christianity in the their areas of jurisdiction during the colonial period. In order to complete the missionary story, the inclusion of the mission hospital nurses and dressers story to the existing literature is long overdue.. The pioneering nurses and nurses took advantage of their position to spread the Gospel, opened and taught in the school, were local opinion leaders beyond hospital confines and added voices to the socio-political and economic developments in their communities. Their diverse roles were beyond the hospital boundaries.

Recycling of Al-Si alloys for high integrity structural components for the automotive industry applications has gained attention in the recent times. In this article, scrap of cylinder heads containing 6.01%Si and 2.62%Cu were recycled by casting into four alloys invariants: base alloy (no alloying elements added), 0.02%Ca, 0.38%Fe and 0.9%Fe+0.45%Mn additions. The structural properties were analysed through optical and SEM/EDS microscopy, X-ray diffraction (XRD). The wear characteristics of the alloys were investigated using a multi-pass ball on the flat reciprocating method under a normal load of 30 N and velocity of 4 mm/s. The results showed delamination and adhesive wear as the predominant wear mechanisms for the recycled Al-Si alloys. The base and 0.02%Ca alloys exhibited the lowest coefficients of friction and rates of wear. A comparison of the wear data to the published data on primary alloys revealed that our secondary alloys have the potential for applications in the automotive industry.

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.

Lodwar town in Turkana County faces water security issues relating to its strategic location, (semi-)arid climate, hydroclimatic variability, high poverty rates, low piped water service and a rapidly growing population challenges that are also relevant to many Kenyan and African small towns in fragile environments. Political, economic and environmental changes affecting Lodwar, including devolution, climate variation and change, demographic shifts, and the exploration of subterranean resources (both water and oil), make this an important time to examine the challenges and prospects for inclusive water security. This working paper discusses findings from a 2016 study of the institutions involved in water decision-making in Lodwar, focusing on their access to and use (or non-use) of weather and climate information. What organisations are involved in water decisions affecting Lodwar town; how do they negotiate information access, accountability and uncertainty; and what is at stake? Drawing on qualitative material collected during a 10-week study of institutional arrangements and decision-making, this paper explores
connections and mismatches between weather/climate knowledge and water decisions in Lodwar town and the wider Turkwel basin.

Lodwar town in Turkana County faces water security issues relating to its strategic location, (semi-)arid climate, hydroclimatic variability, high poverty rates, low piped water service and a rapidly growing population – challenges that are also relevant to many Kenyan and African small towns in fragile environments. Political, economic and environmental changes affecting Lodwar, including devolution, climate variation and change, demographic shifts, and the exploration of subterranean resources (both water and oil), make this an important time to examine the challenges and prospects for inclusive water security. This working paper discusses findings from a 2016 study of the institutions involved in water decision-making in Lodwar, focusing on their access to and use (or non-use) of weather and climate information. What organisations are involved in water decisions affecting Lodwar town; how do they negotiate information access, accountability and uncertainty; and what is at stake? Drawing on qualitative material collected during a 10-week study of institutional arrangements and decision-making, this paper explores connections and mismatches between weather/climate knowledge and water decisions in Lodwar town and the wider Turkwel basin.

In order to fully appreciate the contribution of geoinformatics in monitoring climate change caused by increase in temperature, a distinction between weather and climate, on one hand, and climate variability and climate change, on the other hand, is essential. Burroughs (2007) points out that weather is what is happening to the atmosphere at any given time (i.e., what one gets), whereas climate is what would be expected to occur at any given time of the year based on statistics built up over many years (i.e., what one expects).

In developing countries, air pollution is increasing especially in urban centers. This has led to enhanced cases of cardio-respiratory diseases. According to World Health Organization, air pollution is estimated to cause about two million premature deaths worldwide annually. Additionally an estimated 800,000 premature deaths are caused each year by urban air pollution, a principle component of which is particulate matter. Studies have indicated that the levels and distribution of air pollution are highly dependent on the meteorology. This study was conducted based on this theory.
The study sought to examine the relationship between fine particulate matter (PM2.5) and selected meteorological variables over Kenya during the period 2001 to 2012. The data used included monthly rainfall, relative humidity, temperature and wind speed from synoptic stations and satellite air quality data from the period 2001 to 2012. Monthly Global 1o by 1o level-3 Aerosol Optical Depth data was obtained through Giovanni at 550 nm from MODIS-Terra Version. 5.1 and employed as PM2.5 proxy. Detailed monitoring of temporal and spatial patterns of fine particulate matter (PM2.5) pollution and meteorological parameters was carried out using time series analysis and surfer software. Correlation, simple regression and multiple regression techniques were used to model PM2.5 concentrations and distribution as a function of meteorological conditions.
The results reveal that a correlation between PM2.5 and rainfall, temperature and wind speed yields reasonable negative relationship with the r-value ranging from -0.429 to -0.785. A positive relationship with RH is realized, r-value ranging between 0.081 and 0.269. Student t-test showed that the results were statistically significant at 95% confidence level. The variation of rainfall, relative humidity, wind speed and temperature on the average explains 47% of PM2.5 concentrations.
Keywords: Fine Particulate Matter, Pollution, Aerosol Optical Depth, Regression.

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The Internet and web-based technology has dramatically influenced the access to and dissemination of information among communities, locally and globally. This is no less true in the domain of geographic information systems (GIS) which have traditionally been constrained in terms of information access and the communities that use them. Geospatial data has traditionally been captured and managed within individual and separate organizational databases with access by a limited number of expert users. Now, with the integrated use of the web, not just geospatial data, but also the functionality of GIS can be accessed globally by citizens and non-experts.

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Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who has become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in the identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even is such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.

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Understanding the organization of the vertebrate retina has been the goal of many talented visual scientists during the past 100 years. With Cajal's (1892) anatomic descriptions of the cell types that constitute the retina in a number of vertebrate species, and with an early understanding of the role of visual purple in photochemistry in combination with psychophysical studies of adaptation and color vision, we had in the sixties the rudiments of an understanding of how the retina might be organized and functioning. To go further, though, we were beginning to need detailed information of neural circuits that underlie these functions. It was the advent of electron microscopy, microelectrode recording techniques, and pharmacology that then allowed us an era of very rapid advancement. The purpose of this Electronic Tutorial is to summarize these recent advances and to describe our present understanding, based primarily on anatomic investigations, of the Neural Organization of the Mammalian Retina. As time goes on we have been inviting other authors to write chapters on their speciality concerning the retina or other visual pathways. A great addition has been a section on Psychophysics of Vision which we hope will be of general information to all interested in learning the basics of visual perception.

Understanding the organization of the vertebrate retina has been the goal of many talented visual scientists during the past 100 years. With Cajal's (1892) anatomic descriptions of the cell types that constitute the retina in a number of vertebrate species, and with an early understanding of the role of visual purple in photochemistry in combination with psychophysical studies of adaptation and color vision, we had in the sixties the rudiments of an understanding of how the retina might be organized and functioning. To go further, though, we were beginning to need detailed information of neural circuits that underlie these functions. It was the advent of electron microscopy, microelectrode recording techniques, and pharmacology that then allowed us an era of very rapid advancement. The purpose of this Electronic Tutorial is to summarize these recent advances and to describe our present understanding, based primarily on anatomic investigations, of the Neural Organization of the Mammalian Retina. As time goes on we have been inviting other authors to write chapters on their speciality concerning the retina or other visual pathways. A great addition has been a section on Psychophysics of Vision which we hope will be of general information to all interested in learning the basics of visual perception.

Understanding the organization of the vertebrate retina has been the goal of many talented visual scientists during the past 100 years. With Cajal's (1892) anatomic descriptions of the cell types that constitute the retina in a number of vertebrate species, and with an early understanding of the role of visual purple in photochemistry in combination with psychophysical studies of adaptation and color vision, we had in the sixties the rudiments of an understanding of how the retina might be organized and functioning. To go further, though, we were beginning to need detailed information of neural circuits that underlie these functions. It was the advent of electron microscopy, microelectrode recording techniques, and pharmacology that then allowed us an era of very rapid advancement. The purpose of this Electronic Tutorial is to summarize these recent advances and to describe our present understanding, based primarily on anatomic investigations, of the Neural Organization of the Mammalian Retina. As time goes on we have been inviting other authors to write chapters on their speciality concerning the retina or other visual pathways. A great addition has been a section on Psychophysics of Vision which we hope will be of general information to all interested in learning the basics of visual perception.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Hepatocellular carcinoma results when cancerous cells are localized in the liver. It is distributed globally with high prevalence in sub-Saharan African, southern Asia, China and Japan. Diagnosis is experimental and in many cases inaccurate due to unreliability of markers. Prognosis is poor and the cost of treatment prohibitive. Conventional radiation and chemotherapy lead to loss of hair, fertility and general weakening of the body`s immune system increasing a patient`s risk to infection. These observations underscore the need for improved, or additional methods of cancer diagnosis and management. We investigated the effect of polysaccharide rich Pleurotus pulmonarius fruit body extracts on progression of chemically induced hepatocellular carcinoma in CBA mice. Addition of Pleurotus pulmonarius extracts in diet delayed progression of carcinogenesis suggesting   that these extracts may be useful as   adjuvants to conventional cancer therapies.   Key words: carcinogenesis; mice; mushroom extracts; pleurotus pulmunarius   Corresponding author: Ms Carolyne Wasonga, Department of Biochemistry, University of Nairobi, P.O. Box 30197, Nairobi,  Kenya. E-mail: carox27@yahoo.ca     Charles O.A. Omwandho, Susanne E. Gruessner, John Falconer, Hans-R Tinneberg, Timothy K. Roberts. IS OVINE PLACENTAL IGG TOXIC TO HUMAN PERIPHERAL BLOOD NATURAL KILLER CELLS?

Kent papers in POlitics and International Relations, Series 4, No. 4.

Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Hepatocellular carcinoma results when cancerous cells are localized in the liver. It is distributed globally with high prevalence in sub-Saharan African, southern Asia, China and Japan. Diagnosis is experimental and in many cases inaccurate due to unreliability of markers. Prognosis is poor and the cost of treatment prohibitive. Conventional radiation and chemotherapy lead to loss of hair, fertility and general weakening of the body`s immune system increasing a patient`s risk to infection. These observations underscore the need for improved, or additional methods of cancer diagnosis and management. We investigated the effect of polysaccharide rich Pleurotus pulmonarius fruit body extracts on progression of chemically induced hepatocellular carcinoma in CBA mice. Addition of Pleurotus pulmonarius extracts in diet delayed progression of carcinogenesis suggesting   that these extracts may be useful as   adjuvants to conventional cancer therapies.   Key words: carcinogenesis; mice; mushroom extracts; pleurotus pulmunarius   Corresponding author: Ms Carolyne Wasonga, Department of Biochemistry, University of Nairobi, P.O. Box 30197, Nairobi,  Kenya. E-mail: carox27@yahoo.ca     Charles O.A. Omwandho, Susanne E. Gruessner, John Falconer, Hans-R Tinneberg, Timothy K. Roberts. IS OVINE PLACENTAL IGG TOXIC TO HUMAN PERIPHERAL BLOOD NATURAL KILLER CELLS?

PROBLEM: Maternal mortality in Uganda has remained unchanged at 500/100 000 over the past 10 years despite concerted efforts to improve the standard of maternity care. It is especially difficult to improve standards in rural areas, where there is little money for improvements. Furthermore, staff may be isolated, poorly paid, disempowered, lacking in morale, and have few skills to bring about change. DESIGN: Training programme to introduce criteria based audit into rural Uganda. SETTING: Makerere University Medical School, Mulago Hospital (large government teaching hospital in Kampala), and Mpigi District (rural area with 10 small health centres around a district hospital). STRATEGIES FOR CHANGE: Didactic teaching about criteria based audit followed by practical work in own units, with ongoing support and follow up workshops. EFFECTS OF CHANGE: Improvements were seen in many standards of care. Staff showed universal enthusiasm for the training; many staff produced simple, cost-free improvements in their standard of care. LESSONS LEARNT: Teaching of criteria based audit to those providing health care in developing countries can produce low cost improvements in the standards of care. Because the method is simple and can be used to provide improvements even without new funding, it has the potential to produce sustainable and cost effective changes in the standard of health care. Follow up is needed to prevent a waning of enthusiasm with time.

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Antisera to thermostable muscle antigens from 13 wild animals: Buffalo, Waterbuck, Bushbuck, Eland, Oryx, Kongoni, Bushpig, Warthog, Topi, Thomson’s gazelle, Grant’s gazelle, Sheep, Pig, Horse, Camel & Dog, were raised in rabbits and/or goats. Absorptions of the antisera with copolymerized pooled serum from the 20 species and the thermostable muscle antigens rendered most of the antisera mmonospecific. It was possible to identify the species of origin of saline extracts of both cooked and fresh meat samples in immunodiffusion tests. The method is promising for use in identification of the species origin of fresh and cooked animal meats.

Serum acid phosphatase was measured in patients with enlarged benign and malignant prostate before and after rectal examination. Amongst the patients with benign glands, rectal examination did not produce any significant false elevation of the enzyme. Rectal examination, however, caused a rise in the enzyme level in a few untreated cancer patients and in cancer patients who has become refractory to hormonal therapy. This rise would help rather than mislead in the diagnosis of malignant prostate and also in the identifying treated patients who had become refractory to treatment. Thus, when serum acid phosphatase is properly determined, elevated levels should always arouse suspicion of malignant prostate or other lesions associated with high enzyme level even is such determination was preceded by rectal examination. There appears to be no merit in the teaching that the determination of serum acid phosphatase should be delayed after rectal examination.

Department of Medical Physiology, University of Nairobi, Kenya. Finding a simple and easily reproducible formula for assessing fitness and growth for human body has been one constant search over the ages. It was the aim of this project to try and add to this search. Most formulae in this field have complex calculations. Most of them have been derived using single system measurements. To delineate our factor, multisystem measurements were used; metric and imperial. This yielded a factor for describing the relationship between weight and height over the ages. The height is in inches and weight in kilograms. This produced factors (D) and (G) which have childhood, adolescent, adult and old age values. A total of 368 black Kenyans were studied. The age range was 3-85 years.

In Kenya, welding services are extensively employed in both the formal and informal sectors. The needs continue to increase with increasing population, infrastructure and vehicle fleet, and economic development. Welding need is even currently very important in support of …

This paper presents comparative qualitative and quantitative evidence from rural Kenya and Madagascar in an attempt to untangle the causality behind persistent poverty. We find striking differences in welfare dynamics depending on whether one uses total income, including stochastic terms and inevitable measurement error, or the predictable, structural component of income based on a household's asset holdings. Our results suggest the existence of multiple dynamic asset and structural income equilibria, consistent with the poverty traps hypothesis. Furthermore, we find supporting evidence of locally increasing returns to assets and of risk management behaviour consistent with poor households' defence of a critical asset threshold through asset smoothing.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

Animal welfare is defined as the ability of an animal to interact comfortably with its environment through its physiological, psychological and behavioural systems. About 70% of dairy production in Kenya is from the smallholder production systems. These production systems are negatively impacted by a number of factors including poor nutrition, substandard husbandry and management practices, lack of appropriate farm inputs, diseases and low incomes. These factors influence the welfare of dairy cattle, hence their importance for its evaluation. This study was therefore designed with the following objectives: 1. to determine the welfare of dairy cattle in the smallholder production units in Nairobi and its environs, 2. to determine the risk factors contributing to poor welfare of dairy cattle in the smallholder production units, 3. to determine the indicators of poor welfare of dairy cattle in the smallholder production units, 4. to determine the farmers’ and stockmen’s perspectives of animal welfare. These objectives were achieved through a cross-sectional study carried out in 80 smallholder dairy units purposively selected in Nairobi and its environs, in which 306 dairy cows were examined. The welfare of cattle in these dairy units was evaluated through several methods which included: visual observations for animal- and farm-level factors that indicate poor welfare of cattle; taking measurements of dairy housing unit dimensions such as cubicle, walk-alley, kerb and feeding bunk; and using a structured questionnaire to interview farmers and stockmen on nutritional regimes and other management practices such as removal of slurry, milking techniques, record keeping and disease control. These factors were recorded and later analyzed. Analyses included descriptive statistics, and simple associations using chi-square at p< 0.05 significance level. Over 80% of these smallholder units had factors that contributed to poor welfare of dairy cattle. These factors included under-size cubicles, small walk-alleys, too high feeding bunks with traumatic edges, too low positioning of neck rails at the feed bunks, sharp objects and edges within the housing units and dilapidated housing structures. The main evidence of poor welfare was injuries on the animals. The body condition score (BCS) of the cows was the main indicator of welfare relating to feeding. Presence of injuries or scars on the skin at various parts of the body was considered a positive indicator of poor welfare either associated with housing structures, management practices or animal interactions. Other causes of poor welfare of the cows were hind-limb tying during milking, teat pulling during hand-milking, more than 24-hour delay before sick cows were treated, and mixing of cattle of different age-groups in the same compartment. Cow-human interaction was poor as evidenced by fearful response and long avoidance distance. This study concludes that poor welfare of dairy cattle exists in all the smallholder units evaluated, which is mainly caused by improper housing and management. Training of farmers and stockmen on animal welfare issues would therefore be a prerequisite to the improvement of dairy cattle welfare. Research on the physiological response to poor welfare of dairy cows in the smallholder units needs to be carried out to enhance the understanding of the impact of these risk factors on smallholder dairy animals.

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

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

During a recent outbreak of Rhodesian sleeping sickness in the Lambwe Valley no asymptomatic Rhodesian sleeping sickness patients were found although 54% of the primary patients had mild symptoms and 9% were stuporous or comatose at presentation. The duration of symptoms was three months or less in 90% of the patients. Headache, weakness, joint and back pains and weight loss were claimed by at least 75% of the patients, while 82% of the females reported amenorrhoea and 70% of the males claimed impotency. Physical examination revealed lymphadenopathy in 86% but fever in only 36% of the patients, while chancres were found in only 16%. Patients had significantly lower levels of haemoglobin and thrombocytes than controls and their erythrocyte sedimentation rates were elevated. A comparison of both blood group and haemoglobin type between patients and controls yielded no significant differences. Fifty-seven per cent of the primary patients reporting mild symptoms had abnormal levels of leucocytes in their CSF. All relapse patients had abnormal CSF parameters. Levels of serum urea nitrogen were significantly elevated in patients, but SGOT, SGPT and total bilirubin were not. Levels of albumin and beta-globulin in patients were significantly lower than controls while gamma-globulin was elevated. Mean serum IgM levels in patients were elevated to nearly three-fold those of controls, but 35% of the individual patient values fell within the 95% range of control values. Some patients had extended prothrombin and thrombin times while fibrinogen levels were significantly elevated. No patients reported haemorrhage, and none was seen.

Department of Pathology, University of Toronto, Ontario, Canada. Red blood cells and lysate products (erythrolysate) are observed consistently in lymph draining acute and chronic inflammatory reactions and from tissues subjected to trauma or surgical procedures. Using hemoglobin as a marker for erythrolysate, we have measured hemoglobin in lymph up to the 10(-6) M range in a number of pathophysiological states. Data demonstrate that erythrolysate alters the pumping characteristics of lymphatic vessels. To test the effects of erythrolysate on lymphatic pumping, bovine lymphatics were suspended in an organ bath preparation with the vessels cannulated at both inflow and outflow ends. By raising the heights of the Krebs reservoir and the outflow catheters appropriately, a transmural pressure that stimulated pumping activity could be applied to the vessels. With a fixed transmural pressure of 6 cm H2O applied to the ducts, sheep erythrolysate depressed pumping activity between 40% and 100%, with dilutions containing between 10(-8) and 10(-5) M hemoglobin. Although the active principle in the red blood cells has not been characterized, evidence from precipitation purification experiments suggests that hemoglobin is an important component. Once suppressed, pumping could be restored in many but not all vessels (often to control levels) by elevating the distending pressure above 6 cm H2O. The relation between transmural pressure and fluid pumping is expressed as a bell-shaped curve, with pumping increasing up to a peak pressure (usually 8 cm H2O) and declining at pressures above this level. By comparing pressure/flow curves, we were able to ascertain that hemoglobin shifted the lymphatic function curve to the right and, on average, reduced the maximum pumping capability of the vessels. We speculate that the presence of erythrolysate/hemoglobin in lymph may modulate the ability of lymphatic vessels to drain liquid and protein from the tissue spaces.

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

A 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

End stage renal disease requiring renal replacement therapy is a common complication of several renal diseases that are seen in the tropics. World over, the costs of the various modalities of therapy that constitute renal replacement therapy, including hemodialysis, continuous ambulatory peritoneal dialysis and renal transplantation, is prohibitive. All the above modes of therapy are provided in Kenya, unlike most countries with similar level of socioeconomic development. This article analyses the factors behind the limited success that renal replacement therapy enjoys in Kenya, which is faced with more pressing basic problems of malnutrition and infection.

This was a cross sectional descriptive study to discuss the median age of menopause in a rural area of Western Kenya. The broad objective of the study was to describe the demographic and biophysical characteristics of the study population and determine the age of menopause. A review of the current and medieval records shows average age of menopause has remained relatively constant at 50 years in contrast to the receeding age of menarche. A total of 1078 women aged between 40-60 years were interviewed. The majority (98.8%) were from one ethnic group, the Luhya. Of the 1078 women, 880 (81.4%) were married and 198 (18.6%) were single. The average number of children per woman was 7.74. Most of the women (75.1%) had attained primary school education. Their husbands were unskilled workers in 30.1% of the cases. The mean weight and height of the women was 60.74 kg and 161.1 cm respectively. Using methods of probit analysis, the median and modal age of menopause was found to be 48.28 years in this group of western Kenya women. If generalised for the whole country, these results suggest that an average Kenyan woman lives for over ten years beyond menopause. It is recommended that more attention should be given to the special health problems of postmenopausal population. PIP: This study describes the demographic and biophysical characteristics of rural menopausal women in Western Kenya. Menopause occurs as the gradual unresponsiveness of the human ovary to gonadotropins, premature ovarian failure at under 40 years, and menopause following surgical procedures of the uterus and ovaries. A 3-phase process starts with low serum estradiol and progesterone, followed by a rise in follicle stimulating hormone, and a rise in luteinizing hormone. Clinical symptoms include vasomotor ones, genitourinary ones, osteoporosis and increased incidence of bone fractures, increased incidence of thromboembolic and ischemic heart disease, and psychological symptoms of anxiety, depression, and memory loss. The age of menopause varies with socioeconomic conditions, race, parity, height, weight, skinfold thickness, lifestyle, and education. Data were obtained for this study from a sample of 1078 women from 7 sublocations in Vihiga division, Kenya. Women were aged 40-60 years. The most populous ethnic group was the Luhya. 81.6% were married, 15.6% were widowed, and 0.7% were divorced. 4 women had never been married. 75.1% had a primary school education; 18.6% had not received any formal education. 30.1% had husbands who were unskilled workers, 28.8% had husbands who were farmers, and 20.6% had husbands who were skilled workers. 1.3% had no children, and 1 woman had 17 children. The average number of children was 7.74. 9 of the nulliparous women were menopausal. The mean height was 161.1 cm. The median age at menopause was 48.28 years. Almost all women were menopausal by 55 years. The total fertility period averaged 35 years. Female life expectancy was 59 years

PIP: In November and December, 1993, a self-administered questionnaire was distributed to men in the town of Machakos and to nonmedical hospital workers of Machakos General Hospital. The purpose of the study was to assess their knowledge about and attitude towards vasectomy. The majority of men were in the age group of 30-44 years and were married; the hospital group was more educated. The town men perceived the pill to be the best contraceptive method for women in contrast to the hospital group who gave more importance to bilateral tubal ligation. The hospital group also perceived vasectomy as the best method for men. Overall, 53.2% men were aware of the correct procedure of vasectomy, but only 24% had correct knowledge of how the procedure affects masculinity. The knowledge of the procedure among hospital workers was not very different from that of the town group. Recommendations were made to increase information and education to all groups of people through various media. author's modified

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Background: The knowledge of evolutionary patterns of the HA gene of the influenza virus is important in vaccinestrain selection.Objective: Genetic analysis of HA1 of influenza viruses isolated in Kenya during the 2010-2011 season with referenceto WHO vaccine strains.Methods: A total of twenty seven (27) influenza A (H1N1) pdm09, Nineteen (19) influenza A (H3N2) and Sixteen (16)influenza B virus isolates were analyzed. A partial HA1 gene was amplified by RT-PCR and sequenced.Results: Phylogenetic analyses revealed that influenza B viruses were closely related to B/Brisbane/60/2008 vaccinestrain while A (H1N1) pdm09 viruses were genetic variants of A/California/07/2009. The Kenyan A (H1N1) pdm09isolates had P83S, D97N, S185T, I321V and E374K amino acid substitutions. Influenza A/H3N2 isolates showed K62E,T212A and S214I simultaneous amino acid substitutions when compared to A/Perth/10/2009. The K62E changeoccurred at antigenic site E. Majority of the Kenyan H3N2 isolates further had S45N and K144N amino acidsubstitutions at sites C and A respectively, which introduced N-glycosylation motifs absent in the vaccine strain.Conclusion: The study showed that although the WHO 2010 vaccine strains recommendations for the southernhemisphere matched with influenza viruses which circulated in Kenya during the 2010-2011 season, the viruses hadevolved genetically from the vaccine strains.

To evaluate whether determinants of consistent condom use vary by partner type among young sexually active Kenyan men, we conducted a cross-sectional assessment of lifetime sexual histories from a sub-sample of men enrolled in a clinical trial of male circumcision. 7913 partnerships of 1370 men were analyzed. 262 men (19%) reported never, 1018 (74%) sometimes and 92 (7%) always using a condom with their partners. Condoms were always used in 2672 (34%) of the total relationships-212 (70%) of the relationships with sex workers, 1643 (40%) of the casual and 817 (23%) of the regular/marital relationships. Factors influencing condom use varied significantly by partner type, suggesting that HIV prevention messages promoting condom use with higher-risk partners have achieved a moderate level of acceptance. However, in populations of young, single men in generalized epidemic settings, interventions should promote consistent condom use in all sexual encounters, independently of partner type and characteristics.

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.

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Extreme wet spells affect the East Africa Coast (EAC) during March to June (long rains) and October to December (short rains). While these spells are less frequent during the short rains, some of the most extreme wet spells occur at this time of the year. The present study examined the general characteristics of the wet spells during the short rains. A detailed study of the anomalous wet spell event of October 1997, with record rainfall around Mombasa (4.0°S, 39.6°E), was also carried out.
Daily rainfall for 1962-1997 and NCEP2 reanalysis data for 1979-1997 were used to study the characteristics of the wet events. A high spatial coherence is found in the rainfall over the EAC. The circulation features that were common during most of the wet events were: weakening or reversal of the east-west (Walker type) circulation over the Indian Ocean, enhanced convergence between the northern and southern hemisphere trade winds and westward-moving disturbances in the low-level equatorial wind field. During the 1997 wet event, it is shown that prior to the heavy rainfall event a ridge of high pressure, on the eastern coast of southern Africa, intensified and propagated eastwards leading to the strengthening of moist easterlies reaching the EAC. The zonal wind component along longitude 40°E showed shears in the flows that were associated with the development of the Mozambique Channel low/trough in the lower troposphere round which southerlies surged northwards. These southerlies converged with the easterlies near the EAC. Thus, the warm and wet air from the east interacted with the relatively cold and mainly continental air from the south generating instability at the EAC.

This study was carried out in one of the agriculturally high potential and densily populated areas of Kenya The data presented in this paper was collected during soil survey carried out to asses the suitability of some of these waterlogged areas for drainage and their capability to sustain agricultural production.The wetland soils of central Kenya have histic, gleyic, stagnic, plinthic and/or vertic properties. They occur on mountain areas, structural plains and valleys and generally imperfectly to poorly, drained, shallow to very deep, dark reddish brown to black, friable to firm, in places mottled clay. The Wetland soils are used for irrigated rice production in the plains, cultivation of subsistence crops and horticultural crops in the seasonally flooded Valleys. Reeds and papyrus dominate the Mountains, which are used for forestry, mountains, mountaineering, game reserve and is important water shed zone

The study of operators having some special spectral properties like Weyl's theorem, Browder's theorem
and the SVEP has been of important interest for some time now. The SVEP is very useful in the study of
the local spectral theory. In this paper, we explore the single-valued extension property (SVEP) for some
operators on Hilbert spaces. We characterize operators with or without SVEP at zero and those where
Weyl's and Browder's theorems hold. It is shown that if a Fredholm operator has no SVEP at zero, then
zero is an accumulation point of the spectrum of the operator. It is also shown that quasi similar Fredholm
operators have equal Weyl spectrum.

Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 20956-00202, Nairobi, Kenya. BACKGROUND: Early growth in very low birth weight (VLBW) infants has been found predictive of their later outcomes. This has led to increased interest in establishing measures to optimise such growth. In facilities without the resources required to undertake long-term audits for all the high risk infants they graduate, these growth parameters may also be used as selection criteria for those meriting such follow up reducing costs. OBJECTIVES: To describe early growth patterns among a cohort of VLBW infants and determine some of the factors associated with poor growth among them. DESIGN: Cross section survey. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: One hundred and seventy five neonatal survivors. RESULTS: Of the 175 infants recruited, the male/female ratio was 4:6, sixty four (36.6%) were intrauterine growth retarded while significant illnesses during the neonatal period were reported in 109 (62.3%). Forty seven percent of the infants had been fed on exclusive breast milk, 33% on mixed feeds while 20% received exclusive preterm formula. The mean neonatal weight gain for the whole cohort was 13.5 (3.9) g/kg/day, length of 0.34 (0.11) cm/week and head circumference of 0.32 (0.71) cm/week. By term only 33 (18.9%), 37 (21.1%) and 48 (28%) had reached the expected (the 3rd percentile) weight, length and head circumference respectively. Sixty percent of the infants gained weight at <15 g/kg/day while 70% and 78% grew in head circumference and length at < 0.5 cm/week respectively. At term weight, head and linear growth faultering were recorded in 81%, 72% and 79% respectively. The factors that were associated with better growth at this stage included feeding on preterm formula (P < 0.001) and absence of neonatal morbidity (P < 0.001). Infants who were appropriate for gestational age at birth also had better catch up growth at term compared to those born small for gestation (P < 0.001) but their neonatal growth itself was not significantly better. CONCLUSION: The mean neonatal growth in all anthropometric measures was less than expected and by the time of their expected delivery, less than 30% of these infants had reached the 3rd percentile of the expected measurement in all the three growth parameters. Choice of milk and neonatal morbidity influenced these growth patterns. RECOMMENDATIONS: Routine fortification of mother's milk or addition of preterm formula and reorganised care of sick newborns is recommended to improve early growth. PMID: 16771104 [PubMed - indexed for MEDLINE]

The development of the urban fringes is an inevitable consequence of urbanization given that as cities continue to grow, urban activities spread outwards in waves towards the rural areas. The rural-urban fringes of cities thus, are the exit points for residents relocating from major urban built areas, and entry points for rural migrants into the towns. Firstly, rural-urban fringes are determined by two major factors; that is, administrative boundaries and the differences in the intensity of built up areas and the farmland. Secondly, policy and legal guidelines exhibit inadequacies in handling the dynamism of the fringes and thus the failure by planning agencies in managing the impending growth. Thirdly, prospective land developers, businesses and communities fail to anticipate the results of development because they lack information on potential or approved development plans. This research paper applies urban development theories to explain the drivers of growth at the rural-urban fringes. In this regard, the study draws heavily from a paper by Alonso and Wingo’s explanations on the spatial structure in terms of how the market allocates space to users according to supply and demand; von Thunen’s agricultural land use model whose building blocks are economic rent, distance from the centre and individual decision making explains how the urban structure is influenced by the locational behavior of households in the city. A sample of 134 respondents, drawn from the five (5) neighborhoods located within the Nairobi-Kiambu development corridor informed the research. This was further informed by the rather heterogeneous nature of the neighborhoods in terms of physical characteristics, livelihoods and historical evolution. Observation, questionnaires, focus group discussions and interviews were the main methods applied in the collection of primary data. A synopsis of the findings reveals that, contrary to conclusions in studies carried out elsewhere in Africa that periphery development accommodates low income residents, the Nairobi-Kiambu corridor presents an area interspersed with low and high income households; households locate at the fringes so as to take advantage of relaxed regulations and therefore engage in land use practices that are allowable.

The purpose of the research paper is to inform readers and other researchers on the dynamics of fringe development of a city in an African country. The paper provides insights into causes and effects of rural land conversion into urban land uses. The research is based on a most vibrant development corridor of the city of Nairobi.

Key words: rural-urban fringe, drivers of growth, development corridor, land,
planning.

nto the possible roles for the method in Kenya, we assessed the knowledge of and attitudes towards emergency contraception in two groups of potential users, and we focus on these data specifically in this paper. We interviewed clustered samples of clients at ten family planning clinics in Nairobi (n = 282) and conducted four focus group discussions with students at two universities in Kenya (n = 42). Results show that despite relatively low levels of awareness and widespread misinformation, when the method was explained, both clients and students expressed considerable interest, but also expressed some health and other concerns.

Background

The creation of a clinical network was proposed as a means to promote implementation of a set of recommended clinical practices targeting inpatient paediatric care in Kenya. The rationale for selecting a network as a strategy has been previously described. Here, we aim to describe network activities actually conducted over its first 2.5 years, deconstruct its implementation into specific components and provide our ‘insider’ interpretation of how the network is functioning as an intervention.
Methods

We articulate key activities that together have constituted network processes over 2.5 years and then utilise a recently published typology of implementation components to give greater granularity to this description from the perspective of those delivering the intervention. Using the Behaviour Change Wheel we then suggest how the network may operate to achieve change and offer examples of change before making an effort to synthesise our understanding in the form of a realist context–mechanism–outcome configuration.
Results

We suggest our network is likely to comprise 22 from a total of 73 identifiable intervention components, of which 12 and 10 we consider major and minor components, respectively. At the policy level, we employed clinical guidelines, marketing and communication strategies with intervention characteristics operating through incentivisation, persuasion, education, enablement, modelling and environmental restructuring. These might influence behaviours by enhancing psychological capability, creating social opportunity and increasing motivation largely through a reflective pathway.
Conclusions

We previously proposed a clinical network as a solution to challenges implementing recommended practices in Kenyan hospitals based on our understanding of theory and context. Here, we report how we have enacted what was proposed and use a recent typology to deconstruct the intervention into its elements and articulate how we think the network may produce change. We offer a more generalised statement of our theory of change in a context–mechanism–outcome configuration. We hope this will complement a planned independent evaluation of ‘how things work’, will help others interpret results of change reported more formally in the future and encourage others to consider further examination of networks as means to scale up improvement practices in health in lower income countries.

Obstetric fistula, a devastating maternal health complication associated with social stigma and isolation, is often found in resource-poor settings where access to specialized care is constrained. In this study, the authors examine the perspectives of the healthcare providers on the factors that contribute to obstetric fistulae formation in West Pokot, Kenya. Key informant interviews with healthcare providers, social workers and traditional birth attendants were held to generate information on factors contributing to formation of obstetric fistulae. Thematic analysis based on grounded theory approach was used. Factors that contribute to the occurrence of obstetric fistulae include: female genital mutilation and early forced marriage; unskilled birth attendants and associated birth rituals; infrastructural constraints; and lack of women's empowerment. There is interplay between sociocultural, structural and economic forces in the region that culminate in maternal morbidity and possible mortality. Healthcare providers' perspectives are vital in understanding maternal health problems in rural Kenya. Community level initiatives aimed at improving the health of women in rural resource-poor areas should be encouraged.

To estimate the potential impact of an HIV/AIDS Vaccine in Kenya. Design: The Kenyan HIV/AIDS epidemic was modeled using the most current data from national sources including epidemiology and behavioral surveillance. The model’s baseline projection was validated against adult HIV prevalence at antenatal clinics and ge- neral population surveys. The model was used to analyze the effects of scaling up current pre- vention programs and adding potential HIV vac- cines with varying levels of effectiveness and coverage. Results: Even with full scale-up of currently available prevention, care and treat- ment programs, new infections will continue to burden Kenya. The introduction of a partially ef- fective AIDS vaccine could significantly alter the trajectory of the epidemic. Conclusion: The game changing impact that an AIDS vaccine could have on the AIDS epidemic in Kenya under- scores the importance of sustaining political support and financial investment to accelerate HIV/AIDS vaccine research and development.

To estimate the potential impact of an HIV/AIDS Vaccine in Kenya. Design: The Kenyan HIV/AIDS epidemic was modeled using the most current data from national sources including epidemiology and behavioral surveillance. The model’s baseline projection was validated against adult HIV prevalence at antenatal clinics and ge- neral population surveys. The model was used to analyze the effects of scaling up current pre- vention programs and adding potential HIV vac- cines with varying levels of effectiveness and coverage. Results: Even with full scale-up of currently available prevention, care and treat- ment programs, new infections will continue to burden Kenya. The introduction of a partially ef- fective AIDS vaccine could significantly alter the trajectory of the epidemic. Conclusion: The game changing impact that an AIDS vaccine could have on the AIDS epidemic in Kenya under- scores the importance of sustaining political support and financial investment to accelerate HIV/AIDS vaccine research and development.

To estimate the potential impact of an HIV/AIDS Vaccine in Kenya. Design: The Kenyan HIV/AIDS epidemic was modeled using the most current data from national sources including epidemiology and behavioral surveillance. The model’s baseline projection was validated against adult HIV prevalence at antenatal clinics and ge- neral population surveys. The model was used to analyze the effects of scaling up current pre- vention programs and adding potential HIV vac- cines with varying levels of effectiveness and coverage. Results: Even with full scale-up of currently available prevention, care and treat- ment programs, new infections will continue to burden Kenya. The introduction of a partially ef- fective AIDS vaccine could significantly alter the trajectory of the epidemic. Conclusion: The game changing impact that an AIDS vaccine could have on the AIDS epidemic in Kenya under- scores the importance of sustaining political support and financial investment to accelerate HIV/AIDS vaccine research and development.

This integrative review on the teaching of reading in Kenyan primary schools provides a foundation for the growing movement there to improve reading education. In gathering sources for this review, we took an inclusive historical stance. Thus, we did not dismiss research reports that lacked traditional indicators of quality such as being published in peer-reviewed journals. We used multiple methods to find relevant research and associated documents, including two trips to Kenya. The review is organized by six topics: (a) language of instruction, (b) reading instruction, (c) reading materials, (d) reading culture, (e) assessment, and (f) teacher development. The review concludes with six proposals for policymakers, educational researchers, and teacher educators for the development of reading instruction based on what we learned in reviewing the literature. The first proposals are intended specifically to address the teaching of reading in Kenya, but they may be relevant to other sub-Saharan nations. The final proposal encourages others to conduct similar reviews to make possible a handbook of reading in Africa.

Introduction: A survey to determine the prevalence of trachomatous trichiasis (TT) requires a large sample size and the recommended participant age is >15 years. This study sought to establish the appropriate age range of individuals to be included in TT surveys.
Methods: Data from six previous surveys of adults >15 years old were reanalysed.
Results: Reanalysis indicated that 69.6-93.3% (average
87.0%) of untreated TT occurred in those aged 40+ years and 52.2e86.7% (average 73.1%) in those aged 50+ years (age >50 years is used in rapid assessment of avoidable blindness). Age >40 years was adopted in a TT survey conducted in Turkana district because it allowed a smaller sample size than age >15 years.
Conclusions: The estimated backlog of untreated TT in people aged >40 years old in Turkana was 5932 and the overall TT backlog was likely to be 6358-8523. These findings cannot be generalised because all surveys were carried out in the same country.

Introduction A survey to determine the prevalence of trachomatous trichiasis (Tl] requires a large sample size and the recommended participant age is 2': 15 years. This study sought to establish the appropriate age range of individuals to be included in Tl surveys. Methods Data from six previous surveys of adults 2': 15 years old were reanalysed. Results Reanalysis indicated that 69.6-93.3% (average 87.0%) of untreated n occurred in those aged 40+ years and 52.2-86.7% (average 73.1%) in those aged 50 + years (age 2':50 years is used in rapid assessment of avoidable blindness). Age 2':40 years was adopted in a Tl survey conducted in Turkana district because it allowed a smaller sample size than age 2':15 years. Conclusions The estimated backlog of untreated Tl in people aged 2':40 years old in Turkana was 5932 and the overall n backlog was likely to be 6358-8523. These findings cannot be generalised because all surveys were carried out in the same country.

Introduction A survey to determine the prevalence of trachomatous trichiasis (Tl] requires a large sample size and the recommended participant age is 2': 15 years. This study sought to establish the appropriate age range of individuals to be included in Tl surveys. Methods Data from six previous surveys of adults 2': 15 years old were reanalysed. Results Reanalysis indicated that 69.6-93.3% (average 87.0%) of untreated n occurred in those aged 40+ years and 52.2-86.7% (average 73.1%) in those aged 50 + years (age 2':50 years is used in rapid assessment of avoidable blindness). Age 2':40 years was adopted in a Tl survey conducted in Turkana district because it allowed a smaller sample size than age 2':15 years. Conclusions The estimated backlog of untreated Tl in people aged 2':40 years old in Turkana was 5932 and the overall n backlog was likely to be 6358-8523. These findings cannot be generalised because all surveys were carried out in the same country.

Abstract
This paper assesses the impact of access to credit from rural and community banks (RCBs) on the technical efficiency of smallholder cassava farmers in Ghana. The study employed the stochastic frontier, and endogenous switching regression models to estimate the technical efficiency, and the impact of RCB credit access, respectively, on a randomly selected sample of 300 smallholder cassava farmers in the Fanteakwa District of Ghana. Results suggest that cassava farmers in the District are 70.5 percent technically efficient implying that cassava yield levels could be increased further by 29.5 percent without changing the current levels of inputs. The results further reveal that the gender of the household head, access to extension services, membership in farmer organizations, and proximity to the bank are the major factors that positively influence farmers to access credit from RCBs. On average, farmers who accessed credit from RCBs have significantly higher technical efficiencies than farmers who did not access, suggesting that access to credit from RCBs positively impacts the technical efficiency of smallholder cassava farmers.

Keywords: Credit access; Endogenous switching regression; Rural and community banks; Stochastic frontier model; Technical efficiency.

The problem of school non-attendance is an increasing one in our setting and yet its cause has not been established. This paper presents data of work done through interviews with parents and observations of the home environments of the sample cases in attempt to establish factors associated with school non-attendance. After the initial interviews, the children were seen periodically for follow-ups, usually at two to three monthly intervals for at least one year, by the team which consisted of a consultant psychiatrist, a clinical psychologist, a paediatric registrar and a psychiatric social worker. Out of the ten cases sampled for the study, nine were of school phobia and one of conduct disorder (truancy). Generally, family characteristics significantly associated with school non-attendance in this study were neuroticism in parents, unstable family relationships occasioned by marital discord, parental expectations of high academic performance by the child and, to some extent, poverty. The common management approaches used were family therapy, counselling and anti-depressant pharmacotherapy.

Origin of labyrinthine artery is important because it influences the presentation of occlusion of anterior inferior
cerebellar and basilar arteries. It shows ethnic and geographical variation, but there is no data from black African
populations. This study, therefore examined the pattern of origin of labyrinthine artery in adult black Kenyans.
Three hundred and fourty six arteries from one hundred and seventy-three formalin fixed brains were examined
by dissection at the Department of Human Anatomy University of Nairobi, Kenya. Labyrinthine artery arose from
basilar artery in 260 (75.1%); as common trunk with anterior inferior cerebellar artery in 48 (13.9%) and from
the latter in 38 (11.0%) of cases. There was no side and gender difference in the pattern of origin. This implies
that majority of labyrinthine arteries arise from basilar artery, different from that in oriental, Indo-Asian and
Caucasian populations, in which it arises from the anterior inferior cerebellar artery. Preoperative evaluation of
basilar artery branching is recommended.

This integrative review on the teaching of reading in Kenyan primary schools provides a foundation for the growing movement there to improve reading education. In gathering sources for this review, we took an inclusive historical stance. Thus, we did not dismiss research reports that lacked traditional indicators of quality such as being published in peer-reviewed journals. We used multiple methods to find relevant research and associated documents, including two trips to Kenya. The review is organized by six topics: (a) language of instruction, (b) reading instruction, (c) reading materials, (d) reading culture, (e) assessment, and (f) teacher development. The review concludes with six proposals for policymakers, educational researchers, and teacher educators for the development of reading instruction based on what we learned in reviewing the literature. The first proposals are intended specifically to address the teaching of reading in Kenya, but they may be relevant to other sub-Saharan nations. The final proposal encourages others to conduct similar reviews to make possible a handbook of reading in Africa.

HIV testing and counseling services in Africa began in the early 1990s, with limited availability and coverage. Fears of stigma and discrimination, complex laboratory systems, and lack of available care and treatment services hampered expansion. Use of rapid point-of-care tests, introduction of services to prevent mother-to-child transmission, and increasing provision of antiretroviral drugs were key events in the late 1990s and early 2000s that facilitated the expansion of HIV testing and counseling services. Innovations in service delivery included providing HIV testing in both clinical and community sites, including mobile and home testing. Promotional campaigns were conducted in many countries, and evolutions in policies and guidance facilitated expansion and uptake. Support from President's Emergency Plan for AIDS Relief and national governments, other donors, and the Global Fund for AIDS, Tuberculosis, and Malaria contributed to significant increases in the numbers of persons tested in many countries. Quality of both testing and counseling, limited number of health care workers, uptake by couples, and effectiveness of linkages and referral systems remain challenges. Expansion of antiretroviral treatment, especially in light of the evidence that treatment contributes to prevention of transmission, will require greater yet strategic coverage of testing services, especially in clinical settings and in combination with other high-impact HIV prevention strategies. Continued support from President's Emergency Plan for AIDS Relief, governments, and other donors is required for the expansion of testing needed to achieve international targets for the scale-up of treatment and universal access to knowledge of HIV status.

n/a

Land is a critical resource in Kenya, having economic, social, political, environmental and cultural significance. Kenya’s population continues to rely on land for both subsistence and economic activities. In fact, the increase of the population from about 20 million people in the 1960s to about 40 million currently, has put enormous pressure on land. Only a third of Kenya’s land is arable while the rest is arid and semi-arid. With most Kenyans still living off the land, contestations over access to, control over and ownership of land are prevalent. In the broader Kenya context, the land question has emerged as a major political issue that can erupt anytime and threaten the existence of the state, as was witnessed in the post-election violence in December 2007 (Kameri-Mbote and Kindiki, 2009). Within this context, women’s rights to land have remained at the core of the quest for gender equality in Kenya. Among various Kenyan communities, women do not traditionally own land or other immovable property. They have use rights which are anchored in their relationships with men as husbands, fathers, brothers or uncles. Such access is tenuous and can be denied by the male benefactors. This situation affects the survival and livelihoods of women and also stifles their effective role in, and contribution to, national development. This is despite the fact that women provide the bulk of agricultural labour.

n/a

Wheeze is an important sign indicating a potentially severe adverse event in vaccine and drug trials, particularly in children. However, there are currently no consensus definitions of wheeze or associated respiratory compromise in randomized controlled trials (RCTs).

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