There is a fine line between child discipline and maltreatment. Perceptions of child discipline in three tribal groups living in an informal community in Kenya are reported.

Climate change and variability is bound to impact Smallholder Dairy Farming Systems as a result of overreliance on rainfed fodder production; yet climate models project increased frequencies of droughts that have a bearing on the Length of Growing Period. Similarly higher environmental temperatures are partly attributed to biome-range shifts, implying a likelihood of emerging and re-emergence of livestock and fodder diseases and pests. Nonetheless not much is documented of perceptions and adaptation strategies employed by Smallholder Dairy Farming Systems geared towards resilience to climatie shocks. By employing a mixed method approach that included household surveys, focused group discussions and statistical data analysis using SPSS package, this study aimed to bridge some of the existing gaps in adaptation strategies on Smallholder Dairy Farming Systems in Siaya Sub-County of Western Kenya. Survey results obtained from 100 households and Focused Group Discussions revealed that the climate of the study location was perceived to have changed, with droughts singled out as the most frequent. These perceptions were consistent with long-term climate data analysis which affirmed that all seasons, i.e. MAM, JJA, and DJF with the exception of SON showed longterm drying trends. Similarly, environmental temperature showed upward trends in both maximum and minimum temperatures that were perceived to be the cause of proliferation of noxious weeds previously associated with hotter areas of the Sub-County. Typologies of adaptation strategies used in the study showed that adaptation options were limited since these were viewed through a narrow lens of disease control by regular spraying and maize stovers as supplementary livestock feed during fodder dearth periods. This study recommends that besides awareness creation of adverse impacts of climate change and variability, facilitation for ease of access to technologies that ameliorate its adverse effects ought to be put in place. Additionally, empirical studies on consequences of biome range shifts on pasture and fodder productivity, and future possible impacts of diseases on Bos taurus breeds associated with climate change and variability should be undertaken.

Introduction  The practice of dissection, as part of undergraduate medical education, has recently resurfaced in the public eye. This paper focuses on a number of important learning outcomes that were reported by Year 1–5 medical students in a British medical school, during the dissection sessions in the first 2 years of their training, as part of a wider qualitative research project into undergraduate medical education. Methods  A group of 29 students was selected by quota sampling, using the whole student population of the medical school as the sampling frame. Qualitative data were collected by 1 : 1 interviews with students and from formal non-participatory observations of dissection sessions. Results  Apart from learning to cope with the overt ‘emotional confrontation’ with the cadavers which assists anatomical learning, 7 additional covert learning outcomes were identified by the students: teamwork, respect for the body, familiarisation of the body, application of practical skills, integration of theory and practice, preparation for clinical work, and appreciation of the status of dissection within the history of medicine. Discussion  A number of medical schools have either removed the practical, hands-on aspect of dissection in the medical undergraduate curriculum or are seriously considering such a measure, on financial and/or human resource grounds. This study highlights the fact that dissection can impart anatomical knowledge as well as offer other relevant, positive learning opportunities to enhance the skills and attitudes of future doctors.

The Government of Kenya formed a multidisciplinary committee to address the issues of special needs offenders (SNO) in 2009. Because of the widely varying concepts of who could be included in this category, this study was necessary to clearly define and prioritise the interventions. Thus the views of 425 personnel who work with offenders in Kenyan institutions were assessed to determine their perception regarding SNOs and their modes of management. Qualitative methods and the Attitude Towards Prisoners (ATP) Scale were used to gauge the perceptions. The workers identified the following as special needs offenders: the mentally disabled (28.6%), orphans and vulnerable children (21.9%), the physically disabled (14.8%) and child offenders (11.9%). Overall the workers attitude towards offenders was positive but they relied mainly on intuition in identifying the SNOs and used counselling as the main mode of intervention. The study therefore recommends the development of assessment tools, and screening procedures at the intake so as to identify SNOs; establishment of special rehabilitative programmes for the categories of SNOs identified especially the following: intellectual disability and those with mental illness, alcohol and substance users, vulnerable children and those children whose mothers are in prison and the sexual offenders. Other challenges regarding the management of SNOs in Kenya are discussed

The Government of Kenya formed a multidisciplinary committee to address the issues of special needs offenders (SNO) in 2009. Because of the widely varying concepts of who could be included in this category, this study was necessary to clearly define and prioritise the interventions. Thus the views of 425 personnel who work with offenders in Kenyan institutions were assessed to determine their perception regarding SNOs and their modes of management. Qualitative methods and the Attitude Towards Prisoners (ATP) Scale were used to gauge the perceptions. The workers identified the following as special needs offenders: the mentally disabled (28.6%), orphans and vulnerable children (21.9%), the physically disabled (14.8%) and child offenders (11.9%). Overall the workers attitude towards offenders was positive but they relied mainly on intuition in identifying the SNOs and used counselling as the main mode of intervention. The study therefore recommends the development of assessment tools, and screening procedures at the intake so as to identify SNOs; establishment of special rehabilitative programmes for the categories of SNOs identified especially the following: intellectual disability and those with mental illness, alcohol and substance users, vulnerable children and those children whose mothers are in prison and the sexual offenders. Other challenges regarding the management of SNOs in Kenya are discussed

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Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202 Nairobi, Kenya. OBJECTIVE: To describe the echocardiographic features of children with rheumatic heart disease seen at the Kenyatta National Hospital. DESIGN: A retrospective study. SETTING: The Kenyatta National Hospital Heart Unit. SUBJECTS: Patients aged 20 years and less with echocardiographic diagnosis of rheumatic heart disease. RESULTS: Two hundred and twenty four echocardiograms were analysed. Seventy six point four of cases were aged between 5 and 15 years, while on 3% were less than five years. The combinations mitral and aortic regurgitation was the most common lesion followed by isolated mitral regurgitation. Isolated aortic regurgitation was as rare as isolated mitral stenosis in the paediatric age group 1.8% and 2.7% respectively. When seen in the younger age group, the leaflet morphology in mitral regurgitation was predominantly thickening and clubbing of the leaflets while in the older children the pathology was of marked fibrosis of the sub-valvular apparatus. Leaflet prolapse and commissural fusion was the major pathology in aortic regurgitation. Pulmonary hypertension was the most common complication commonly seen in mitral valve disease. Calcification was a rare encounter in this age bracket. CONCLUSIONS: Rheumatic heart disease in the paediatric age commonly presents as isolated mitral regurgitation or in combinations of mitral and aortic regurgitation. The complications of pulmonary hypertension was predominant in mitral valve disease. Valvular calcification is rare in juvenile rheumatic heart disease. PMID: 16450679 [PubMed - indexed for MEDLINE]

OBJECTIVE: To determine efficacy and safety of the new multi-track catheter system for percutaneous baloon mitral valvotomy. DESIGN: Open, non-randomised intervention. SETTING: Cardiac catheterisation Laboratories of Mater Misericordiae Hospital (1997) and Kenyatta National Hospital, Nairobi(1994). PATIENTS: Twenty four consecutive patients with symptomatic severe pure mitral stenosis (less than 2+ mitral regurgitation) and suitable mitral valve apparatus(leaflets, chordae and papillary muscles) for successful commissurotomy. INTERVENTION: Percutaneous mitral baloon valvotomy under local anaesthesia. Standard left and right heart catheterisation for mitral valve disease. Transeptal left atrial entry using standard septal puncture technique and left ventricle position secured by single long-stiff guide-wire. Double-baloon mitral valvotomy on single guide-wire using multi-track baloon catheters. MAIN OUTCOME MEASURES: Mitral valve area, left atrial pressures, mitral regurgitation grade. RESULTS: Mitral valve area increased from 0.65 +/- 0.15cm2 to 1.98 +/- 0.34cm2 (P < 0.01), left atrial pressures from 30.5 +/- 9.1 to 11.9 +/- 5.1mmHg (P < 0.01). No significant change in mitral regurgitation grades. No complications related to multi-track technique. CONCLUSION: Percutaneous baloon mitral valvotomy using the multi track technique is effective and safe.

Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya. Percutaneous transluminal baloon valvuloplasty is currently the treatment of choice for most cases of pulmonary valve stenosis. In the first series of cases performed at Kenyatta National Hospital, six patients aged 4 to 24 years with severe pulmonary valve stenosis and no other associated cardiac lesions were selected for the procedure. Immediately following baloon valvuloplasty, the pressure gradients across pulmonary valve measured by both echo-Doppler technique and cardiac catheterisation dropped very significantly (P < 0.001). Catheterisation peak systolic gradients (psg) dropped from 162.5 +/- 23.7 to 56.5 +/- 19.0 while echo-Doppler pressure gradients dropped from 112.0 +/- 11.9 to 42.8 +/- 16.0. No complications occurred during or after the procedure. This initial short-term experience in our set-up confirms the safety and effectiveness of this procedure. Furthermore, this procedure is much cheaper and technically easier to perform than cardiac surgery. PMID: 8062769 [PubMed - indexed for MEDLINE]

Summing multipliers is an important class of operators in the geometric theory of general Banach spaces. They are particularly useful in the study of the structure of the classical spaces. The work done by Grothendieck and Pietsch provides a good basis for the study of this class of operators. The topic of this study is Aspects on (p,q)-summing multipliers. (p,q)-summing multipliers are sequences of bounded linear operators mapping weakly p-summable sequences into strongly q-summable sequences. This study is concerned with using the concepts of absolute and p-summing multipliers to characterize the space of all (p,q)-summing multipliers. In particular we show that the space of all (p, q)-summing multipliers is complete. This is accomplished through a detailed study of the concepts of the summing operators and absolute and p-summing multipliers

Rural Kalahari agro-pastoral communities of Southern Africa have been exposed to drought shocks throughout history and have adapted their livelihoods accordingly. Yet, drought continues to disrupt or threaten to disrupt their production systems. With semi arid Botswana as a case study, this paper hence sought to unearth the factors limiting agro-pastoral communities from adequately coping and adapting to drought. Low rainfall, which is also highly variable, coupled with relatively low soil fertility status make subsistence livestock keeping and crop cultivation risky. This marginal agricultural potential of the land is further compounded by other constraints. Some of the major constraints included persistence of droughts, limited diversification options outside agriculture, inadequate and poor quality drinking water (high salinity) for livestock, crop damage by wild animals as well as the current land tenure system which curtails the traditional response of livestock mobility during drought. All these factors may act solely or in combination to render rural communities vulnerable during droughts. It is therefore recommended that effective interventions be tailored to local conditions to enhance resilience among Kalahari’s rural population.

Key words: Adaptation, Botswana, coping, drought, variability, vulnerability.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

This paper investigates the possibilities of applying emerging management theories and techniques to constitutionally created offices in Kenya and East African region. The benefits from application of these theories, particularly in the judicial services are highlighted.

The usefulness and limitations in climate information are due to uncertainty inherent in the climate system. The reduction of errors increases the reliability of the information. Therefore, for any given region to have sustainable development there is need to apply climate information into its socio-economic strategic plans.
The overall objective of the study was to assess the performance of the Coupled Model Intercomparison Project (CMIP5) over the Lake Victoria Basin. The data used in the study included the observed point station data, gridded rainfall data from Climate Research Unit, University of East Anglia (CRU) and hindcast data from eight Coupled Model Intercomparison Project 5 (CMIP5) for the period 1971 to 2005 for historical and 2006-2100 for model future projections. The methodology employed included trend analysis, spatial analysis, correlation analysis, Principal Component Analysis (PCA) regression analysis, and categorical statistical skill score.

Published reports on perforated peptic ulcers indicate increasing rates for the elderly, those chronically ill and females. Our local observations are at variance. This study analysed patients treated for peptic ulcer perforations at the Kenyatta National Hospital between January 2005 and December 2006 Perforated peptic ulcer disease is a disease of young males. Efforts to reduce delay in presentation in this population may reduce the complications

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Introduction: Gathering data on socioeconomic status (SES) is a prerequisite for any health programme that aims to assess and improve the equitable distribution of its outcomes. Many different modalities can be used to collect SES data, ranging from (1) face-to-face elicitation, to (2) telephone-administered questionnaires, to (3) automated text message-based systems. The relative costs and perceived benefits to patients and providers of these different data collection approaches is unknown. This protocol is for a systematic review that aims to compare the resource requirements, performance characteristics, and acceptability to participants and service providers of these three approaches to collect SES data from those enrolled in health programmes.

Methods and analysis: An information specialist will conduct searches on the Cochrane Library, MEDLINE, Embase, Global Health, ClinicalTrials.gov, the WHO ICTRP and OpenGrey. All databases will be searched from 1999 to present with no language limits used. We will also search Google Scholar and check the reference lists of relevant articles for further potentially eligible studies. Any empirical study design will be eligible if it compares two or more modalities to elicit SES data from the following three; in-person, voice call, or automated phone-based systems. Two reviewers will independently screen titles, abstracts and full-text articles; and complete data extraction. For each study, we will extract data on the modality characteristics, primary outcomes (response rate and equivalence) and secondary outcomes (time, costs and acceptability to patients and providers). We will synthesise findings thematically without meta-analysis.

Ethics and dissemination: Ethical approval is not required, as our review will include published and publicly accessible data. This review is part of a project to improve equitable access to eye care services in low-ioncome and middle-income countries. However, the findings will be useful to policy-makers and programme managers in a range of health settings and non-health settings. We will publish our findings in a peer-reviewed journal and develop an accessible summary of results for website posting and stakeholder meetings.

Prospero registration number: CRD42021251959.

Background: The rheumatoid factor (RF) test has been the main serological test for
diagnosis of rheumatoid arthritis. Reports of it’s low sensitivity and specificity led to the
introduction of anti cyclic citrullinated peptide (anti CCP) test, which was added to the
diagnostic criteria. The analytical method and cost of the anti CCP test limits its availability
in resource constrained environments.
Objective: To determine the analytical performance characteristics of anti CCP in patients
with rheumatoid arthritis (RA) and undiffentiated arthritis (UA), and compare with those of RF.
Design: Cross-sectional study.
Methodology: The study subjects comprised 64 RA and 31 UA patients. Serum anti CCP
was measured using an automated immunoassay and 3rd generation anti-CCP test. RF was
determined using a qualitative particle agglutination method. Manufacturer cut-offs were
used for interpretation of results. Sensitivity, specificity, negative and positive predictive
values were calculated and compared, for anti-CCP and RF tests.
Results: Anti CCP showed a higher sensitivity than RF (62.5% versus 50%). Specificity
was however higher with RF (90.3%) than anti-CCP (83.9%). RF also had a slightly higher
positive predictive value (91.4%) than anti-CCP (88.9%). Combining RF and anti-CCP tests
led to a slightly higher sensitivity and negative predictive values than those obtained with
RF alone but not specificity or positive predictive values.
Conclusion: Although the anti CCP test has shown better sensitivity than RF in RA, there
was slightly higher specificity and positive predictive value with RF compared with anti-
CCP. The findings show that the latex RF test is an effective test for initial evaluation of
patients with arthritis.

The paper shows that in the analysis of a queuing system with fixed-size batch arrivals, there emerges a set of polynomials which are a generalization of Chebyshev polynomialsof the second kind. The paper uses these polynomials in assessing the transient behaviour of the overflow (equivalently call blocking) probability in the system. A key figure to noteis the proportion of the overflow (or blocking) probability resident in the transient component,which is shown in the results to be more significant at the beginning of the transient and naturally decays to zero in the limit of large t. The results also show that the significanceof transients is more pronounced in cases of lighter loads, but lasts longer for heavier loads.

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Fusarium wilt caused by Fusarium udum Butler, is an economically important disease of pigeonpea (Cajanus cajan (L.) Mill). Information on the mechanisms of resistance to this disease in pigeonpea is limited. To study the role of vascular occlusion in wilt resistance, isolates of F.udum were inoculated onto resistant and susceptible varieties of pigeonpea and observed under light and transmission electron microscopes. The presence of F. udum in wilt susceptible plants was characterized by mycelia and conidia in the xylem vessels, plugging in some vessels, disintegration of xylem parenchyma cells in the infected areas, and the formation of cavities due to heavy colonization in the pith cortex vascular bundle. Resistance to F. udum in the roots and stems of wilt resistant plants was associated with low fungal colonization and high occlusion due to tyloses and gels in the xylem vessels. There were significant differences (P = 0:05) in the number of xylem vessels occluded by tyloses in resistant and susceptible plants with a maximum of 22.5% and 8.0% occlusion, respectively. It is probable that tyloses and gels formed as a result of F. udum interaction in wilt resistant plants are part of a resistance mechanism. Key words: Fusarium wilt,cajanus cajan, resistance, tylose, vascular occlusion

Presents results of a trial carried out in Kilifi District, Coast Province in Kenya to evaluate genetic and environmental factors affecting birth weight, preweaning average daily gain, weaning weight (at 5 months) and preweaning survival for 8 genotypes of crossbred and straightbred of Ayrshire, Friesian and Sahiwal calves.

A method is presented for obtaining the error probability for block codes. The method is based on the eigenvalue-eigenvector properties of the code correlation matrix. It is found that under a unary transformation and for an additive white Gaussian noise environment, the performance evaluation of a block code becomes a one-dimensional problem in which only one eigenvalue and its corresponding eigenvector are needed in the computation. The obtained error rate results show remarkable agreement between simulations and analysis.

Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy (ART), approximately 50% die before 2 years. Methods We evaluated sensitivity and specificity of clinical algorithms for diagnosis of HIV-1 infection and ART initiation among HIV-1-exposed children aged less than 18 months. Children were identified with routine HIV-1 testing and assessed using 3 sets of criteria: 1) Integrated Management of Childhood Illnesses (IMCI), 2) World Health Organization Presumptive Diagnosis (WHO-PD) for HIV-1 infection, and 3) CD4 T-lymphocyte cell subsets. HIV-1 infection status was determined using DNA PCR testing. Findings A total of 1,418 children (median age 5.4 months) were screened for HIV-1 antibodies, of whom 144 (10.2%) were seropositive. Of these, 134 (93%) underwent HIV-1 DNA testing and 80 (60%) were found to be HIV-1-infected. Compared to HIV-1 DNA testing, sensitivity and specificity of the IMCI were 19% and 96% and for WHO-PD criteria 43% and 88%, respectively. Inclusion of severe immune deficiency determined by CD4 percent improved sensitivity of IMCI and WHO-PD to 74% and 84% respectively, however, specificity declined to 43% and 41%, respectively. Interpretation Diagnosis of HIV-1 infection among exposed children less than 18 months in a high prevalence, resource-limited setting remains a challenge and current recommended algorithms have low sensitivity. This underscores the need for rapid scale-up of viral assays for early infant diagnosis.

Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy (ART), approximately 50% die before 2 years. Methods We evaluated sensitivity and specificity of clinical algorithms for diagnosis of HIV-1 infection and ART initiation among HIV-1-exposed children aged less than 18 months. Children were identified with routine HIV-1 testing and assessed using 3 sets of criteria: 1) Integrated Management of Childhood Illnesses (IMCI), 2) World Health Organization Presumptive Diagnosis (WHO-PD) for HIV-1 infection, and 3) CD4 T-lymphocyte cell subsets. HIV-1 infection status was determined using DNA PCR testing. Findings A total of 1,418 children (median age 5.4 months) were screened for HIV-1 antibodies, of whom 144 (10.2%) were seropositive. Of these, 134 (93%) underwent HIV-1 DNA testing and 80 (60%) were found to be HIV-1-infected. Compared to HIV-1 DNA testing, sensitivity and specificity of the IMCI were 19% and 96% and for WHO-PD criteria 43% and 88%, respectively. Inclusion of severe immune deficiency determined by CD4 percent improved sensitivity of IMCI and WHO-PD to 74% and 84% respectively, however, specificity declined to 43% and 41%, respectively. Interpretation Diagnosis of HIV-1 infection among exposed children less than 18 months in a high prevalence, resource-limited setting remains a challenge and current recommended algorithms have low sensitivity. This underscores the need for rapid scale-up of viral assays for early infant diagnosis.

Abstract
BACKGROUND:
Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy, approximately 50% die before 2 years.
METHODS:
We evaluated sensitivity and specificity of clinical algorithms for diagnosis of HIV-1 infection and antiretroviral therapy initiation among HIV-1-exposed children aged less than 18 months. Children were identified with routine HIV-1 testing and assessed using 3 sets of criteria: (1) Integrated Management of Childhood Illnesses (IMCI), (2) World Health Organization Presumptive Diagnosis (WHO-PD) for HIV-1 infection, and (3) CD4 T-lymphocyte cell subsets. HIV-1 infection status was determined using DNA polymerase chain reaction testing.
FINDINGS:
A total of 1418 children (median age 5.4 months) were screened for HIV-1 antibodies, of whom 144 (10.2%) were seropositive. Of these, 134 (93%) underwent HIV-1 DNA testing and 80 (60%) were found to be HIV-1 infected. Compared with HIV-1 DNA testing, sensitivity and specificity of the IMCI criteria were 19% and 96% and for WHO-PD criteria 43% and 88%, respectively. Inclusion of severe immune deficiency determined by CD4% improved sensitivity of IMCI and WHO-PD criteria to 74% and 84%, respectively; however, specificity declined to 43% and 41%, respectively.
INTERPRETATION:
Diagnosis of HIV-1 infection among exposed children less than 18 months in a high-prevalence resource-limited setting remains a challenge, and current recommended algorithms have low sensitivity. This underscores the need for rapid scale-up of viral assays for early infant diagnosis.

Filtration accounts for a substantial portion of water treatment cost. The dual media filter, by operating at a higher filtration rate than the conventional rapid sand filter, can reduce the cost of filtration considerably. However, use of the dual media filter in Kenya is limited by lack of suitable material for use as coarse media. In this study, pilot plant filtration tests have been carried out to investigate the performance of crushed coconut shell as coarse media in dual media filters. Filtration rate, size of crushed coconut shell, relative depth of media and backwash requirements have been investigated. A dual media filter with equal depths of 1.20 rom effective size crushed coconut shell and 0.42 romeffective size sand was found to give the best performance. The filter was found to operate at 2.4 times the filtration rate of the conventional rapid sand filter while maintaining the same effluent quality and length. of filter runs as the rapid sand filter. The filter also required a smaller percentage of filtered water for backwashing than the rapid sand filter. Durability tests on crushed coconut shell media have indicated that the media would be durable against microbiological degradation while in service. Scrapping off the less compact surface layer of the shell was found to improve the durability of the media

This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

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Nanocrystalline porous titanium oxide films of varying thickness have been deposited in ambient by reactive DC magnetron sputtering at a fixed but high oblique angle of 60o, and then converted to TiO2 by thermal annealing at 450 oC for 4 hours. X-ray diffraction analysis of the films showed that they were predominantly of anatase phase, whereas the as deposited films were amorphous. Top–down scanning electron microscope images of the annealed films showed cauliflower-like surfaces, and exhibited well-defined columns. Atomic force microscope images revealed rough surfaces with larger nodules for thicker films. With the annealed films as the working electrodes in a dye-sensitised solar cell, it was established that the photoelectric conversion efficiency increased with the film thickness. The highest efficiency was ~ 3.3 % at an illumination intensity of 100 W/m2.

Nanocrystalline porous titanium oxide films of varying thickness have been deposited in ambient by reactive
DC magnetron sputtering at a fixed but high oblique angle of 60o, and then converted to TiO2 by thermal
annealing at 450 oC for 4 hours. X-ray diffraction analysis of the films showed that they were predominantly of
anatase phase, whereas the as deposited films were amorphous. Top–down scanning electron microscope
images of the annealed films showed cauliflower-like surfaces, and exhibited well-defined columns. Atomic
force microscope images revealed rough surfaces with larger nodules for thicker films. With the annealed films
as the working electrodes in a dye-sensitised solar cell, it was established that the photoelectric conversion
efficiency increased with the film thickness. The highest efficiency was ~ 3.3 % at an illumination intensity of
100 W/m2.

Implementation of WHO case management guidelines for serious common childhood illnesses remains a challenge in hospitals in low-income countries. The impact of locally adapted clinical practice guidelines (CPGs) on the quality-of-care of patients in tertiary hospitals has rarely been evaluated.

vailability of HAART has improved the outcome of HIV-associated neurocognitive disorders (HAND) though the prevalence is still high. Routine screening for HAND may offer room for early detection and prompt management that may improve overall outcome.

Objective

To compare the performance of International HIV dementia scale (IHDS) and Mini Mental Status Examination (MMSE) Scale in assessing HIV-associated neurocognitive disorders.

Methods

This was a case- control study involving 351 HIV-cases and 150 HIV-negative controls. International HIV dementia scale and Mini Mental Status Examination scale were used to screen for neurocognitive deficits.

Results

For cases, 91(25.9%) were males and 260(74.1%) were females while for 150 controls, 38(25.3%) were males and 112 (74.7%) were females. Under IHDS score 240(68.4%) of cases had HAND compared to 10(2.8%) when MMSE was used. The mean scores under MMSE for cases was 29±1.7 compared to 29.3± 1.2 for controls (p = 1.00). The mean IHDS scores for cases was 9.35 ± 1.89 compared to 10.35±0.89 (p < 0.0001) for controls.

Conclusion

Our findings suggests that IHDS has better sensitivity in detecting cases of HAND and perform better in identifying HIV/AIDS cases that requires further cognitive evaluation on comprehensive neuropsychological batteries.

Hollow fiber membrane is the latest and advanced gas separation technology currently employed in the gas industries. Malaysia which is rich in natural resources has huge natural gas reserves amounting to more than 5 Trillion Standard Cubic Feed (5 TSCF). Membrane Research Unit has produced a hollow-fiber module by using locally made spinneret which is capable of producing hollow fiber membranes using a wet-spinning method. This module contains hollow fiber membranes with surface area of 72.22cm2. The module is utilised in the existing membrane gas separation pilot plant (MGSPP) for performance test. The performance of third module was based on its permeation rate and selectivity for each pure gases tested namely N2, CO2 and O2. Based on the result obtained the module has the capability to separate CO2 from natural gas, helium recovery in Enhanced Oil Recovery (EOR), nitrogen and oxygen recovery in the production of urea.

This article deals with multistage group screening in which group-factors contain the same number of factors. A usual assumption of this procedure is that the directions of possible effects are known. In practice, however, this assumption i s often unreasonable. This paper examines, in the case of no errors in observations, the performance of multistage group screening when this assumption is false . This enails consideration of cancellation effects within group-factors

Studies on the trypanotolerance of Orma Boran X Maasai Zebu (Orma Zebu) crossbred cattle (F1 progeny) and pure-bred Maasai Zebu contemporaries were carried out in Nguruman, south western Kenya. The two groups were monitored from birth for a period of 2 years. The incidence of trypanosomosis, parasitaemia, packed cell volume (PCV), body mass and average daily mass gain were monitored. During the study period, overall trypanosomosis incidence was low (3%).The crossbred cattle had a higher incidence of infection (61% vs 39%). The mean PCV and the mean mass gain for the crossbred cattle was higher than that of the Maasai Zebu. The mean calf body mass at weaning (8 months) for the Orma Zebu and Maasai Zebu was 72 kg and 64 kg, respectively, while at 18 months of age their mean body mass was 164 kg and 123 kg, respectively. During the rainy season significant differences in average daily mass gains were noted (p<0.05). The superior mass gain of the Orma Zebu observed during the rainy season, despite higher infection rates, indicate an enhanced trypanotolerance. Moreover, the better performance of the Orma Zebu is an attribute that could be exploited in the adoption of the trypanotolerance genotype, as a sustainable trypanosomosis control strategy.   Keywords: Cattle, productivity, Maasai Zebu, Orma Boran, Orma Zebu, trypanotolerance

Performances of serological parallel and serial testing algorithms were analyzed using a combination of three ELISA and three rapid tests for the confirmation of HIV infection. Each was assessed individually for their sensitivity and specificity on a blinded panel of 769 retrospective sera of known HIV status. Western blot was used as a confirmatory assay for discordant results. Subsequently, one parallel and one serial testing algorithm were assessed on a new panel of 912 HIV-positive and negative samples. Individual evaluation of the ELISAs and rapid tests indicated a sensitivity of 100% for all assays except Uni-Gold with 99.7%. The specificities ranged from 99.1% to 99.4% for rapid assays and from 97.5% to 99.1% for ELISAs. A parallel and serial testing algorithms using Enzygnost and Vironostika, and Determine followed by Uni-Gold respectively, showed 100% sensitivity and specificity. The cost for testing 912 samples was US$4.74 and US$ 1.9 per sample in parallel and serial testing respectively. Parallel or serial testing algorithm yielded a sensitivity and specificity of 100%. This alternative algorithm is reliable and reduces the occurrence of both false negatives and positives. The serial testing algorithm was more cost effective for diagnosing HIV infections in this population.

Since its introduction in the early 1970s, socially responsible investment (SRI) has gained prominence as both a rival and a complement to conventional investment. SRI is the philosophy and practice of making strategic investment decisions by integrating financial and non-financial considerations, including personal values, societal demands, environmental concerns and corporate governance issues. One of the major concerns in socially responsible investing is whether there is a difference between the performance of socially screened portfolios and that of conventional funds. This study sought to determine whether applying social screens to a portfolio would affect the portfolio`s performance. Two portfolios were formulated each comprised of 20 firms. One comprised of the NSE 20-share index firms and the second comprised 20 firms that passed the negative screening criterion that was employed. The descriptive research design approach was used. The target population was all the firms listed at the NSE. The risk adjusted returns were computed using the Sharpe index. Monthly and annual returns were calculated for years 2007 - 2011. F and T-tests were used to determine whether there was significant difference between the risk adjusted returns of the two portfolios. The NSE-20 portfolio had a higher average Sharpe ratio than the social screened portfolio hence it outperformed the socially screened portfolio when compared in terms of risk adjusted returns. The study concludes that social screening results in reduced portfolio performance.

To compare the performance of the Focus HerpeSelect-2 enzyme immunoassay (EIA) with the gold standard herpes simplex virus (HSV) type 2 western blot, among HIV-1-uninfected men and women in east and southern Africa.

Abstract
OBJECTIVES:
Early infant HIV-1 diagnosis and treatment substantially improve survival. Where virologic HIV-1 testing is unavailable, integrated management of childhood illness (IMCI) clinical algorithms may be used for infant HIV-1 screening. We evaluated the performance of the 2008 WHO IMCI HIV algorithm in a cohort of HIV-exposed Kenyan infants.
METHODS:
From 1999 to 2003, 444 infants had monthly clinical assessments and quarterly virologic HIV-1 testing. Using archived clinical data, IMCI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using virologic testing as a gold standard. Linear regression and survival analyses were used to determine the effect of age on IMCI performance and timing of diagnosis.
RESULTS:
Overall IMCI sensitivity, specificity, PPV, and NPV value were 58, 87, 52, and 90%, respectively. Sensitivity (1.4%) and PPV (14%) were lowest at 1 month of age, when 81% of HIV infections already had occurred. Sensitivity increased with age (P < 0.0001), but remained low throughout infancy (range 1.4-35%). Specificity (range 97-100%) was high at each time point and was not associated with age. Fifty-eight percent of HIV-1-infected infants (50 of 86) were eventually diagnosed by IMCI, and use of IMCI was estimated to delay diagnosis in HIV-infected infants by a median of 5.9 months (P < 0.0001).
CONCLUSION:
IMCI had low sensitivity during the first month of life, when the majority of HIV-1 infections had already occurred and initiation of treatment is most critical. Although sensitivity increased with age, the substantial delay in HIV-1 diagnosis using IMCI limits its utility in early infant HIV-1 diagnosis.

Early infant HIV-1 diagnosis and treatment substantially improve survival. Where virologic HIV-1 testing is unavailable, integrated management of childhood illness (IMCI) clinical algorithms may be used for infant HIV-1 screening. We evaluated the performance of the 2008 WHO IMCI HIV algorithm in a cohort of HIV-exposed Kenyan infants.

Maize Streak virus (MSV) disease is a major disease in many parts of Africa, and is the most important viral pathogen of maize in Kenya. A study was conducted in 2004 to evaluate the agronomic performance and maize streak virus (MSV) resistance of maize ( Zea mays check for this species in other resources L.) three-way crosses developed in Kenya. Twenty hybrids and one check were grown under normal conditions in a randomized complete block design, in two replications at Embu, 1540 masl; and Muguga, 2093 masl). In a parallel trial in Muguga, hybrids were also evaluated in two replications under artificial inoculation with MSV. The analyses of variance combined across environments showed significant differences (P<0.05) among genotypes for grain yield, days to 50% pollen shed, days to mid-silk and ear height. Genotype x environment interaction was significant (P<0.01) for grain yield and days to mid-silk, indicating some hybrids were more adapted in some environments. Grain yield for MU03-025 (10.04 t ha-1) was significantly better (P<0.05) than the check, H513 (7.53t ha-1). In the disease inoculated experiment, the best hybrids for disease resistance were MU03-012 and MU03-006 (score of 1.75), while H513 had a mean score of >3.0. The highest yielding hybrid under disease inoculation, MU03-026 showed yield gain of 5.2 t ha-1 above that of H513. The results indicate adoption of disease resistant hybrids would result in a higher maize yields in the mid-altitude areas of Kenya.

In this work, Titanium Dioxide (TiO2) thin films were prepared by spray pyrolysis and thermally annealed at 400℃. The films were characterized as deposited (no annealing) as well as after annealing. Optical studies showed that the energy band gap of the films was lowered from 3.25 eV to 2.90 eV on Nitrogen (N2) doping. The reduction in energy band gap was attributed to the introduction of N2 impurity states on the bands (conduction band and or valence band). The effect of N2 doping of Titanium Dioxide window layer on the efficiency of the ETA TiO2/In(OH)iSj/Pb(OH)xSy solar cell was investigated using a conventional current-voltage (I-V) technique. The photovoltaic conversion efficiency (η) increased from 1.06% for the solar cell with undoped films to 1.32% for the solar cell with N2-doped films. The increase in photovoltaic conversion efficiency on doping was attributed to increased light absorption due to the Nitrogen doping.

In this work, Titanium Dioxide (TiO2) thin films were prepared by spray pyrolysis and thermally annealed at 400 oC. The films were characterized as deposited (no annealing) as well as after annealing. Optical studies showed that the energy band gap of the films was lowered from 3.25 eV to 2.90 eV on Nitrogen (N2) doping. The reduction in energy band gap was attributed to the introduction of N2 impurity states on the bands (conduction band and or valence band). The effect of N2 doping of Titanium Dioxide window layer on the efficiency of the ETA TiO2/In(OH)iSj/Pb(OH)xSy solar cell was investigated using a conventional current-voltage (I-V) technique. The photovoltaic conversion efficiency (η) increased from 1.06% for the solar cell with undoped films to 1.32% for the solar cell with N2-doped films. The increase in photovoltaic conversion efficiency on doping was attributed to increased light absorption due to the Nitrogen doping.

The performance of weaner lambs fed for 90 days Rhodes grass hay alone (A) or supplemented with silages containing 0, 20 or 40% (B, C, D) caged layer waste (CLW) was examined. Weaver sheep on the diet of hay supplemented with 40% CLW silage had higher total DMI (P<0.01) and average daily gain (ADG) than sheep on the other treatments. Mean DMI/kg W 0.75 and ADG were 59.4, 58.7, 60.0 and 65.0 g/day and 15.0, 20.5, 17.6 and 33.2 g/day for treatments A, B, C and D, respectively. Carcass composition did not (P>0.05) differ between treatments except that kidney fat was lower (P<0.05) for sheep on the B silage diet. Dressing percentage, % lean, % fat were: 30.4, 31.4, 32.1 and 33.5, 58.0, 59.0, 58.9 and 58:5, 8.3, 7.2, 8.2 and 8.9% for treatments A, B, C and D, respectively. The study showed that CLW was a suitable protein supplement for sheep when processed by ensilage for 42 days at a level of 40% inclusion with wheat straw.

The performance of weaner lambs fed for 90 days Rhodes grass hay alone (A) or supplemented with silages containing 0, 20 or 40% (B, C, D) caged layer waste (CLW) was examined. Weaver sheep on the diet of hay supplemented with 40% CLW silage had higher total DMI (P<0.01) and average daily gain (ADG) than sheep on the other treatments. Mean DMI/kg W 0.75 and ADG were 59.4, 58.7, 60.0 and 65.0 g/day and 15.0, 20.5, 17.6 and 33.2 g/day for treatments A, B, C and D, respectively. Carcass composition did not (P>0.05) differ between treatments except that kidney fat was lower (P<0.05) for sheep on the B silage diet. Dressing percentage, % lean, % fat were: 30.4, 31.4, 32.1 and 33.5, 58.0, 59.0, 58.9 and 58:5, 8.3, 7.2, 8.2 and 8.9% for treatments A, B, C and D, respectively. The study showed that CLW was a suitable protein supplement for sheep when processed by ensilage for 42 days at a level of 40% inclusion with wheat straw.

The performance of weaner lambs fed for 90 days Rhodes grass hay alone (A) or supplemented with silages containing 0, 20 or 40% (B, C, D) caged layer waste (CLW) was examined. Weaver sheep on the diet of hay supplemented with 40% CLW silage had higher total DMI (P<0.01) and average daily gain (ADG) than sheep on the other treatments. Mean DMI/kg W 0.75 and ADG were 59.4, 58.7, 60.0 and 65.0 g/day and 15.0, 20.5, 17.6 and 33.2 g/day for treatments A, B, C and D, respectively. Carcass composition did not (P>0.05) differ between treatments except that kidney fat was lower (P<0.05) for sheep on the B silage diet. Dressing percentage, % lean, % fat were: 30.4, 31.4, 32.1 and 33.5, 58.0, 59.0, 58.9 and 58:5, 8.3, 7.2, 8.2 and 8.9% for treatments A, B, C and D, respectively. The study showed that CLW was a suitable protein supplement for sheep when processed by ensilage for 42 days at a level of 40% inclusion with wheat straw.

The performance of weaner lambs fed for 90 days Rhodes grass hay alone (A) or supplemented with silages containing 0, 20 or 40% (B, C, D) caged layer waste (CLW) was examined. Weaver sheep on the diet of hay supplemented with 40% CLW silage had higher total DMI (P<0.01) and average daily gain (ADG) than sheep on the other treatments. Mean DMI/kg W 0.75 and ADG were 59.4, 58.7, 60.0 and 65.0 g/day and 15.0, 20.5, 17.6 and 33.2 g/day for treatments A, B, C and D, respectively. Carcass composition did not (P>0.05) differ between treatments except that kidney fat was lower (P<0.05) for sheep on the B silage diet. Dressing percentage, % lean, % fat were: 30.4, 31.4, 32.1 and 33.5, 58.0, 59.0, 58.9 and 58:5, 8.3, 7.2, 8.2 and 8.9% for treatments A, B, C and D, respectively. The study showed that CLW was a suitable protein supplement for sheep when processed by ensilage for 42 days at a level of 40% inclusion with wheat straw.

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Step by step guide

No abstract available. PMID: 11957248 [PubMed - indexed for MEDLINE]

Gastrointestinal tuberculosis is rampant in Africa. Nonetheless, isolated duodenal involvement is rare, and is more likely to mimic other causes of duodenal obstruction. We report a patient who succumbed to an isolated mid duodenal tuberculosis, diagnosed at laparatomy, whose clinical presentation, endoscopy and computerised tomography scans resembled annular pancreas. The limitations of clinical evaluation, endoscopy and radiology are highlighted as the importance of diagnostic laparoscopy is emphasized.

Gastrointestinal tuberculosis is rampant in Africa. Nonetheless, isolated duodenal involvement is rare, and is more likely to mimic other causes of duodenal obstruction. We report a patient who succumbed to an isolated mid duodenal tuberculosis, diagnosed at laparatomy, whose clinical presentation, endoscopy and computerised tomography scans resembled annular pancreas. The limitations of clinical evaluation, endoscopy and radiology are highlighted as the importance of diagnostic laparoscopy is emphasized.

Periduodenal Tuberculosis masquerading as Annular Pancreas
K Ongeti, A Pulei, P Mandela, P Kimpiatu

Abstract

Gastrointestinal tuberculosis is common in Africa. Nonetheless, isolated duodenal involvement is rare, and is more likely to mimic other causes of duodenal obstruction. We report a patient who succumbed to an isolated mid duodenal tuberculosis, diagnosed at laparatomy, whose clinical presentation, endoscopy and computerised tomography scans resembled annular pancreas. The limitations of clinical evaluation, endoscopy and radiology are highlighted as the importance of diagnostic laparoscopy is emphasized.

No abstract available.

This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC).

This study is part of the Global Maternal Sepsis Study (GLOSS). It aimed to estimate neonatal near-miss (NNM) and perinatal death frequency and maternal risk factors among births to women with infection during pregnancy in low-income and middle-income countries (LMIC).

Background: Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes, especially for the second twin. In addition, the maternal complications (potentially life-threatening conditions-PLTC, maternal near miss-MNM, and maternal mortality-MM) are directly related to twin pregnancy and independently associated with adverse perinatal outcome. The objective of the preset study is to evaluate perinatal outcomes associated with twin pregnancies, stratified by severe maternal morbidity and order of birth.

Methods: Secondary analysis of the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS), a cross-sectional study implemented in 29 countries. Data from 8568 twin deliveries were compared with 308,127 singleton deliveries. The occurrence of adverse perinatal outcomes and maternal complications were assessed. Factors independently associated with adverse perinatal outcomes were reported with adjusted PR (Prevalence Ratio) and 95%CI.

Results: The occurrence of severe maternal morbidity and maternal death was significantly higher among twin compared to singleton pregnancies in all regions. Twin deliveries were associated with higher rates of preterm delivery (37.1%), Apgar scores less than 7 at 5th minute (7.8 and 10.1% respectively for first and second twins), low birth weight (53.2% for the first and 61.1% for the second twin), stillbirth (3.6% for the first and 5.7% for the second twin), early neonatal death (3.5% for the first and 5.2% for the second twin), admission to NICU (23.6% for the first and 29.3% for the second twin) and any adverse perinatal outcomes (67% for the first twin and 72.3% for the second). Outcomes were consistently worse for the second twin across all outcomes. Poisson multiple regression analysis identified several factors independently associated with an adverse perinatal outcome, including both maternal complications and twin pregnancy.

Conclusion: Twin pregnancy is significantly associated with severe maternal morbidity and with worse perinatal outcomes, especially for the second twin.

Keywords: Maternal morbidity; Perinatal outcome; Twin pregnancy.

In Kenya hepatitis B virus (HBV) infection and its sequelae are common. We followed up 49 hepatitis B surface antigen (HBsAg)- positive mothers and their newborn infants for 9 months to determine the importance of perinatal transmission in the African and to relate this to the HBe and HBV-DNA status of the mother. Our study shows that perinatal transmission is relatively unimportant in Kenya and that this may be a consequence of the low levels of circulating HBV-DNA in the maternal plasma. These results imply that vaccination without hyperimmune globulin may be adequate to control HBV infection in Kenya

Bacterial vaginosis (BV) may increase women's susceptibility to sexually transmitted infections (STIs). In a randomized trial of periodic presumptive treatment (PPT) to reduce vaginal infections, we observed a significant reduction in BV. We further assessed the intervention effect on incident Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium infection.

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To assess the periodontal health status ofHIV infected adults including the periodontal lesions associated with HIV infection. Design: Descriptive cross-sectional study of HI V patients. Setting: Kenyatta National Hospital. Subjects: HIV positive patients admitted at Kenyatta National Hospital Methods: All HIV infected adults admitted in the medical wards at KNH during the months of Aug and Sept 2005 were examined. Plaque levels were assessed and the periodontal tissues examined for gingival inflammation, probing pocket depths and recession on four sites per tooth. Examination for the presence or absence of linear gingival erythema (LGE), necrotizing ulcerative gingivitis/periodontitis (NUG/P) was included. Results: A total of 109 patients were examined. 40 (36.7%) of them were male and 69 (63.3%) female. 43 (39.4%) of the patients were between 30-39 years. 4 (3.7%) were 17-19 years while 6 (5.5%) were 50-59 years. Only 15 patients (13.8%) were on Anti-Retrovirals. All the patients had plaque however, none had abundant plaque. The mean plaque score was 1.2 and all the individuals were found to have plaque. 95.4% of the patients had early inflammatory changes of the gingival tissues with redness but no bleeding on probing. Bleeding on probing was seen in 40.3% of the patients. Linear gingival erythema was recorded in 17.4% (19) of the patients. Necrotizing ulcerative gingivitis was seen in 6 (5.5%) of the patients while necrotizing ulcerative periodontitis was also seen in 6 (5.5%) individuals. 10 (9.2% ) individuals examined did not have any periodontal breakdown since they did not exhibit any clinical loss of attachment. 21 (19.3%) hadat least one site with 4mm or more loss ofattachment and of these 10 (9.2%) had one site with 5mm or more. 89 (81.7%) had mean loss of attachment of between 0.25-2.5mm. Conclusions: This group of HIV infected individuals did not exhibit extensive periodontal destruction. The presence of periodontal lesions associated with HIV like Liner Gingival Erythema was seen in 17.4%, Necrotizing Ulcerative Gingivitis and Necrotizing Ulcerative Periodontitis were present in 5.5%. Recommendations: The management ofHIV/AlDS patients should include periodontal therapy, oral hygiene instructions and other measures to improve periodontal health. In addition, comparative studies of HIV negative and HIV positive persons are needed so as to define the effects ofHIV on periodontal health

Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital.
Design: hospital based cross-sectional study.
Setting: Kenyatta National Hospital Rheumatology outpatient clinic.
Subjects: Rheumatoid Arthritis patients.
Results: We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD, two (8.7%) had moderate PAD; none had severe PAD nor incompressible vessels. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age( ≥45 males, ≥55 females), Established RA(> 5 year duration) and severe RA were found to be significantly associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. twenty five (27.7%) of the study subjects exhibited symptoms of intermittent claudication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detection
of PAD in RA patients. Conclusion: There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impared arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients.

Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital.
Design: hospital based cross-sectional study.
Setting: Kenyatta National Hospital Rheumatology outpatient clinic.
Subjects: Rheumatoid Arthritis patients.
Results: We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD, two (8.7%) had moderate PAD; none had severe PAD nor incompressible vessels. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age( ≥45 males, ≥55 females), Established RA(> 5 year duration) and severe RA were found to be significantly associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. twenty five (27.7%) of the study subjects exhibited symptoms of intermittent claudication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detection
of PAD in RA patients. Conclusion: There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impared arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients.

Objective: To determine the magnitude of the rosclerotic arterial disease in Rheumatoid Arthritis(RA) patients at Kenyatta National Hospital.
Design: hospital based cross-sectional study.
Setting: Kenyatta National Hospital Rheumatology outpatient clinic.
Subjects: Rheumatoid Arthritis patients.
Results: We obtained ABI measurements in 90 RA patients, among them 23(25.5% 95% CI 17.2-36.1) had obstructed lower limb arteries. Among the 23, 21(91.3%) had mild PAD, two (8.7%) had moderate PAD; none had severe PAD nor incompressible vessels. The obstruction of vessels was independent of diabetes, hypertension, dyslipidemia and cigarette smoking though these factors increased the likelihood of having PAD. Risk age( ≥45 males, ≥55 females), Established RA(> 5 year duration) and severe RA were found to be significantly associated with the likelihood of having PAD. These trends remained significant after multivariable adjustment for potential confounders. twenty five (27.7%) of the study subjects exhibited symptoms of intermittent claudication, 13(52%) of them had PAD on ABI measurements, The Edinburgh claudication questionnaire was found to have 56.5% sensitivity and 82% specificity in detection
of PAD in RA patients. Conclusion: There seems to be an association between PAD in RA with chronicity and severity of the RA. This association may support the pathogenic role of accumulated systemic inflammation in atherosclerosis. Clinicians should be alert to the possibility of impared arterial function and thus subsequent cardiovascular morbidity and mortality in this group of patients.

2nd East Africa Neuroscience Conference, 18-19 June 2012, Nairobi,
Kenya
Peripheral Neuropathy among Patients with Type Diabetes mellitus attending
Kenyatta National Hospital
Stephen Kainga1
,2, Margaret Chegel, Miriam Wagoro\ Samuel Kiman!' ~
'University of Nairobi and 2Ministry of Medical Services, Government of Kenya.
Diabetes mellitus (DM) has become the epidemic of the 21st century with the
poorest nations bearing the greatest burden. DM affects both central and peripheral
nerves causing dysfunctional sensory activity with peripheral neuropathy (PN)
being the most common complication. Peripheral neuropathy has been associated
with lower limbs pain and ulceration among diabetic patients resulting to increased
morbidity, disability and reduced quality of life. Objective: We determined the
prevalence ofPN among patients with type 2 DM attending Kenyatta National
Hospital. Methods: We carried out descriptive cross-sectional study involving 147
patients with DM attending the KNH. Clinical history and physical findings were
captured using questionnaires and a focused physical examination. Data was
analyzed using SPSS software (version 17). Statistical significance was set at a cut
off value of 0.05. Results: Based on history and signs of peripheral numbness and
pain, 60 (41.1 %) participants with DM had PN. Peripheral neuropathy was
significantly associated with coexistence of DM and hypertension. Furthermore,
the duration of DM, participants' age and difficulties in healthcare financing were
significantly associated with PN. However, our study did not elicit any association
between smoking, alcohol consumption and prevalence of PN among the
participants. Conclusion: Our findings underscore the role ofDM on the
occurrence ofPN, the main cause of morbidity, disability, and reduced quality of
life among patients. Early diagnosis and adequate management of DM can
significantly reduce diabetic neuropathy and should be incorporated

Between June and December 1992 forty AIDS patients as defined by the CDC criteria, admitted to the medical wards of the Kenyatta National Hospital, were studied to determine the prevalence and pattern of peripheral neuropathy. Their mean age was 33 +/- 3 years with a range of 16 to 55 years. Clinical and laboratory assessment were carried out both to confirm peripheral neuropathy and exclude other causes of peripheral neuropathy apart from AIDS. All the patients had nerve conduction and electromyographic studies done. Eighteen patients were asymptomatic while fourteen had both signs and symptoms. The commonest symptom was painful paresthesiae of the limbs (35%) while the commonest sign was loss of vibration sense (60%). When symptoms, signs, and electrophysiological studies were combined, all the patients fitted the definition of peripheral neuropathy. The commonest type of peripheral neuropathy was distal symmetrical peripheral neuropathy (DSPN) (37.5%). PIP: In Kenya, physicians evaluated 40 AIDS patients admitted to Kenyatta National Hospital during June-December 1992 to determine the prevalence and types of peripheral neuropathy in AIDS patients. 75% were 21-40 years old. 18 (45%) of the 40 AIDS patients had symptoms of peripheral neuropathy. Symptoms included increased sensitivity to stimulation (43%), hyperpathia (15%), and muscle or limb weakness (13%). 26 AIDS patients had signs of peripheral neuropathy, especially impaired sense of vibration (60%). 14 of these patients had both signs and symptoms. Electromyographic and nerve conduction velocity revealed peripheral neuropathy in 16 (40%) AIDS patients. The types of peripheral neuropathy included distal symmetrical peripheral neuropathy (37.5%), polyneuropathy, and mononeuritis multiplex. When the symptoms, signs, and electroneurophysiological test findings were considered, all 40 AIDS patients had evidence of peripheral neuropathy.

Nyeri Provincial General Hospital, Kenya. Between June and December 1992 forty AIDS patients as defined by the CDC criteria, admitted to the medical wards of the Kenyatta National Hospital, were studied to determine the prevalence and pattern of peripheral neuropathy. Their mean age was 33 +/- 3 years with a range of 16 to 55 years. Clinical and laboratory assessment were carried out both to confirm peripheral neuropathy and exclude other causes of peripheral neuropathy apart from AIDS. All the patients had nerve conduction and electromyographic studies done. Eighteen patients were asymptomatic while fourteen had both signs and symptoms. The commonest symptom was painful paresthesiae of the limbs (35%) while the commonest sign was loss of vibration sense (60%). When symptoms, signs, and electrophysiological studies were combined, all the patients fitted the definition of peripheral neuropathy. The commonest type of peripheral neuropathy was distal symmetrical peripheral neuropathy (DSPN) (37.5%). PIP: In Kenya, physicians evaluated 40 AIDS patients admitted to Kenyatta National Hospital during June-December 1992 to determine the prevalence and types of peripheral neuropathy in AIDS patients. 75% were 21-40 years old. 18 (45%) of the 40 AIDS patients had symptoms of peripheral neuropathy. Symptoms included increased sensitivity to stimulation (43%), hyperpathia (15%), and muscle or limb weakness (13%). 26 AIDS patients had signs of peripheral neuropathy, especially impaired sense of vibration (60%). 14 of these patients had both signs and symptoms. Electromyographic and nerve conduction velocity revealed peripheral neuropathy in 16 (40%) AIDS patients. The types of peripheral neuropathy included distal symmetrical peripheral neuropathy (37.5%), polyneuropathy, and mononeuritis multiplex. When the symptoms, signs, and electroneurophysiological test findings were considered, all 40 AIDS patients had evidence of peripheral neuropathy. PMID: 8898471 [PubMed - indexed for MEDLINE]

Virology Research Division, Institute of Primate Research, Karen, Nairobi, Kenya. ipr@elci.sasa.unep.no The objective of this study was to investigate the gastro-intestinal (GIT) parasites commonly occurring in captive and wild-trapped (WT) non-human primates (baboons, vervets and Sykes) in Kenya and compare their prevalence. Three hundred and fifteen faecal samples were subjected to a battery of diagnostic tests, namely, direct smear, modified formal ether sedimentation, Kato thick smear, Harada-Mori techniques for parasite detection and culture to facilitate nematode larvae identification. Of these, 203 (64.4%) harboured helminths and 54 (17.1%) had protozoa. The helminth parasites comprised Strongyloides fulleborni 141 (44.8%), Trichuris trichuira 200 (63.5,%), Oesophagostomum sp. 48 (15.2%), Trichostrongylus sp. 73 (23.2%), Enterobius vermicularis 44 (14.0%), Schistosoma mansoni 4/92 (4.3%) and Streptopharagus sp. 68 (21.6%). Protozoan parasites consisted of Entamoeba coli 204 (64.8%), Balantidium coli 127 (40.3%) and Entamoeba histolytica 78 (24.8%). Both WT and colony-borne (CB) primates had similar species of parasites, but higher prevalences of protozoan infection were observed in CB baboons while helminth infections were relatively more common in WT primates. Some of the parasites observed in this study are reported to be zoonotic in various parasitological literatures. Chemoprophylaxis and other managerial practices were believed to be responsible for the lower worm prevalence in CB primates. Similar intervention against protozoa and other agents will not only improve primate health, but also increase safety to animal handlers and colony workers. PMID: 9760061 [PubMed - indexed for MEDLINE]

A retrospective study of 42 patients with perforations of the oesophagus during the period 1981-1987 indicated that 57.1% of the perforations were iatrogenic. Diseases of the oesophagus and in contiguous structures and foreign bodies in the oesophagus caused perforations in 31% of the cases. Perforations in 35.7% of the patients were located in the middle third of the oesophagus. The lower and upper thirds were affected in 31% of the patients in each site. The presenting physical signs included tachycardia (78.6%), fever (76.2%) and dyspnoea (59.5%). The main accompanying symptoms were chest pain and coughs in 100% and in 50% of the patients respectively. Radiographic findings showed hydropneumothorax in 40.5% of the cases and consolidation in 38.1% of the patients. Oesophagoscopy was positive in 78% of cases tested while thoracocentesis was positive in all cases that were tested.

OBJECTIVE: To assess the relationship between maternal factors and child nutritional status among children aged 6-36 months. DESIGN: Cross sectional descriptive survey. SETTING: Urban slum settlement in Nairobi, Kenya. SUBJECTS: This study included a random sample of 369 households of mothers with children aged 6-36 months at the time of the study. RESULTS: Maternal factors which showed a positive significant association with at least one of the three child nutritional status indicators (height for age, weight for age and weight for height) were birth spacing, parity, maternal education level and mothers marital status. Child spacing and parity emerged as the most important predictors of stunting among study children. Maternal nutritional status was also shown to be positively associated with child nutritional status. Maternal ill health had a negative effect on child nutritional status. CONCLUSION: Maternal factors are an underlying cause of childhood malnutrition.

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Fusarium wilt caused by Fusarium udum Butler, is an economically important disease of pigeonpea (Cajanus cajan (L.) Mill). Information on the mechanisms of resistance to this disease in pigeonpea is limited. To study the role of vascular occlusion in wilt resistance, isolates of F.udum were inoculated onto resistant and susceptible varieties of pigeonpea and observed under light and transmission electron microscopes. The presence of F. udum in wilt susceptible plants was characterized by mycelia and conidia in the xylem vessels, plugging in some vessels, disintegration of xylem parenchyma cells in the infected areas, and the formation of cavities due to heavy colonization in the pith cortex vascular bundle. Resistance to F. udum in the roots and stems of wilt resistant plants was associated with low fungal colonization and high occlusion due to tyloses and gels in the xylem vessels. There were significant differences (P = 0:05) in the number of xylem vessels occluded by tyloses in resistant and susceptible plants with a maximum of 22.5% and 8.0% occlusion, respectively. It is probable that tyloses and gels formed as a result of F. udum interaction in wilt resistant plants are part of a resistance mechanism. Key words: Fusarium wilt,cajanus cajan, resistance, tylose, vascular occlusion

Fusarium wilt caused by Fusarium udum Butler, is an economically important disease of pigeonpea (Cajanus cajan (L.) Mill). Information on the mechanisms of resistance to this disease in pigeonpea is limited. To study the role of vascular occlusion in wilt resistance, isolates of F.udum were inoculated onto resistant and susceptible varieties of pigeonpea and observed under light and transmission electron microscopes. The presence of F. udum in wilt susceptible plants was characterized by mycelia and conidia in the xylem vessels, plugging in some vessels, disintegration of xylem parenchyma cells in the infected areas, and the formation of cavities due to heavy colonization in the pith cortex vascular bundle. Resistance to F. udum in the roots and stems of wilt resistant plants was associated with low fungal colonization and high occlusion due to tyloses and gels in the xylem vessels. There were significant differences (P = 0:05) in the number of xylem vessels occluded by tyloses in resistant and susceptible plants with a maximum of 22.5% and 8.0% occlusion, respectively. It is probable that tyloses and gels formed as a result of F. udum interaction in wilt resistant plants are part of a resistance mechanism. Key words: Fusarium wilt,cajanus cajan, resistance, tylose, vascular occlusion

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Rabies Unit, Institut Pasteur, Paris, France. This paper presents a modification of the previously described Rapid Rabies Enzyme Immuno-Diagnosis test (RREID) by using biotinylated antibodies, streptavidin conjugate and a mixture of monospecific polyclonal antibodies against several lyssaviruses. In the modified technique (RREID-lyssa), microplates were sensitized with a mixture of purified antibodies against ribonucleoprotein (RNP) from Pasteur virus (Lyssavirus serotype 1), European Bat Lyssavirus (EBL, unclassified) and Mokola virus (Lyssavirus serotype 3). Bound RNP was detected by the same antibodies labelled with biotin and peroxidase-strepavidin conjugate. These techniques were used for the detection of RNP of different Lyssavirus serotypes (rabies and rabies-related viruses). For lyssavirus specimens of serotype 1, the threshold of detection of RREID and RREID-lyssa were similar. However, a smaller amount of labelled antibodies was needed when biotinylated antibodies were used. For specimens infected by rabies-related strains (serotypes 2, 3, 4 and EBL), the threshold of detection of the RREID-lyssa was between two and 512 times lower than with the RREID. The sensitivity and the specificity of the RREID-lyssa for rabies virus (serotype 1) when tested on a small field trial (53 specimens) were found to be identical to the RREID. Consequently, RREID-lyssa can be a useful tool for diagnostic laboratories that receive specimens infected by rabies-related viruses.

Unite de la Rage, Institut Pasteur, Paris, France. Cell-mediated immunity induced by rabies vaccination was studied in humans by the determination of specific interleukin-2 (IL-2) production in a large number of donors (postexposure immunized patients and pre-exposure immunized laboratory workers). Peripheral blood lymphocytes (PBL) from 35 donors were tested for IL-2 production after in vitro stimulation by different rabies and rabies-related viruses. IL-2 responses were compared to antibody recognition of these different virus serotypes by sera from the same individuals. IL-2 was produced by PBL from more than 85% of donors after stimulation with inactivated and purified rabies viruses (IPRV) prepared from either Pittman Moore (PM) or Pasteur Virus (PV) strains. IL-2 was also produced by 65 and 45% of donor PBL stimulated with IPRV from the European Bat Lyssavirus (EBL) and Mokola (Mok) rabies-related virus strains respectively. No correlation was found between the production of IL-2 by PBL and the levels of virus neutralizing antibody (VNAb). Moreover, 50, 25 and 35% of donors produced IL-2 after stimulation of their PBL with ribonucleoprotein (RNP) from PV-, EBL- and Mok-viruses, respectively. These results obtained with a large number of human rabies vaccinees and using an assay specific to T-cell activation confirm the significant cross-reactivity of T-cell responses directed against rabies and rabies-related viruses. This study shows that IL-2 production could be used for the study of cell-mediated immunity and T-cell memory induced in humans by rabies vaccination.

Measurement of tooth lengths was carried out on 537 extracted human teeth. The teeth were collected from adults aged 17 years and above and preserved in formalin. The tooth lengths were obtained by taking measurements off calibrated graph paper. The lengths obtained in this study were comparable to previous data reported in the literature. However, this new data will provide useful guidelines in Kenya for the management of endodontic patients especially in the purchase and stocking of the most appropriate endodontic instruments.

Two experimental models simulating the traditional storage conditions prevalent in Kenya, i.e. the open basket model and the modern wooden box model, were used to study the rate of dissipation and fate of malathion residues in maize grains and beans stored for periods of up to one year at ambient temperatures averaging 23°C. The grain samples were initially treated with 10·36 mg kg−1 of radiolabelled malathion dust prior to storage and portions analysed at regular intervals for malathion, malaoxon and the transformation products isomalathion, malathion α-monocarboxylic acid and malathion β-monocarboxylic acid using a combination of chromatographic, radioisotopic and mass-spectrometric techniques. The findings showed a gradual penetration of malathion into the grains in amounts which were slightly higher in maize than in beans irrespective of the method of storage. After 51 weeks of storage, 34–60% of the initial residues persisted in all the grains. The total residual levels were slightly higher in beans than in maize irrespective of the storage methods though the persistence was a little higher in the wooden box than in the open basket. The rates of dissipation of the pesticide from the grains decreased with storage time and followed a biphasic pattern. Applying first-order reaction kinetics, the following half-lives were obtained: maize grains stored in open basket: 194 days; maize grains stored in closed wooden box: 261 days; beans stored in open basket: 259 days; beans stored in closed wooden box: 405 days. Beans stored in the wooden box had higher levels of bound residues than those sampled from the open basket. This trend was similar in maize grains although the concentrations were lower. The analysis of malathion metabolites confirmed the degradation trend of the residues.

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Fusarium wilt caused by Fusarium udum Butler, is an economically important disease of pigeonpea (Cajanus cajan (L.) Mill). Information on the mechanisms of resistance to this disease in pigeonpea is limited. To study the role of vascular occlusion in wilt resistance, isolates of F.udum were inoculated onto resistant and susceptible varieties of pigeonpea and observed under light and transmission electron microscopes. The presence of F. udum in wilt susceptible plants was characterized by mycelia and conidia in the xylem vessels, plugging in some vessels, disintegration of xylem parenchyma cells in the infected areas, and the formation of cavities due to heavy colonization in the pith cortex vascular bundle. Resistance to F. udum in the roots and stems of wilt resistant plants was associated with low fungal colonization and high occlusion due to tyloses and gels in the xylem vessels. There were significant differences (P = 0:05) in the number of xylem vessels occluded by tyloses in resistant and susceptible plants with a maximum of 22.5% and 8.0% occlusion, respectively. It is probable that tyloses and gels formed as a result of F. udum interaction in wilt resistant plants are part of a resistance mechanism. Key words: Fusarium wilt,cajanus cajan, resistance, tylose, vascular occlusion

A double antibody enzyme linked immunosorbent assay for identification of thermostable muscle antigens of autoclaved meat samples is described. The assay differentiates heterologous thermostable muscle antigens from homologous at P 0.001. In model meat mixtures, the assay detects adulterants at the level of 1% at p0.001 even in phylogenetically related species such as buffalo and cattle.

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

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AMIA Annu Symp Proc. 2007 Oct 11:1018.
Personal digital assistants for HIV treatment adherence, safer sex behavior support, and provider training in resource-constrained settings.
Kurth AE, Curioso WH, Ngugi E, McClelland L, Segura P, Cabello R, Berry DL.
Source

University of Washington, Seattle, WA, USA.
Abstract

We developed a Web-based application delivered on PDAs (Colecta-PALM in Peru, Pambazuko-PALM in Kenya), to collect data from HIV patients and to facilitate HIV provider training. Colecta-PALM provides tailored feedback (behavioral messaging) based on risk assessment responses for HIV patients. Pambazuko-PALM collects patient risk assessment data, and delivers counseling protocol training and evaluation to nurses involved in HIV care.

PMID:
18694116
[PubMed - indexed for MEDLINE]

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Ever since Professor G.D. Killam of the University of Guelph edited The
Writings of East and Central Africa (1984),and the conferences that lead
to the changes in the English syllabi of Secondary Schools, nothing has
brought the writers,booksellers,librarians,literary critics,journalists,and
intellectual property lawyers of the region together more than book fairs
which take place annually in Harare, Zimbabwe, and Nairobi, Kenya.
Names like Ali A. Mazrui, Njabulo Ndebele, Ngugi wa Thiong’o, David
Rubadiri, Charles Mungoshi, Chenjerai Hove, Micere Githae Mugo,
which one sees on book covers suddenly stick into one’s mind as one
meets their owners at either the Zimbabwe or Nairobi International
Book Fairs.
During the years under review (2000–4), Jared Angira, the internationally
known Kenyan poet and chairman of the Kenya Organization
of Writers Association (KOWA) could be seen with Dr. Jack Mapanje,
the famous Malawian linguist and poet, at the international book fair
almost every day. At the meetings of the National Book Development
Council of Kenya,one met the stakeholders in the book production and
book marketing industry meeting under the aegis of the East African
Book Development Association (EABDA),a consortium comprising of
the National Book Development Councils of Kenya, Uganda, and
Tanzania. As constituent bodies,these councils and the organizers of the
book fairs in Nairobi and Harare argue that the challenges facing all the
stakeholders of the books is the fight against the monster of illiteracy. A
nation that has to operate satisfactorily in the twenty-first century has to
be a reading nation. It must celebrate the book.

Ever since Professor G.D. Killam of the University of Guelph edited The
Writings of East and Central Africa (1984),and the conferences that lead
to the changes in the English syllabi of Secondary Schools, nothing has
brought the writers,booksellers,librarians,literary critics,journalists,and
intellectual property lawyers of the region together more than book fairs
which take place annually in Harare, Zimbabwe, and Nairobi, Kenya.
Names like Ali A. Mazrui, Njabulo Ndebele, Ngugi wa Thiong’o, David
Rubadiri, Charles Mungoshi, Chenjerai Hove, Micere Githae Mugo,
which one sees on book covers suddenly stick into one’s mind as one
meets their owners at either the Zimbabwe or Nairobi International
Book Fairs.
During the years under review (2000–4), Jared Angira, the internationally
known Kenyan poet and chairman of the Kenya Organization
of Writers Association (KOWA) could be seen with Dr. Jack Mapanje,
the famous Malawian linguist and poet, at the international book fair
almost every day. At the meetings of the National Book Development
Council of Kenya,one met the stakeholders in the book production and
book marketing industry meeting under the aegis of the East African
Book Development Association (EABDA),a consortium comprising of
the National Book Development Councils of Kenya, Uganda, and
Tanzania. As constituent bodies,these councils and the organizers of the
book fairs in Nairobi and Harare argue that the challenges facing all the
stakeholders of the books is the fight against the monster of illiteracy. A
nation that has to operate satisfactorily in the twenty-first century has to
be a reading nation. It must celebrate the book.

A dozen years after the adoption of Uganda's new constitution, the democratization process has been thrown into reverse. Uganda today is sliding backward toward a system of one-man rule engineered by the recently reelected President Yoweri Museveni, who has now been in power for more than two decades. Due to Museveni's use of force and intimindation on the one hand, and his manipulation of patronage on the other, the stakeholders whom one would naturally expect to denounce the backsliding have been silent.

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.

Operations Research techniques involving modelling a situation or a problem and finding an optimal solution for it. These tools are not designed nor intended to replace managerial decision making, but rather their purpose is to aid in the decision-making process by providing a quantitative basis for decision making. Unfortunately, the proliferation of OR tools in organizational decision making has been lacking, with concerns been expressed about the limited awareness of the business community of OR's potential and capability. Current study was based in the premise that students provide an appropriate avenue, as agent of change, in sensitizing and demonstrating the potential and capacity of OR tools/techniques in resolving various problems, both in public and private sector. Study aimed at evaluating the use of OR as tools of data analysis at MBA level. A sample of 100 MBA research projects undertaken between 2005 and 2007 was randomly selected and their objectives and selected data analysis tools recorded. Where OR tools were not used, the research evaluated if there was a possibility of using OR tools. Results indicated low usage of OR as data analysis, though there was a high potential for the use of OR tools.

Perspectives and concerns of clients at primary health care facilities involved in evaluation of a national mental health training programme for primary care in Kenya.

Sexual debut for boys in Kenya occurs mostly by mid-adolescence. This study looks at the perspectives of adolescent boys aged 15–19 attending schools in rural, eastern Kenya on the dual risks of unwanted pregnancy, STDs and HIV, based on qualitative data from eight focus group discussions with 90 boys. Despite a high knowledge of sexual risks, fear of HIV and awareness of the protective value of condoms, the young men exhibit high risk behaviour. They feel the need to conform to social prescriptions of male prowess, early sexual experience, and having more than one partner, yet their feelings about this behaviour are ambiguous and contradictory. They consider getting girls pregnant and having had a treatable STD as marks of masculinity, blame girls for not protecting themselves (and girls' parents), and want to boast about their sexual conquests to their peers. Yet they feel embarrassed and reticent about discussing sexual issues with adults, and are unwilling to get condoms from places where anonymity is not assured as they know their sexual activity is not sanctioned. There is a clear need for educational programmes that confront male sexual norms, address issues of gender power relations, promote communication skills, informed choice and sexual responsibility among boys as well as girls, and provide a consistent supply of good quality condoms free or at affordable prices.