A Reasoned Action Model of Male Client
Involvement in Commercial Sex Work in Kibera,
A Large Informal Settlement in Nairobi, Kenya
Eric Abella Roth, Elizabeth Ngugi, Cecilia Benoit,
Mikael Jansson, and Helga Hallgrimsdottir
Male clients of female sex workers (FSWs) are epidemiologically important because they can form bridge groups linking high- and
low-risk subpopulations. However, because male clients are hard to locate, they are not frequently studied. Recent research emphasizes
searching for high-risk behavior groups in locales where new sexual partnerships form and the threat of HIV transmission is high. Sub-
Saharan Africa public drinking venues satisfy these criteria. Accordingly, this study developed and implemented a rapid assessment
methodology to survey men in bars throughout the large informal settlement of Kibera, Nairobi, Kenya, with the goal of delineating
cultural and economic rationales associated with male participation in commercial sex. The study sample consisted of 220 male patrons
of 110 bars located throughout Kibera’s 11 communities. Logistic regression analysis incorporating a modified Reasoned Action Model
indicated that a social norm condoning commercial sex among male peers and the cultural belief that men should practice sex before
marriage support commercial sex involvement. Conversely, lacking money to drink and/or pay for sexual services were barriers to male
commercial sex involvement. Results are interpreted in light of possible harm reduction programs focusing on FSWs’ male clients.
Key words: commercial sex work, rapid assessment methodology, Reasoned Action Model, Kenya

This study explores type identities among rural and urban slum women on antiretroviral therapies who become pregnant. Narrative structuring was chosen to develop type narratives that illustrate how rural and urban women handle their HIV-infection and how they reason and decide about PMTCT-adherence during pregnancy and childbirth. Women in rural areas described their lives as 'secure and family controlled'. This gave the women security and predictability in life, but also meant that it was difficult to keep secrets about HIV infection. For women in the urban slum area the narratives were a tale of the uncertain and hard to predict reality in the slum, but also about self-reliance and decisiveness. They portrayed themselves as 'vulnerable and striving to survive' thus managing a tough situation without long-term solutions. We conclude that pregnancy poses different social challenges in rural and urban areas affecting how women choose to manage their adherence to PMTCT, which is also affected by HIV stigma and lack of disclosure

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

Background: Highly active anti-retroviral therapy (HAART) reduces morbidity and mortality in HIV/AIDS infected patients. HAART is used indefinitely and the regimens are changed over the course of treatment due to resistance, adverse drug reactions or access to drugs. Few studies have been done in resource constrained setting to assess these factors that have a bearing on compliance and success of treatment.
Objective: To determine the number of patients who changed HAART regimen and reasons for change, their CD4+ cell counts and clinical events in the course of HAART.
Design: A prospective, observational study.
Setting: Kisumu District Hospital and Nairobi Rheumatology Clinic.
Subjects: Twenty nine of the 101 patients who were on HAART.
Main Outcome Measures: Resistance to HAART, adverse drug reactions, change of drugs (HAART) regimen or failed response to HAART regimen.
Results: One hundred and one (60 males and 41 females) patients were screened and initiated on HAART. Twenty nine (12 males and 17 females) were included in the study. The mean age was 41.7 years, mean CD4+ cell count prior HAART initiation was 140.8 cells/µl. Thirteen patients developed treatment failure on HAART and their mean CD4+ cell count at the 12th month when the drug were changed was 96.5 cells/µl. Five patients developed neuropathy, one developed lipodystrophy, one ART related
liver injury, three pancreatitis, four changed due to cost and one due to Steven Johnson syndrome. Thirteen patients had resistance to HAART and ten of the 13 had new clinical events: - cryptococcous meningitis, pulmonary tuberculosis, cytomegalovirus (CMV), herpes zoster virus (HZV), pneumocystis jiroveci pneumonia and chronic diarrhoea. Five patients had a documented high HIV-RNA viral load mean of 619,919.5 copies/ml (5.792 log units) at the time of changing HAART at 12 months. Eight of the 13 did not have HIV-RNA viral load due to high cost.
Conclusion: Reasons for Changing HAART included: cost of HAART, Poor tolerability Toxicities (neuropathy, and lipodystrophy, anti-retroviral related liver injury (ARLI), Steven Johnson Syndrome, pancreatitis) and probable failure of to HAART. CD4+ cell count was declining in the HAART resistance group. Failing response to HAART in routine clinical practice is recognised. Effort must be made to put in place resistance surveillance without HAART, CD4+ cell count, HIV viral load and clinical assessment are in patients on parameters to consider when changing treatment.

Background:
With the persistent challenges towards controlling the HIV epidemic, there is an ongoing need for research
into HIV vaccines and drugs. Sub-Saharan African countries - worst affected by the HIV pandemic - have participated in the
conduct of clinical trials for HIV vaccines. In Kenya, the Kenya AIDS Vaccine Initiative (KAVI) at the University of Nairobi has
conducted HIV vaccine clinical trials since 2001.
Methodology:
Participants were recruited after an extensive informed consent process followed by screening to determine
eligibility. Screening included an assessment of risk behavior, medical history and physical examination, and if clinically
healthy, laboratory testing. In the absence of locally derived laboratory reference ranges, the ranges used in these trials were
derived from populations in the West.
Principal findings:
Two hundred eighty-one participants were screened between 2003 and 2006 for two clinical trials. Of
these, 167 (59.4%) met the inclusion/exclusion criteria. Overall, laboratory abnormalities based on the non-indigenous
laboratory references used were the most frequent reasons (61.4%) for ineligibility. Medical abnormalities contributed 30.7%
of the total reasons for ineligibility. Based on the laboratory reference intervals now developed from East and Southern
Africa, those ineligible due to laboratory abnormalities would have been 46.3%. Of the eligible participants, 18.6% declined
enrolment.
Conclusions:
Participant recruitment for HIV vaccine clinical trials is a rigorous and time-consuming exercise. Over 61% of
the screening exclusions in clinically healthy people were due to laboratory abnormalities. It is essential that laboratory
reference ranges generated from local populations for laboratory values be used in the conduct of clinical trials to avoid
unnecessary exclusion of willing participants and to avoid over-reporting of adverse events for enrolled participants.
Trial registration:
Protocol IAVI VRC V001 [1]. ClinicalTrials.gov NCT00124007 Protocol IAVI 010 [2]
(registration with
ClincalTrials.gov is in progress)
Protocols IAVI 002 and IAVI 004 are Phase 1 trials only mentioned in introductory
paragraphs; details will not be reported. Registration was not required when they were conducted

With the persistent challenges towards controlling the HIV epidemic, there is an ongoing need for research into HIV vaccines and drugs. Sub-Saharan African countries - worst affected by the HIV pandemic - have participated in the conduct of clinical trials for HIV vaccines. In Kenya, the Kenya AIDS Vaccine Initiative (KAVI) at the University of Nairobi has conducted HIV vaccine clinical trials since 2001

With the persistent challenges towards controlling the HIV epidemic, there is an ongoing need for research into HIV vaccines and drugs. Sub-Saharan African countries - worst affected by the HIV pandemic - have participated in the conduct of clinical trials for HIV vaccines. In Kenya, the Kenya AIDS Vaccine Initiative (KAVI) at the University of Nairobi has conducted HIV vaccine clinical trials since 2001

With the persistent challenges towards controlling the HIV epidemic, there is an ongoing need for research into HIV vaccines and drugs. Sub-Saharan African countries - worst affected by the HIV pandemic - have participated in the conduct of clinical trials for HIV vaccines. In Kenya, the Kenya AIDS Vaccine Initiative (KAVI) at the University of Nairobi has conducted HIV vaccine clinical trials since 2001

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

A survey of 272 University of Nairobi undergraduate students was undertaken to assess their dental chairside experience and what reasons they gave for failing to seek dental treatment. Most respondents considered dental treatment uncomfortable and painful. The cost of treatment and fear arising from information given by other dental patients were important reasons that kept the respondents from visiting a dental clinic. This paper reveals the need for the dental profession to playa greater role in red ucing costs of treatment and odontophobia.

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Participatory research on bovine trypanosomiasis was conducted with Orma pastoralists in Tana River District, Kenya. The use of participatory methods to understand local perceptions of disease signs, disease causes, disease incidence by cattle age group, seasonal patterns of disease and preferences for indigenous and modern control methods are described. Results indicated that local characterization of diseases called gandi and buku by Orma pastoralists was similar to modern veterinary knowledge on chronic trypanosomiasis and haemorrhagic trypanosomiasis (due to Trypanosoma vivax), respectively. The mean incidence of gandi varied from 10.2% in calves to 28.6% in adult cattle. The mean incidence of buku varied from 3.1% in calves to 9.6% in adults. Pearson correlation coefficients for disease incidence by age group were 0.498 (P < 0.01) and 0.396 (P < 0.05) for gandi and buku, respectively. Informants observed cases of trypanosomiasis in 24.1% of cattle (all age groups); these cases accounted for 41.8% of all sick cattle during the preceding 12-month period. Eight indigenous and three modern trypanosomiasis control methods were identified. Results indicated that an integrated approach to trypanosomiasis control based on private, individual action was well established in the assessment area. When presented with four different trypanosomiasis control methods, community representatives selected 'better use of trypanocides' as the most preferred intervention and 'community-based tsetse control' as the least preferred intervention. This finding prompted researchers to modify the original project activities. Constraints facing the sustainability of community-based tsetse control are discussed.

Participatory research on bovine trypanosomiasis was conducted with Orma pastoralists in Tana River District, Kenya. The use of participatory methods to understand local perceptions of disease signs, disease causes, disease incidence by cattle age group, seasonal patterns of disease and preferences for indigenous and modern control methods are described. Results indicated that local characterization of diseases called gandi and buku by Orma pastoralists was similar to modern veterinary knowledge on chronic trypanosomiasis and haemorrhagic trypanosomiasis (due to Trypanosoma vivax), respectively. The mean incidence of gandi varied from 10.2% in calves to 28.6% in adult cattle. The mean incidence of buku varied from 3.1% in calves to 9.6% in adults. Pearson correlation coefficients for disease incidence by age group were 0.498 (P < 0.01) and 0.396 (P < 0.05) for gandi and buku, respectively. Informants observed cases of trypanosomiasis in 24.1% of cattle (all age groups); these cases accounted for 41.8% of all sick cattle during the preceding 12-month period. Eight indigenous and three modern trypanosomiasis control methods were identified. Results indicated that an integrated approach to trypanosomiasis control based on private, individual action was well established in the assessment area. When presented with four different trypanosomiasis control methods, community representatives selected 'better use of trypanocides' as the most preferred intervention and 'community-based tsetse control' as the least preferred intervention. This finding prompted researchers to modify the original project activities. Constraints facing the sustainability of community-based tsetse control are discussed.

Participatory research on bovine trypanosomiasis was conducted with Orma pastoralists in Tana River District, Kenya. The use of participatory methods to understand local perceptions of disease signs, disease causes, disease incidence by cattle age group, seasonal patterns of disease and preferences for indigenous and modern control methods are described. Results indicated that local characterization of diseases called gandi and buku by Orma pastoralists was similar to modern veterinary knowledge on chronic trypanosomiasis and haemorrhagic trypanosomiasis (due to Trypanosoma vivax), respectively. The mean incidence of gandi varied from 10.2% in calves to 28.6% in adult cattle. The mean incidence of buku varied from 3.1% in calves to 9.6% in adults. Pearson correlation coefficients for disease incidence by age group were 0.498 (P < 0.01) and 0.396 (P < 0.05) for gandi and buku, respectively. Informants observed cases of trypanosomiasis in 24.1% of cattle (all age groups); these cases accounted for 41.8% of all sick cattle during the preceding 12-month period. Eight indigenous and three modern trypanosomiasis control methods were identified. Results indicated that an integrated approach to trypanosomiasis control based on private, individual action was well established in the assessment area. When presented with four different trypanosomiasis control methods, community representatives selected 'better use of trypanocides' as the most preferred intervention and 'community-based tsetse control' as the least preferred intervention. This finding prompted researchers to modify the original project activities. Constraints facing the sustainability of community-based tsetse control are discussed.

OBJECTIVE: There is substantial epidemiological evidence that infection by Herpes simplex virus type 2 (HSV2) enhances both HIV susceptibility and subsequent sexual transmission. Both infections are extremely common in female sex workers (FSWs) in sub-Saharan Africa, and up to 80% of new HIV infections in urban men in the region are acquired via transactional sex. The present study aimed to elucidate the mucosal immune interactions between HIV and HSV2 in the genital tract. METHODS: Endocervical immune cell populations, cytokine/chemokine protein levels in cervico-vaginal secretions and cervical immune gene expression profiles were measured in a well-defined cohort of HIV-infected and uninfected Kenyan FSWs. Associations between the genital immune milieu and infection by and/or shedding of common genital co-pathogens were examined. RESULTS: HIV-infected FSWs were much more likely to be infected by HSV2, and to shed HSV2 DNA in the genital tract. There was also a profound negative 'mucosal synergy' between these viruses. In HIV uninfected FSWs, HSV2 infection was associated with a ten-fold increase in cervical immature dendritic cells (iDC) expressing DC-SIGN, and a three-fold increase in cervical CD4+ T cells expressing CCR5. HIV infection was associated with iDC depletion in the cervix, and with increased HSV2 genital reactivation, which in turn was associated with HIV shedding levels. CONCLUSIONS: The findings suggest a mucosal vicious circle in which HSV2 infection increases HIV target cells in the genital mucosa, subsequent HIV infection impairs HSV2 mucosal immune control, and local HSV2 reactivation enhances both HSV2 and HIV transmission.

OBJECTIVE: There is substantial epidemiological evidence that infection by Herpes simplex virus type 2 (HSV2) enhances both HIV susceptibility and subsequent sexual transmission. Both infections are extremely common in female sex workers (FSWs) in sub-Saharan Africa, and up to 80% of new HIV infections in urban men in the region are acquired via transactional sex. The present study aimed to elucidate the mucosal immune interactions between HIV and HSV2 in the genital tract. METHODS: Endocervical immune cell populations, cytokine/chemokine protein levels in cervico-vaginal secretions and cervical immune gene expression profiles were measured in a well-defined cohort of HIV-infected and uninfected Kenyan FSWs. Associations between the genital immune milieu and infection by and/or shedding of common genital co-pathogens were examined. RESULTS: HIV-infected FSWs were much more likely to be infected by HSV2, and to shed HSV2 DNA in the genital tract. There was also a profound negative 'mucosal synergy' between these viruses. In HIV uninfected FSWs, HSV2 infection was associated with a ten-fold increase in cervical immature dendritic cells (iDC) expressing DC-SIGN, and a three-fold increase in cervical CD4+ T cells expressing CCR5. HIV infection was associated with iDC depletion in the cervix, and with increased HSV2 genital reactivation, which in turn was associated with HIV shedding levels. CONCLUSIONS: The findings suggest a mucosal vicious circle in which HSV2 infection increases HIV target cells in the genital mucosa, subsequent HIV infection impairs HSV2 mucosal immune control, and local HSV2 reactivation enhances both HSV2 and HIV transmission.

Recent findings are reported about certain aspects of the structure and function of the mammalian and avian lungs that include (a) the architecture of the air capillaries (ACs) and the blood capillaries (BCs); (b) the pulmonary blood capillary circulatory dynamics; (c) the adaptive molecular, cellular, biochemical, compositional, and developmental characteristics of the surfactant system; (d) the mechanisms of the translocation of fine and ultrafine particles across the airway epithelial barrier; and (e) the particle-cell interactions in the pulmonary airways. In the lung of the Muscovy duck Cairina moschata, at least, the ACs are rotund structures that are interconnected by narrow cylindrical sections, while the BCs comprise segments that are almost as long as they are wide. In contrast to the mammalian pulmonary BCs, which are highly compliant, those of birds practically behave like rigid tubes. Diving pressure has been a very powerful directional selection force that has influenced phenotypic changes in surfactant composition and function in lungs of marine mammals. After nanosized particulates are deposited on the respiratory tract of healthy human subjects, some reach organs such as the brain with potentially serious health implications. Finally, in the mammalian lung, dendritic cells of the pulmonary airways are powerful agents in engulfing deposited particles, and in birds, macrophages and erythrocytes are ardent phagocytizing cellular agents. The morphology of the lung that allows it to perform different functions-including gas exchange, ventilation of the lung by being compliant, defense, and secretion of important pharmacological factors-is reflected in
its "compromise design."

PMID:
20687843
[PubMed - indexed for MEDLINE]

We assessed the association between recent bacterial vaginosis (BV) and incident Mycoplasma genitalium, a sexually transmitted bacterium associated with adverse female reproductive health outcomes. Female sex workers in Mombasa, Kenya completed a monthly sexual behavior interview and clinical examination. During February 2005-February 2006, vaginal fluid specimens collected from women every other month were tested for M. genitalium by nucleic acid amplification testing. Vaginal microbiota was assessed monthly and categorized by Nugent score (0-3 normal, 4-6 intermediate microbiota, 7-10 BV). A discrete time failure analysis for multiple events using logistic regression was used to estimate the odds of incident M. genitalium infection at follow-up visits in women with BV versus normal microbiota at the preceding visit. Among the 280 women, 54.3% were HIV positive. At baseline, 16.1% had prevalent M. genitalium infections and 40.4% had prevalent BV. There were 59 incident M. genitalium infections among 50 women for an incidence rate of 34.6 per 100 person-years. Following adjustment for age, HIV status, and time, prior BV was associated with a 3.5-fold increase in odds of incident M. genitalium (adjusted odds ratio = 3.49; 95% confidence interval: 1.86, 6.56). This strong association suggests that BV may enhance susceptibility to M. genitalium infection.

Protozoan infections are the leading causes of morbidity and mortality among parasitic infections of humans, accounting for approximately 800 thousand mortalities and a loss of more than 30 million disability-adjusted life years annually. The major protozoan infections of humans, namely malaria, Chagas disease, human African trypanosomiasis, and leishmaniasis, are primarily centered in the tropics, with a reach into some subtropical regions of the world. Though globally massive in their impact, these diseases mostly afflict the least economically endowed and geographically marginalized populations in low-income countries. As such, there is no sufficient market incentive for industrial business-driven antiprotozoal drug discovery due to poor marketing prospects and low returns on investment. Consequently, the pharmacopoeia for majority of these diseases, composed mainly of agents with poor efficacy and unsatisfactory safety profiles, has essentially remained unchanged for decades, creating a compelling need for more efficacious and better tolerated medicines. The policy makers and the scientific community are seeking effective ways to meet this need. So far, two approaches have emerged promising in this regard: combination chemotherapy and drug repositioning. Molecular hybridization has been cited as a potential third approach that could be used to deliver new antiprotozoal chemical entities. In this review article, recent applications of this novel strategy in antimalarial, antichagasic, antitrypanosomal, and antileishmanial drug discovery research and development over the last five years will be presented and discussed.

This is a prospective study of the recent explosive epidemic of group A meningococcal meningitis that occurred in Nairobi from April 1989 to January 1990. It was compared with previous less explosive outbreaks that occurred from 1975 to 1981. The recent epidemic was correlated to its Neisseria meningiriais carrier status among case-control samples with carrier rate in nasopharyngeal respiratory pathogens of children born of human immunodeficiency virus (HIV-1) positive and negative mothers at about the same time of the outbreak. The effect of mass vaccination on the course of the outbreak is presented on selected affected areas of Nairobi city residents who were offered the bivalent meningococcal polysaccharide vaccine against serotype A and C

This is a prospective study of the recent explosive epidemic of group A meningococcal meningitis that occurred in Nairobi from April 1989 to January 1990. It was compared with previous less explosive outbreaks that occurred from 1975 to 1981. The recent epidemic was correlated to its Neisseria meningiriais carrier status among case-control samples with carrier rate in nasopharyngeal respiratory pathogens of children born of human immunodeficiency virus (HIV-1) positive and negative mothers at about the same time of the outbreak. The effect of mass vaccination on the course of the outbreak is presented on selected affected areas of Nairobi city residents who were offered the bivalent meningococcal polysaccharide vaccine against serotype A and C

Using raingauge daily rainfall data documenting the Horn of Africa and the Long Rains over the period 1961-2012, the aim of this study is three-fold:1/ confirming the drying trend detected by Lyon et DeWitt (2012) during the Long Rains using gridded rainfall, 2/ understanding how this drying is expressed at the intraannual time scale using the sub-seasonal scenario approach developed by Moron et al. (2013) and 3/ assess its impact on vegetation. A drying is actually measured using raingauge data but is less severe than the one measured using gridded data. It is the strongest at the driest stations and during the rainfall climatological peak (April). It seems to be associated with a higher frequency of the dry subseasonal scenarios i.e. characterized by negative rainfall anomalies through the whole or the core of the seasonal cycle. But we don't observe yet a diminution of the vegetation photosynthetic activity in response to the rainfall decrease. To the contrary, the Rainfall Use Efficiency (RUE) displays a slightly positive trend.

{ OBJECTIVE: To establish a cohort of high-risk individuals suitable for HIV-prevention trials, and to measure changes in sexual behaviour and sexually transmitted disease (STD) incidence after a behavioural intervention. DESIGN: Prospective cohort study in trucking company depots in Mombasa, Kenya. PARTICIPANTS: A total of 556 male HIV-seronegative employees of trucking companies. INTERVENTIONS: HIV serological testing, individual counselling, condom promotion, STD diagnosis and management. MAIN OUTCOME MEASURES: Sexual risk behaviour and symptomatic STD incidence. RESULTS: Using time-trend modelling, significant declines in self-reported high-risk sexual behaviour were demonstrated during a 1-year follow-up. The percentage of men reporting any extramarital sex during the 3-month period prior to a follow-up visit decreased from 49% durig the first quarter of follow-up to 36% during the last quarter (P < 0.001). The decline in reported female sex worker contact was from 12% to 6% (P = 0.001). Approximately 30% of men reported consistent condom use during extramarital sex and this percentage remained unchanged during the study period. The incidence of STD declined from 34 per 100 person years (PY) during the first quarter to 10 per 100 PY during the last quarter (P = 0.001). Significant reductions in gonorrhoea (15 to five cases per 100 PY

Recycled polypropylene filaments for fused filament fabrication were investigated with and without 14 wt% short fibre carbon reinforcements. The microstructure and mechanical properties of the filaments and 3D printed specimens were characterized using scanning electron microscopy and standard tensile testing. It was observed that recycled polypropylene filaments with 14 wt% short carbon fibre reinforcement contained pores that were dispersed throughout the microstructure of the filament. A two-stage filament extrusion process was observed to improve the spatial distribution of carbon fibre reinforcement but did not reduce the pores. Recycled polypropylene filaments without reinforcement extruded at high screw speeds above 20 rpm contained a centreline cavity but no spatially distributed pores. However, this cavity is eliminated when extrusion is carried out at screw speeds below 20 rpm. For 3D printed specimens, interlayer cavities were observed larger for specimens printed from 14 wt% carbon fibre reinforced recycled polypropylene than those printed from unreinforced filaments. The values of tensile strength for the filaments were 21.82 MPa and 24.22 MPa, which reduced to 19.72 MPa and 22.70 MPa, respectively, for 3D printed samples using the filaments. Likewise, the young’s modulus of the filaments was 1208.6 MPa and 1412.7 MPa, which reduced to 961.5 MPa and 1352.3 MPa, respectively, for the 3D printed samples. The percentage elongation at failure for the recycled polypropylene filament was 9.83% but reduced to 3.84% for the samples printed with 14 wt% carbon fiber reinforced polypropylene filaments whose elongation to failure was 6.58%. The SEM observations on the fractured tensile test samples showed interlayer gaps between the printed and the adjacent raster layers. These gaps accounted for the reduction in the mechanical properties of the printed parts.

Aims: As shown in literature, several authors have adopted various individual frailty mixing distributions as a way of dealing with possible heterogeneity due to unobserved covariates in a group of insurers. This research contribution is to generalize the frailty mixing distribution to nest other classes of frailty distributions not in literature and apply the proposed distributions in valuation of life annuity business.

Methodology: A simulation study is done to assess the performance of the aforementioned models. The baseline parameters is estimated using Bayesian Inference and a better model is suggested for valuation of life annuity business.

Results: As a result of generalizing the frailty some new classes of frailty distributions are constructed such as; the Reciprocal Inverse Gaussian Frailty, the Inverse Gamma Frailty, the Harmonic Frailty and the Positive Hyperbolic Frailty.

From the simulation study, the proposed new frailty models shows that ignoring frailty leads to an underestimation of future residual lifetime since the survival curve shifts to the right when heterogeneity is accounted for. This is consistent with frailty literature.

The Reciprocal Inverse Gaussian model closely represents the Association of Kenya Insurers graduated rates with a slight increase in survival due to longevity risk.

Conclusion: The proposed new frailty models show an increase in the insurers expected liability when unobserved heterogeneity is accounted for. This is consistent with frailty literature and thus can be applied to avoid underestimating the insurer’s liability in the context of life annuity business.

The RIG model as proposed in estimating future liability by directly adjusting the AKI mortality rates shows an increase in longevity risk. The extent of heterogeneity of the insured group determines the level of risk. The RIG frailties should be considered for multivariate cases where the insureds are clustered in groups.

Reclaiming the Future: Pan Africanism, the OAU and Foreign Policy in Africa (Nairibi, USIU, 1999)

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.

To determine whether inexperienced health workers can recognize severe infection in infants less than 3 months of age, a study was conducted of 200 infants with cough, fever or 'not feeling well'. The presence or absence of five symptoms: cough, difficulty in breathing, feeding problem, fever or history of convulsions, and ten signs: appearing ill, respiratory rate > or = 60/min, chest indrawing, grunting, cyanosis, wheeze, lethargy, 'too hot', 'too cold' or abdominal distension, were recorded by a health worker, who made a diagnosis of 'ill' or 'mildly ill'. Each infant was then reviewed by an experienced paediatrician who made a diagnosis of 'ill' (pneumonia, sepsis, meningitis or other severe illness) or 'mildly ill'. Using these diagnoses as the 'gold standard', the sensitivity, specificity, and positive predictive values of each parameter were calculated. In 89% of the 200 infants, the health worker made the correct diagnosis. Forty infants were admitted. In 36 instances (90%) the health worker made the correct decision. The most discriminating symptoms and signs were 'not feeding well', 'appears ill', chest indrawing and grunting. A respiratory rate > or = 60/min was 78% sensitive and 69% specific. Our study suggests that inexperienced health workers can recognize severe illness in infants under 3 months of age.

To determine whether inexperienced health workers can recognize severe infection in infants less than 3 months of age, a study was conducted of 200 infants with cough, fever or 'not feeling well'. The presence or absence of five symptoms: cough, difficulty in breathing, feeding problem, fever or history of convulsions, and ten signs: appearing ill, respiratory rate > or = 60/min, chest indrawing, grunting, cyanosis, wheeze, lethargy, 'too hot', 'too cold' or abdominal distension, were recorded by a health worker, who made a diagnosis of 'ill' or 'mildly ill'. Each infant was then reviewed by an experienced paediatrician who made a diagnosis of 'ill' (pneumonia, sepsis, meningitis or other severe illness) or 'mildly ill'. Using these diagnoses as the 'gold standard', the sensitivity, specificity, and positive predictive values of each parameter were calculated. In 89% of the 200 infants, the health worker made the correct diagnosis. Forty infants were admitted. In 36 instances (90%) the health worker made the correct decision. The most discriminating symptoms and signs were 'not feeding well', 'appears ill', chest indrawing and grunting. A respiratory rate > or = 60/min was 78% sensitive and 69% specific. Our study suggests that inexperienced health workers can recognize severe illness in infants under 3 months of age.

Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

OBJECTIVE: To determine the prevalence of HCV infection and HCV/HIV co-infection among voluntary blood donors at the National Blood Transfusion Centre and clients at the Kenyatta National Hospital HIV-Voluntary Counseling and Testing (VCT) Centre. DESIGN: A prospective cross-sectional descriptive study. SETTING: Kenyatta National Hospital, a tertiary referral and teaching hospital and the National Blood Transfusion Services Centre, Nairobi. SUBJECTS: Volunteer blood donors and VCT attendants. RESULTS: The prevalence of HCV/HIV co-infection among 6154 blood donors in the NBTSC was very low, at 0.02. The HIV prevalence among the 353 KNH HIV-VCT clients was 9.3%, none of the clients tested positive for HCV. The incidence of risk factors in the persons with HCV and/or HIV infection(s) was low. CONCLUSION: The prevalence of HCV infection among pre-screened volunteer blood donors was low. However the current practice of screening all donated blood for HCV remains indispensable to prevent its transmission to blood recipients.

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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Paleoanthropologists have long speculated about the role of environmental change in shaping human evolution in Africa. In recent years, drill cores of late Neogene lacustrine sedimentary rocks have yielded valuable high-resolution records of climatic and ecosystem change. Eastern African Rift sediments (primarily lake beds) provide an extraordinary range of data in close proximity to important fossil hominin and archaeological sites, allowing critical study of hypotheses that connect environmental history and hominin evolution. We review recent drill-core studies spanning the Plio?Pleistocene boundary (an interval of hominin diversification, including the earliest members of our genus Homo and the oldest stone tools), and the Mid?Upper Pleistocene (spanning the origin of Homo sapiens in Africa and our early technological and dispersal history). Proposed drilling of Africa's oldest lakes promises to extend such records back to the late Miocene. ?High-resolution paleoenvironmental records are critical for understanding external drivers of human evolution. ?African lake basin drill cores play a critical role in enhancing hominin paleoenvironmental records given their continuity and proximity to key paleoanthropological sites. ?The oldest African lakes have the potential to reveal a comprehensive paleoenvironmental context for the entire late Neogene history of hominin evolution. Expected final online publication date for the Annual Review of Earth and Planetary Sciences, Volume 50 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.Paleoanthropologists have long speculated about the role of environmental change in shaping human evolution in Africa. In recent years, drill cores of late Neogene lacustrine sedimentary rocks have yielded valuable high-resolution records of climatic and ecosystem change. Eastern African Rift sediments (primarily lake beds) provide an extraordinary range of data in close proximity to important fossil hominin and archaeological sites, allowing critical study of hypotheses that connect environmental history and hominin evolution. We review recent drill-core studies spanning the Plio?Pleistocene boundary (an interval of hominin diversification, including the earliest members of our genus Homo and the oldest stone tools), and the Mid?Upper Pleistocene (spanning the origin of Homo sapiens in Africa and our early technological and dispersal history). Proposed drilling of Africa's oldest lakes promises to extend such records back to the late Miocene. ?High-resolution paleoenvironmental records are critical for understanding external drivers of human evolution. ?African lake basin drill cores play a critical role in enhancing hominin paleoenvironmental records given their continuity and proximity to key paleoanthropological sites. ?The oldest African lakes have the potential to reveal a comprehensive paleoenvironmental context for the entire late Neogene history of hominin evolution. Expected final online publication date for the Annual Review of Earth and Planetary Sciences, Volume 50 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Malaria is a major public health problem that is presently complicated by the development of resistance by Plasmodium falciparum to the mainstay drugs. Thus, new drugs with unique structures and mechanism of action are required to treat drug-resistant strains of malaria. Historically, compounds containing a novel structure from natural origin represent a major source for the discovery and development of new drugs for several diseases. This paper presents ethnophytotherapeutic remedies, ethnodiagnostic skills, and related traditional knowledge utilized by the Digo community of the Kenyan Coast to diagnose malaria as a lead to traditional bioprospecting. The current study was carried out in three Digo villages of Diani sub-location between May 2009 and December 2009. Data was collected using semi-structured interviews, and open and close-ended questionnaires. A total of 60 respondents (34 men and 26 women) provided the targeted information. The results show that the indigenous knowledge of Digo community on malaria encompasses not only the symptoms of malaria but also the factors that are responsible for causing malaria, attributes favoring the breeding of mosquitoes and practices employed to guard against mosquito bites or to protect households against malaria. This knowledge is closely in harmony with scientific approaches to the treatment and control of the disease. The Digo community uses 60 medicinal plants distributed in 52 genera and 27 families to treat malaria. The most frequently mentioned symptoms were fever, joint pains, and vomiting while the most frequently mentioned practices employed to guard against mosquito bites and/or to protect households against malaria was burning of herbal plants such as Ocimum suave and ingestion of herbal decoctions and concoctions. The Digo community has abundant ethnodiagnostic skills for malaria which forms the basis of their traditional bioprospecting techniques. Keywords: malaria, antimalarials, ethnopharmacology, ethnodiagnostic skills, Digo community, bioprospecting

We surveyed the phytoseid mites in four different geographical zones of Kenya: Zone I, upper highland and tropical alpine (2400-4400m): Zone II, lower highland (1800-2400m); zone III, midland (800-1800m); Zone IV, tropical, hot and humid( 0-800m ). A total of 107 species was found. In the sub family, amblyseeinae there were 14 species in the genus Neoseilus , one in Aspereroseius Chant, one in Paraphytoseius Swirski &Schechter, five in typhlodromips De Leon, five in Transeius Chant & McMurty, one in Graminaseius Chant &McMurty, 11 in Amblyseius Berlese, one in Arrenoseius Wanstein, two in Typhlodromalus muma, seven in Ueckemannseius Chant &McMurty, one in Ambylodromalus Chant &Mcmurty,, 20 in Euseius Wanstein, one in Iphiseius Berlese, one in Phytoseilus Evans and one in Gynaseius Ehara & Imano. In the subfamily Phytoseiinae Berlese there were four species in the genus Phytoseiius Ribaga. In the subfamily Typhlodrominae Wanstein, there were four species in the genus Kuzinellus Wainstein and 27 in Typhlodromus Scheuten

We surveyed the phytoseid mites in four different geographical zones of Kenya: Zone I, upper highland and tropical alpine (2400-4400m): Zone II, lower highland (1800-2400m); zone III, midland (800-1800m); Zone IV, tropical, hot and humid( 0-800m ). A total of 107 species was found. In the sub family, amblyseeinae there were 14 species in the genus Neoseilus , one in Aspereroseius Chant, one in Paraphytoseius Swirski &Schechter, five in typhlodromips De Leon, five in Transeius Chant & McMurty, one in Graminaseius Chant &McMurty, 11 in Amblyseius Berlese, one in Arrenoseius Wanstein, two in Typhlodromalus muma, seven in Ueckemannseius Chant &McMurty, one in Ambylodromalus Chant &Mcmurty,, 20 in Euseius Wanstein, one in Iphiseius Berlese, one in Phytoseilus Evans and one in Gynaseius Ehara & Imano. In the subfamily Phytoseiinae Berlese there were four species in the genus Phytoseiius Ribaga. In the subfamily Typhlodrominae Wanstein, there were four species in the genus Kuzinellus Wainstein and 27 in Typhlodromus Scheuten

The Educational Mission of the Church: An African Perspective

Isolation rates for Listeria monocytogenes and the other Listeria spp. typically improve when samples are enriched in more than one primary enrichment medium. This study evaluated the abilities of two primary enrichment media, University of Vermont-modified Listeria enrichment broth (UVM) and Listeria repair broth (LRB), to recover different ribotypes of Listeria spp. from raw meat and poultry samples. Forty-five paired 25-g retail samples of ground beef, pork sausage, ground turkey, and chicken (160 samples) underwent primary enrichment in UVM and LRB (30 degrees C for 24 h) followed by secondary enrichment in Fraser broth (35 degrees C for 24 and 40 h) and plating on modified Oxford agar. After 24 h of incubation of 35 degrees C, 608 Listeria colonies from selected positive samples were biochemically confirmed as L. monocytogenes (245 isolates), L innocua (276 isolates), and L. welshimeri (89 isolates) and then ribotyped with the automated Riboprinter microbial characterization system (E. I. du Pont de Nemours & Co., Inc.). Thirty-six different Listeria strains comprising 16 L. monocytogenes (including four known clinical ribotypes), 12 L. innocua, and 8 L. welshimeri ribotypes were identified from selected positive samples (15 samples of each product type; two UVM and two LRB isolates per sample). Twenty-six of 36(13 L. monocytogenes) ribotypes were detected with both UVM and LRB, whereas 3 of 36 (1 L. monocytogenes) and 7 of 36 (3 L. monocytogenes) Listeria ribotypes were observed with only UVM or LRB, respectively. Ground beef, pork sausage, ground turkey, and chicken yielded 22 (8 L. monocytogenes), 21 (12 L. monocytogenes), 20 (9 L. monocytogenes), and 19 (11 L. monocytogenes) different Listeria ribotypes, respectively, with some Listeria ribotypes confined to a particular product. More importantly, major differences in both the number and distribution of Listeria ribotypes, including previously recognized clinical and nonclinical ribotypes of L. monocytogenes, were observed when 10 UVM and 10 LRB isolates from five samples of each product were ribotyped. When a third set of six samples per product type was examined from which two Listeria isolates were obtained by using only one of the two primary enrichment media, UVM and LRB failed to detect L. monocytogenes (both clinical and nonclinical ribotypes) in two and four samples, respectively. These findings stress the importance of using more than one primary enrichment medium and picking a sufficient number of colonies per sample when attempting to isolate specific L. monocytogenes strains during investigations of food-borne listeriosis.

No abstract available.

Computers were first developed to process business transactions; the trend has been to have computers also support management in decision making. This led to the evolution of Management Information Systems (MIS). The concept of MIS can be traced from four major areas, namely, managerial accounting, management science or operations research, management theory and computer science. MIS is supported by a comprehensive set of data for business operations referred to as a database. There are several databases in any given organization. Organizations have realized that valuable information is hidden in separate databases which might sometimes contain overlapping and contradictory information, and are coming up with data warehouses. A data warehouse provides a platform for advanced, complex and efficient data analysis using On-Line Analytical Processing (OLAP) for data mining or Knowledge Data Discovery (KDD) to extract previously unknown strategic business information or business intelligence (BI). There are a lot of similarities between data warehousing and operations research (OR), they both require analytical processing to support executive decision making, yet OR, MIS and IT exist as separate communities, right from the education level to the organizations. There are many challenges facing data warehousing, with organizations viewing it as a purely IT project. The objective of the paper was to establish how some of the challenges of data warehousing could be addressed so as to reduce the failure rate of BI projects. It was concluded that data warehousing would be more successful if its development was a joint effort of both the OR & MIS community and the IT community. It is recommended that OR and MIS be taught as one discipline whose graduates will work very closely with IT specialists.

Twenty variceal banding sessions were performed in eight patients between February 1995 and September 1996. A total of 69 rings were used to band the varices and at each session between two to six rings were used. Two of the eight had active bleeding and both underwent variceal banding to successfully arrest their bleeding as inpatients. Sixteen other variceal banding sessions were performed on an outpatient basis to obliterate their varices. Four of the eight patients had had sclerotherapy before and varices were still present. No acute or long term complications were noted. In one patient, variceal banding could not be performed as he developed stridor upon placement of the overtube. All the patients had advanced varices (Grade III or IV) and extended for more than 15 cms in the oesophagus. Endoscopic variceal obliteration remains the treatment of choice for patients with portal hypertension with variceal bleeding. Variceal banding is associated with a superior outcome when compared with sclerotherapy; the variceal kill time is shorter, infective complications less, rebleeding occurs less commonly and transfusion requirements are lower.

Delayed-onset pulmonary edema complicating severe diabetic ketoacidosis was observed twice in one patient. Hemodynamic measurements during the second episode showed normal transmural pulmonary capillary wedge pressure, suggesting an alteration in alveolocapillary permeability. Hyperventilation and acidosis may underlie this alteration. Vigorous fluid therapy, while decreasing oncotic pressure, may also contribute to the pulmonary edema. The two episodes in one patient suggest that pulmonary microvascular diabetic angiopathy may predispose some diabetics with severe ketoacidosis to increased-permeability pulmonary edema.

A 33-year old female patient presented with recurrent polyneuropathy during two consecutive pregnancies and recovered completely after spontaneous abortion the first time and after a normal delivery the second time. The patient has had a tubal ligation since then and has remained well up to date.

Abstract

Mixed Poisson distributions are very significant in modeling non-homogeneous populations; for instance in Actuarial applications for modeling total claims in insurance. However, the setback is in their use since the probability mass functions are difficult to evaluate, except for a few mixing distributions. One way of dealing with this problem is to express Mixed Poisson distributions in terms of recursive relations.

In this paper, recursive relations of some mixed Poisson distributions are obtained by use of integration by parts technique.

Keywords: mixtures; recursive relation; generating functions; moments

Electrical power supply in Sub Saharan Africa (SSA) is expensive and very low, and most families have no chance of accessing clean lighting and cooking power. Off grid systems are the best viable solution in SSA and wind energy has a potential. However, the components …

The question how much of the potential soil nutrients contained in urban wastes are being used and what processes are involved led to this study in the early 2000s. The issue is of central importance to understanding the potential benefits of a properly managed urban agriculture sector, since soil fertility is a major problem in Sub- Saharan Africa and urban wastes represent a large potential source of nutrients (Savala et al. 2003). Mougeot (1993, p.114) highlighted the importance of solid waste management and offered insights into the use of organic wastes by farmers as compost for their crops. When the Consultative Group on International Agricultural Research (CGIAR) was starting up its new system-wide program – Urban Harvest – in Africa in late 2000, stakeholders called for better documentation of these processes. In response, we came together from a number of institutions in Kenya to identify and map out the basic market and material flows for composts and manure in Nairobi and identify opportunities for improving the functioning of the system. Several of us were also involved in a UN meeting at the end of 2001 on the links between waste management and urban agriculture (Kahindi et al. 2001), and the two CGIAR centres based in Nairobi both had a stake in the issue. The International Livestock Research Institute (ILRI) had done some preliminary work in 15 countries on crop–livestock system intensification in peri-urban areas (Staal 2002), and the World Agroforestry Centre (ICRAF) was interested in market chains involving urban nurseries using compost and manure. Coming as well from a local NGO and a national research organization, we formed an interdisciplinary team. Participatory methods were employed because a basic value underlying our collective approach was that research has a greater impact if the potential users of its results are engaged in the process and have a stake in the outcome.

Small and medium scale foundry enterprises occupy an important position in the economic growth and development in our societies. They are the main force behind a large number of innovations and contribute significantly to the nation’s growth through employment creation, investments and exports. Their contribution to poverty reduction and wealth creation is enormous. This study investigated the aluminium scrap recycling practices through a survey of 45 foundry enterprises in Kenya; and evaluated the effectiveness of scrap segregation, melt cleanliness and post cast processing in reducing failures of load bearing products using commonly used cylinder head scrap. Survey data was acquired through a questionnaire, onsite observations and individual interviews with the foundry men. Three alloys were developed from carefully segregated cylinder head scrap; which include BA (base alloy), BA + 0.6%Fe and BA + 0.6%Fe + 0.3%Mn. Analysis of microstructure and mechanical properties was done on as cast and T6 heat treated alloys. The foundries involved in the survey were classified into ‘‘jua kali’’(micro), small, medium and large enterprises based on capital investment, number of employees, volume of castings produced and level of technology. It was found that ‘‘jua kali’’ enterprises were majority at 44%. Their operations were limited by low capital base, low level technology and inadequate skills; forcing them to operate below 40% capacity. Further, the approaches adopted for sorting scrap were found to lead to unpredictable chemical composition and uncertainties in mechanical performance. Use of alloying additives to adjust the alloy chemistry and improve properties of load bearing castings was utilized by 10% of the enterprises. This resulted in production of low quality and unreliable castings. BA had composition similar to that of parent cylinder head alloys. A small increase of Fe by 0.2 % as an inclusion in the as cast alloy, resulted in a drop of strength and ductility by 7 and 20 % respectively. Mn mitigated the harmful effects of Fe by increasing strength and ductility by 5 and 12 % respectively. T6 heat treatment of as cast alloy improved the strength and decreased ductility by 40 and 18 % respectively. It was shown that sorting separately the aluminium scrap component by component, observation of melt cleanliness, use of additives, and post cast processing can yield good mechanical performance of the resulting alloy. International market requirements have set quality standards, which local foundries must fulfill through adoption of scrap segregation, casting and melt control procedures in order to ensure high quality products.

Bovine foscioliosis coused by F. giganticais widespread in   There is a large collection of reports of fasciolosis in Kenya based on  abattoir data records from veterinary investigation laboratories (VILS) as well as reports on a few farm study was carried out to improve on the reports. 
Diagnosis of fasciola infection has traditionally been based on detection of typical eggs in the faeces.  A variety of other techniques are now available eg enzyme-linked immunosorbent assay (ELISA), which has shown to be sensitive and useful.
Three agro-ecological zoned were defined depending on the reported prevalence; high risk, medium risk and low risk zones.  Two study districts were picked at random from each zone.  The study farms were selected using the two stage cluster sampling.
Faecal and blood samples were collected on the farm.  Serum was later harvested.  ELISA and faecal sedimatation tests (FST) were carried out.
A total of 2434 faecal and blood samples were screened.  ELISA achieved the highest (66%) positive rate of the samples from Kwale district and the lowest (23%) rate in Nakuru.  An overall positive prevalence of (43%) for fasciolosis was achieved.  The faecal sedimentation test showed prevalence of 19%.  In both tests high prevalence were observed in Kwale and Kilifi districts.  ELSA was always positive when FST was positive but not the converse.
The on-famr survey utilizing two reliable diagnostic tests was meant to improve on existing abattoir reports.  Both tests showed fair to good agreements.  The higher detection by ELISA might be due to deworming and other reasons.  It was concluded that on-farm surveys are better than retrogressive studies; thought the latter are cheaper and faster.,  the current prevalence of fasciolosis are different from past reports with coastal showing higher than expected prevalences.

Malaria infection leads to the formation of circulating immune complexes (CICs) which have been implicated in the pathogenesis of complicated malaria which includes severe malarial anemia. Children with sickle cell trait (HbAS) are less predisposed to getting severe manifestations of malaria. We carried out a study to determine the competence of the red blood cells (RBCs) of children with HbAS to bind immune complexes (ICs) and compared this with normal hemoglobin (HbAA). Methods: Children (aged 0-192 months) were enrolled in a nested case controlled study conducted in Kombewa Division, Kisumu West District, Kenya. Based on hemoglobin (Hb) type, children were stratified into those with HbAS (n=47) and HbAA (n=69). The 47 HbAS individuals were matched to 69 HbAA of similar age. The children were further categorized into three cohorts (0-12, 13-48 and 49-192 months). Immune complex binding capacity (ICBC) was quantified using a FACScan flow cytometer under normal and reduced oxygen saturation. Results: The mean immune complex binding capacity for the HbAS cells was significantly higher than that of HbAA cells (P=0.0191) under normal oxygen saturation or under reduced oxygen saturation (P=0.0050). When a matching variable (UNIANOVA) was done to control for age, gender, the presence or absence of malaria parasitaemia, the binding capacity was again significantly higher for the HbAS than for HbAA under normal oxygen saturation (P=0.025) and under reduced oxygen saturation (P=0.003). The binding capacity was lowest in the 7-12 months age group for both HbAS and HbAA; however, the overall picture showed that HbAS individuals had higher immune complex binding capacity than HbAA in all the age cohorts. Conclusion: These results demonstrate that the protection afforded by HbAS against severe manifestations of malaria may be partly due to higher immune complex binding capacity of the HbAS compared to the HbAA cells. This high binding capacity may lead to the mopping up of ICs formed during malaria attacks and therefore protect these cells from deposition and subsequent destruction.

Measurements of muscle dimensions that affect respiration in relation to body weight were carried out in a tilapia, Oreochromis niloticus. The fish used in all measurements weighed 0.65–812.3 g. The data were analysed with respect to body weight using logarithmic transformations (log Y=log a+blog W). The slopes (b) of the log/log regression lines for weight of body trunk red muscle, average cross-sectional area of muscle fibre, average number of capillaries in direct contact with a muscle fibre, average capillary contact length with a fibre as a fraction of average fibre circumference and number of capillaries mm2 of fibre cross-sectional area [NA(cƒ)] were 1.16, 0.221, 0.084, 0.015, and −0.137 respectively. These results show that there is an increase in muscle cross-sectional fibre area and number of capillaries in contact with muscle fibres whereas number of capillaries supplying a unit area of muscle fibre decreases during development. There is development of new capillaries with increase in cross-sectional area of red muscle fibres.

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Background The maintenance of satisfactory alignment in distal radial fractures following closed reduction and casting of the forearm is challenging. Redisplacement rates of between 2 and 91% have been described, mostly for Western populations and for fractures involving both the forearm bones. The local scenario is unexplored. Objective This study sought to determine the rate of redisplacement in isolated closed distal radial fractures in children aged 6-15 years and the factors contributing to the redisplacement. Setting The Kenyatta National Hospital, a teaching and referral hospital in Kenya. Patients and Methods This was a prospective study carried out between June 2005 and February2006. Patients were recruited from casualty, where the fracture was reduced and casted. Immediate check x-rays were taken to ascertain satisfactory alignment. At follow up the fractures were evaluated for redisplacement in the fracture clinic in the second and fourth weeks with further check x-rays. Redisplacement was regarded as the presence of dorsal or volar- angulation of greater than 200. The data was collected and entered into statistical package for social sciences (SPSS) 12.0 version. Comparison of the binomial outcomes of the factors determining the redisplacement of the distal radial fractures was carried out using Fischer’s exact test. P value <0.05 was taken to be significant. Results Ninety-two patients were evaluated. Overall redisplacement rate was 15.7%. Factors significantly associated with redisplacement included initial displacement, completeness of fracture and non-satisfactory initial reduction. Conclusion
The rate of redisplacement of 15.7% reported here is within the range that is considered acceptable. The success of re-manipulation at the KNH is unsatisfactory. Percutaneous K-wiring should be considered for those with complete fractures with displacement that do not achieve perfect reduction at initial check radiographic film

Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} Products of gene modification have vast implications. Creating public awareness and disseminating information on the subject seeks to demystify some of the widely held falsehoods regarding genetically modified products. This is an informative, thorough and easy to understand guidebook that aims to enlighten and debunk some of the commonly held misconceptions on products of gene modification and to give the reader a better understanding of the role genetic modification will play. The review sheds light on the safety, and application of these products in medicine, the food industry and other areas, especially those where genetic modification may represent a cheap, faster, credible, viable alternative in achieving sustainable development among resource-poor communities.

J Acquir Immune Defic Syndr. 2002 May 1;30(1):69-72.
Reduced HIV risk-taking and low HIV incidence after enrollment and risk-reduction counseling in a sexually transmitted disease prevention trial in Nairobi, Kenya.
Kaul R, Kimani J, Nagelkerke NJ, Fonck K, Keli F, MacDonald KS, Ronald AR, Plummer FA, Bwayo JJ, Ngugi EN, Temmerman M, Moses S.
Source
Department of Medical Microbiology, University of Nairobi, Kenya. rupertkaul@hotmail.com
Abstract
There is an urgent need in sub-Saharan Africa to develop more effective methods of HIV prevention, including improved strategies of sexually transmitted infection (STI) prevention or an HIV vaccine. The efficacy of these strategies may be tested through clinical trials within cohorts at high risk for STI and HIV, such as female commercial sex workers. For ethical reasons, standard HIV prevention services, including access to free condoms, risk-reduction counseling, and STI therapy, will generally be offered to all study subjects. Because study subjects would often not otherwise have access to these prevention services, it is possible that enrollment in such clinical trials will itself reduce incidence rates of STI and HIV below expected levels, reducing the power to test the efficacy of the randomized intervention. We show that the provision of standard HIV prevention services as part of a randomized STI/HIV prevention trial is temporally associated with a dramatic reduction in sexual risk-taking, and that this reduction is directly associated with reduced STI incidence. This finding should be considered in the design of clinical trials with an endpoint of HIV incidence, in particular HIV preventive vaccine trials.
PMID:
12048365
[PubMed - indexed for MEDLINE]

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Background. The host immune response against mucosally-acquired pathogens may be influenced by the mucosal immune milieu during acquisition. Since Neisseria gonorrhoeae can impair dendritic cell and T cell immune function, we hypothesized that co-infection during HIV acquisition would impair subsequent systemic T-cell responses.   Methods. Monthly screening for sexually transmitted infections (STIs) was performed in high risk, HIV seronegative Kenyan female sex workers as part of an HIV prevention trial. Early HIV-specific CD8+ T cell responses and subsequent HIV viral load set point were assayed in participants acquiring HIV, and were correlated with the presence of prior genital infections during HIV acquisition.   Results. Thirty-five participants acquired HIV during follow up, and 16/35 (46%) had a classical STI at the time of acquisition. N. gonorrhoeae co-infection was present during HIV acquisition in 6/35 (17%), and was associated with an increased breadth and magnitude of systemic HIV-specific CD8+ T-cell responses, using both interferon- (IFNg) and MIP-1 beta (MIP1b) as an output. No other genital infections were associated with differences in HIV-specific CD8+ T cell response, and neither N. gonorrhoeae nor other genital infections were associated with differences in HIV plasma viral load at set point.   Conclusion. Unexpectedly, genital N. gonorrhoeae infection during heterosexual HIV acquisition was associated with substantially enhanced HIV-specific CD8+ T-cell responses, although not with differences in HIV viral load set point. This may have implications for the development of mucosal HIV vaccines and adjuvants.

AIDS. 2008 Jan 2;22(1):131-7.
Reduced rates of HIV acquisition during unprotected sex by Kenyan female sex workers predating population declines in HIV prevalence.
Kimani J, Kaul R, Nagelkerke NJ, Luo M, MacDonald KS, Ngugi E, Fowke KR, Ball BT, Kariri A, Ndinya-Achola J, Plummer FA.
Source

Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
Abstract
OBJECTIVES:

Female sex workers (FSWs) form a core group at high risk of both sexual HIV acquisition and secondary transmission. The magnitude of these risks may vary by sexual risk taking, partner HIV prevalence, host immune factors and genital co-infections. We examined temporal trends in HIV prevalence and per-act incidence, adjusted for behavioral and other variables, in FSWs from Nairobi, Kenya.
METHODS:

An open cohort of FSWs followed since 1985. Behavioral and clinical data were collected six monthly from 1985 to 2005, and sexually transmitted infection (STI) diagnostics and HIV serology performed. A Cox proportional hazards model with time-dependent covariables was used to estimate infection risk as a function of calendar time.
RESULTS:

HIV prevalence in new FSW enrollees peaked at 81% in 1986, and was consistently below 50% after 1997. Initially uninfected FSWs remained at high risk of acquiring HIV throughout the study period, but the rate of HIV acquisition during unprotected sex with a casual client declined by over four-fold. This reduction correlated closely with decreases in gonorrhea prevalence, and predated reductions in the Kenyan HIV population prevalence by over a decade.
CONCLUSIONS:

The per-act rate of HIV acquisition in high-risk Nairobi FSWs fell dramatically between 1985 and 2005. This decline may represent the impact of improved STI prevention/therapy, immunogenetic shifts in at-risk women, or changes in the proportion of HIV exposures occurring with clients who had acute HIV infection. Declining HIV incidence in high-risk cohorts may predict and/or be causally related to future reductions in population prevalence.

PMID:
18090401
[PubMed - indexed for MEDLINE]

By device simulation, it is shown that non-square quantum well growth (well shaping) provides a means for reducing the threshold current of bipolar quantum well diode lasers. Calculations of subband structure, optical matrix elements and laser gain are performed based on a 4-band (electron, heavy-hole, light-hole, split-off-hole) Hamiltonian with Burt-Foreman Hermitianization. A non-optimized, compressively strained, InGaAs-AlGaAs (on GaAs) shaped well laser, operating at 0.97 µm is predicted to show improvements in both radiative and non-radiative current performance compared to a device based on an optimal square quantum well of the same well width and emission wavelength. These improvements result from modification of subband structure giving greater subband separation in the shaped well than in the square well

Although the global response to the HIV/AIDS epidemic in the developing world has, in general, been inadequate, there are key interventions which have been proven to be effective in reducing the incidence of HIV and relevant risky behaviors. We review and analyze these interventions according to three criteria: importance to HIV transmission, amenability to change, and cost-effectiveness.

Cells from women who are epidemiologically deemed resistant to HIV infection exhibit a 40-60% reduction in endogenous IRF-1 (interferon regulatory factor-1), an essential regulator of host antiviral immunity and the early HIV replication. This study examined the functional consequences of reducing endogenous IRF-1 on HIV-1 replication and immune response to HIV in natural HIV target cells. IRF-1 knockdown was achieved in ex vivo CD4(+) T cells and monocytes with siRNA. IRF-1 level was assessed using flow cytometry, prior to infection with HIV-Bal, HIV-IIIB, or HIV-VSV-G. Transactivation of HIV long terminal repeats was assessed by p24 secretion (ELISA) and Gag expression (reverse transcription-polymerase chain reaction (RT-PCR)). The expression of IRF-1-regulated antiviral genes was quantitated with RT-PCR. A modest 20-40% reduction in endogenous IRF-1 was achieved in >87% of ex vivo-derived peripheral CD4(+) T cells and monocytes, resulted in >90% reduction in the transactivation of the HIV-1 genes (Gag, p24) and, hence, HIV replication. Curiously, these HIV-resistant women demonstrated normal immune responses, nor an increased susceptibility to other infection. Similarly, modest IRF-1 knockdown had limited impact on the magnitude of HIV-1-elicited activation of IRF-1-regulated host immunologic genes but resulted in lessened duration of these responses. These data suggest that early expression of HIV-1 genes requires a higher IRF-1 level, compared to the host antiviral genes. Together, these provide one key mechanism underlying the natural resistance against HIV infection and further suggest that modest IRF-1 reduction could effectively limit productive HIV infection yet remain sufficient to activate a robust but transient immune response.

Due to the increased importance of DFIGs in optimization of real and reactive power losses and the maintenance of voltage profile, the general methods of DG placement and sizing in the existing literature cannot be of practical importance in DFIG .In this paper a pure PSO method used in general DG is compared with a HGAPSO in the siting and sizing of DFIG with the objective of minimizing power losses. The corresponding Combined participation factors are assigned using the DFIG Domain Distributed Slack Bus Model and a comparison made on the two schemes of loss minimization.

The prevalence of type 2 diabetes has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet. We aimed to depict the current state of type 2 diabetes worldwide in light of the undergoing epidemiologic and nutrition transition, and to posit that a key factor in the nutrition transition has been the shift in the type and processing of staple foods, from less processed traditional foods to highly refined and processed carbohydrate sources.

Seventeen cows of various breeds with varying degrees of severity of advanced ocular squamous cell carcinoma were treated by radical surgery, which included enucleation and extirpation of the surrounding ocular muscles and tissues. The degree of severity and the extent of the carcinoma lesion was correlated with the outcome of treatment for each case. It was observed that: 1. eyeball involvement, 2. ulceration and subsequent infection of carcinoma lesion involving the eyelids and 3. involvement of the regional lymphnodes especially the parotid , are some of the main factors that could be used to draw prognosis of such cases. Although the initial surgery may not be costly, the overall cost of managing postoperative complications is prohibitive and results to vast economic losses that should not be ignored.

PMID: 614126 [PubMed - indexed for MEDLINE]

Symptoms associated with heavy breasts are pain in the upper part of the body; back pains, poor body posture and headache. These patients also have difficulties in finding suitable clothes and experience poor self image and problems such as establishing sexual relationships. Reduction mammoplasty procedure provides weight and volume reduction of the breast as well as enhancement of the aesthetic appearance of the breasts. In this study, the inferior pedicle technique was used in reduction of thirty five patients over the last four years with macromastia. In all the patients except three, good results were achieved. One patient suffered nipple necrosis of the right breast and the other two had superficial wound infection of T-junction and were appropriately treated. The patient who lost the nipples had nipple reconstruction three months later.

This study was conducted to determine the effect of fermentation, solar drying and storage duration on the levels of anti-nutrients: nitrates, oxalates and phenols, in cowpea leaf vegetables. The rationale was reduction of the anti-nutrients. Reduction of nutritional stress factors in plant foods increases bioavailability of nutrients, hence improving their quality as foodstuffs. The cowpea leaves were purchased from the local markets, sorted to remove blemished leaves and foreign materials, washed in running tap water. Then, the vegetables were drained and divided into three batches of 16 kg each. One batch was heat-treated in hot water for 3 minutes and then cooled to ambient temperatures, drained and solar-dried. The second portion was acidified to a pH of 3.8, heat-treated, and solar-dried. The third portion was fermented for 21 days, heat-treated, and solar-dried. The three batches of vegetables were spread at different times on drying trays at the rate of 4 kg/m2 and dried in a solar drier to an approximate moisture content of 10%. The dried vegetables were packaged in either polyethylene bags or Kraft paper bags and stored for three months at 18oC, 22o- 26oC or 32oC. Fermentation, heat-treatment and drying of vegetables led to significant (P < 0.05) reduction in nitrates compared to fresh cowpea leaves, but the reduction in oxalates and phenols was not significant. Storage for three months led to significant (P < 0.05) reduction in nitrates in the fermented sample compared to the other samples. The acidified sample had significantly (P < 0.05) higher levels of phenols after three months of storage than the other samples. Samples stored at 18oC had higher levels of oxalates and phenols but lower levels of nitrates, compared to those stored at higher temperatures. Packaging material had no significant effect on the level of nitrates, oxalates and phenols. Data obtained in this study reveal a novel technique for the reduction of anti-nutrients in cowpea leaf vegetables, namely; fermentation followed by solar drying. The increased acceptability of these fermented-dried vegetables would help rural communities in providing better foodstuff with fewer anti-nutrients, thus alleviating micronutrient malnutrition. This novel long-term storage technology can greatly help to deal with the issue of seasonality and will increase food security, especially during the dry season.

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

A cross sectional study of 115 patients admitted at the Department of Orthopedics, Kenyatta National Hospital, Nairobi, Kenya was carried out to determine the prevalence and antibiotic susceptibility of Staphylococcus aureus isolated from infected wounds. The prevalence of Staphylococcus aureus was 33.0 %. The drugs tested and their corresponding sensitivity was amoxycillin (13.2 %), co-amoxyclav (39.5 %), oxacillin (55.3 %), erythromycin (44.7 %), gentamicin (60.5 %), ciprofloxacin (62.2 %), minocycline (86.8 %), cefuroxime (57.9 %), and clidamycin (84.2 %). These results show the sensitivity profile of Staphylococcus aureus and can be used to choose suitable drugs in the management of wounds for hospitalized patients.

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.

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.

Small-intestinal function was studied in 10 patients with visceral leishmaniasis. Vitamin-A absorption was impaired in 7 and d-xylose in 1. In 5 of the 10 patients Leishmania were demonstrated in biopsy specimens of intestinal mucosa. Parasitised macrophages were present in villous tips and less commonly in the lamina propria and submucosa; a moderate inflammatory infiltrate was composed of lymphocytes and plasma cells. 2 patients had partial villous atrophy. There was no correlation between intensity of parasitisation and severity of malabsorption. After treatment with sodium stibogluconate there was a significant improvement in absorption of vitamin A and d-xylose, and biopsy specimens became normal. In 1 patient visceral leishmaniasis was thought to be the cause of chronic diarrhoea.

At the beginning of the century, splenectomy was used in the treatment of kala-azar, but now is rarely needed, the major indication being for drug resistant kala-azar. Inadvertent splenectomy prior to the diagnosis of kala-azar continues to occur, probably because of a reluctance to perform splenic aspiration in the investigation of splenomegaly. Five Kenyan children underwent splenectomy for drug resistant kala-azar. All were immediately improved, but one died of overwhelming post splenectomy infection (OPSI) two months later and another of a malignant lymphoma seven months after surgery. The other three patients appear to be cured. Splenectomy was considered in a sixth child with kala-azar because of a Salmonella abscess in the spleen, but the abscess ruptured catastrophically before surgery could be arranged.

At the beginning of the century, splenectomy was used in the treatment of kala-azar, but now is rarely needed, the major indication being for drug resistant kala-azar. Inadvertent splenectomy prior to the diagnosis of kala-azar continues to occur, probably because of a reluctance to perform splenic aspiration in the investigation of splenomegaly. Five Kenyan children underwent splenectomy for drug resistant kala-azar. All were immediately improved, but one died of overwhelming post splenectomy infection (OPSI) two months later and another of a malignant lymphoma seven months after surgery. The other three patients appear to be cured. Splenectomy was considered in a sixth child with kala-azar because of a Salmonella abscess in the spleen, but the abscess ruptured catastrophically before surgery could be arranged.

Serum levels for sodium, potassium, calcium, inorganic phosphate, urea nitrogen and creatinine were determined in 1101 male and 181 female patients aged 50 years and above. The determinations were carried out on the SMA II (Technicon Instruments Corp. Tarrytown, NY 10591) with a view to establish the reference intervals for this age group. Quality control of the analytical methods was carried alongside with the determinations. The data collected was used to determine the reference intervals using a simple statistical method. The results indicate that sodium and calcium intervals are low with values of 131-142 mMol/L and 1.94-2.32 mMol/L respectively, in the aged Kenyan population as compared to subjects living in the temperate environment while the interval for inorganic phosphate is comparatively high with a value of 1.2-1.97 mMol/L. Reference values for urea nitrogen, potassium and creatinine were found to be similar to those quoted for caucasians.

To establish the reference ranges of some biochemical parameters for adult Kenyan population. METHODS: In a prospective involving 1100 healthy blood donors (age: 18-55 yr) in Kenyatta National Hospital, Kenya reference ranges of some biochemical analytes were constructed by using the parametric methods to estimate 2.5 and 97.5 percentiles of distribution. RESULTS: The reference ranges of the analytes were: alanine aminotransferase (ALT) [males (0-39) U/L, females (0-34) U/L]; aspartate aminotransferase (AST) [males (6-40) U/L, females (3-37) U/L]; alkaline phosphatase (ALP) [males (13-201) U/L, females (5-227) U/L]; albumin (ALB) [males (29-52) g/L, females (28-50) g/L]; protein (PROT) [males (57-89) g/L, females (56-88) g/L]; creatinine (CREAT) [males (59-127) μmol/L, females (54-122) μmol/L]; glucose (GLU) [males (2.8-6.8) mmol/L, females (2.6-7) mmol/L]; phosphorus (PHOS) [males (0.5-2.0) mmol/L, females (0.2-2.4) mmo/L]; potassium (POT) [males (3-5.3), females (3.1-5.1) mmo/L]; sodium (SOD) [males (111-153) mmol/L, females (117-151) mmol/L]; Blood urea nitrogen BUN [males (1.5-5.9) mmol/L, females (1.2-6.0) mmol/L] and Uric acid (UA) [males (120-458) μmol/L, females (89-415) μmol/L]. Age differences in the established reference ranges were observed in ALT, ALB, CREAT, ALP and UA in males and in ALT, ALB, and CREAT in females. Gender differences were observed in ALT, AST, ALB, CREAT and UA in the 18-28 yr old, ALT, AST, ALB, SOD and UA in 29-39 yr old and AST, ALB, and UA in 40-50 yr old. CONCLUSION: Age and sex specific reference ranges of some biochemical parameters were established some of which were different from those reported in literature. There therefore the need for each clinical chemistry laboratory to establish its own ranges

Orbital morphometry is an important consideration during surgical procedures such as reconstruction of the face and cranium. These are done to restore lost functional capacity or to improve cosmetic appearance. Periorbital and intraorbital neurovascular structures risk relative damage during these maneuvers. A thorough understanding of orbital anatomy is therefore essential in avoiding surgical complications. The aim of this study was to describe the average orbital distances and depths from known identifiable anatomical landmarks. One hundred and thirteen adult crania obtained from National Museum of Kenya, Nairobi were examined. Measurements of superior and inferior orbital depths and the biorbital and marginofissural distances were taken using a sliding vernier caliper and their mean measurements documented. The superior orbital depth was 53.38mm in males and 52.03mm in females. The inferior orbital depth was 55.17mm in males and 53.76mm in females. The marginofissural distance was 23.79mm and 22.30mm in males and females respectively. The biorbital breadth was 99.49mm in males and 96.43mm in females while the interorbital distance was 18.91mm in males and 18.26mm in females. This study proposes that orbital measures be given special consideration during orbital reconstruction. A depth of 53mm is recommended as a safe superior orbital depth during operations involving the deep orbit. Similarly, on the orbital floor 55mm into the orbital cavity should be considered safe from the optic nerve.
Key words: orbital measurements, facial cosmetic surgery, facial plastic surgery, orbital reconstruction, orbital anesthesia

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The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

Exhibition of best Photographers in Kenya

PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]