Oyieke H.A. and Misra A.K:

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

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

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

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

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

Oyieke H.A. and Misra A.K:

n/a

n/a

n/a

Plasmodium falciparum parasites resistant to the combination sulfadoxine-pyrimethamine are spreading in Africa, particularly in East Africa. This is a matter of concern because there are no other affordable drugs available. This article provides the evidence indicating that sulfadoxine-pyrimethamine resistance can be reversed in vitro and discusses how this information might be exploited to extend the therapeutic lifetime of sulfadoxine-pyrimethamine in vivo

Mentorship is critical to develop effective leaders. The Afya Bora Fellowship in Global Health Leadership program, a consortium of four African and four US universities formed in 2008, has incorporated a robust dual mentorship component into its training of over 70 fellows. Each Fellow was assigned two mentors to guide professional growth over the fellowship period. Here, we evaluate 39 Fellows' experiences with their mentors between 2012 and 2014, and identify how these relationships prepare Fellows to lead major health programs

The effect of corchorus olitorius derived binder on the effective thermal conductivity of a kaolinite-based
refractory was investigated. Strong dependence of (effective) thermal conductivity of fired samples on the
binder concentration, temperature and porosity was noted. Comparison of experimental data with Effective
Medium Approximation (EMA) and Geometric Mean Model (GMM) theories showed that predictions from
EMA agreed better with the experimental data than those from GMM. This was attributed to the EMA model
being more rigorous and contained more microstructural information than the simpler GMM.

The effect of corchorus olitorius derived binder on the effective thermal conductivity of a kaolinite-based refractory was investigated. Strong dependence of (effective) thermal conductivity of fired samples on the binder concentration, temperature and porosity was noted. Comparison of experimental data with Effective Medium Approximation (EMA) and Geometric Mean Model (GMM) theories showed that predictions from EMA agreed better with the experimental data than those from GMM. This was attributed to the EMA model being more rigorous and contained more microstructural information than the simpler GMM.

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

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

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

This study investigated the effectiveness of three physical-chemical methods namely; pH adjustment, precipitation with alum and the use of polyelectrolytes. In the treatment of diary wastewater from Brookeside milk processing plant. It also investigated the drainability of the sludge produced by each of the three methods. Laboratory tests were carried out in three different batches, one for each of the three methods. In the alum method enough alum was added to the wastewater samples to cause precipitation by sweep floc. In the pH adjustment method, the pH of samples were lowered to the iso-electric point of the casein proteins of approximately pH 4.5 leading to their precipitation as a result of solubility changes. The polyelectrolytes method involved the use of two polyelectrolytes, Sudfloc 3820 and Sudfloc 3860 each of which was used to coagulate the dirty wastewater. For each of the three methods, the samples were taken in one-litre beakers and subjected to Jar tests to determine the optimum dosages. After one hour of settling the supernatants were decanted and subjected to standard Chemical Oxygen Demand (COD) tests, turbidity and pH measurements. The settled sludge was subjected to drainability studies. Results showed the treatment of dairy wastewater by the three physical-chemical methods to be effective. There were COD removals of between 60% and 90% and turbidity reduction of over 90%. The use of the sudfloc polyelectrolytes was found to be the least demanding in terms of effluent quality control as no pH adjustments of either the wastewater or the effluent was required. The use of polyelectolytes produced the least volumes of sludge and also the better drainability and solids concentration. Sudfloc 3820 was found to achieve better results than Sudfloc 3860 in terms of COD reduction and the drainability of sludge produced although both achieved the same drainability studies. This study showed that each of the three physical-chemical methods can be used effectively to remove the white colour of dairy wastewater as well as the bulk of the proteins and fats, hence, enabling the discharge of the effluents into natural waters to be of good assimilative capacity.

Abstract This paper presents the results of a combined experimental and theoretical study of microstructure and thermal shock resistance of an aluminosilicate ceramic. Shock-induced crack growth is studied in sintered structures produced from powders with different particle size ranges. The underlying crack/microstructure interactions and toughening mechanisms are elucidated via scanning electron microscopy (SEM). The resulting crack-tip shielding levels (due to viscoelastic crack bridging) are estimated using fracture mechanics concepts. The implications of the work are discussed for the design of high refractory ceramics against thermal shock.

Keywords Viscoelastic crack bridging . Crack-tip shielding . Thermal shock . Refractory ceramics

PMID: 614126 [PubMed - indexed for MEDLINE]

PMID: 614126 [PubMed - indexed for MEDLINE]

PMID: 614126 [PubMed - indexed for MEDLINE]

Drying characteristics of both naturally moist and.rew.etted grain sorghum were studied. Three varieties of Kenyan grain sorghum were used. The drying air temperature and its flow rate were varied. Relative humidity of the air and the initial moisture content of the sorghum grains were determined. Moisture content of the grains was determined at various times during the thin-layer drying process. Thin layer drying equations based on Pabis and Henderson equation and Page model were developed. Drying air temperature was the major factor affecting drying rates of sorghum grains. The difference in sorghum varieties also influenced the drying rates. The relationship between parameter k in Pabis and Henderson equation (MR=exp (-kt)) and drying air temperature iuas found to be of Arrhenius type. Parameter K in Page equation (MR=exp (-KfI)), for naturally moist grains, was expressed as an exponential function of temperature terms. But for rewetted grains, it was an exponentiaI function of temperature terms, air flow rate, relative humidity and initial moisture content. Parameter N in Page equation was expressed as and exponential function of temperature temis. Page equation fitted drying data better than Pabis and Henderson equation.

n/a

Amoxycillin and clavulanic acid (Augmentin; Beecham Research Laboratories) was used to treat patients with bacteriologically proved chancroid in three different dose regimens. A single dose of Augmentin (amoxycillin 3 g, clavulanic acid 350 mg) was found to be ineffective. A similar dose repeated after 24 hours was equally ineffective, but a dose (amoxycillin 500 mg, clavulanic acid 250 mg) given every 8 hours for three days was found to be effective. The drug was well tolerated and no side effects were noted in any of the patients treated

Time course investigation of infection with a low virulent Pasteurella multocida strain in normal and immune-suppressed 12 week-old free range chickens

P. G. Mbuthiaa, L. W. Njagia, P. N. Nyagaa, L. C. Beboraa, U. Mingab, Jens Peter Christensenc & J. E. Olsenc*

Date of publication: DOI:10.1080/03079457.2011.623298; Available online: 15 Sep 2011
Avian Pathology
Abstract
Twelve week old indigenous chickens, either immune-suppressed using dexamethasone (IS) or non-immune-suppressed (NIS), were challenged with a low virulent strain, Pasteurella multocida strain NCTC 10322T and developed clinical signs and pathological lesions typical of chronic fowl cholera. NIS birds demonstrated much more severe signs of fowl cholera than IS birds. With few exceptions, signs recorded in IS and NIS birds were of the same types, but significantly milder in the IS birds, indicating that immune-suppression does not change the course of infection, but rather the severity of signs in fowl cholera.
P. multocida signals by fluorescent in situ hybridization (FISH) were observed between 1 hr and 14 days in lungs, trachea, air sacs, liver, spleen, bursa of Fabricius and caecal tonsils, while signals from other organs mostly were observed after 24 hours. More organs had FISH signals in NIS than in IS-birds and at higher frequency per organ. Many organs were positive by FISH even 14 days post infection, and it is suggested that these organs may be likely places for long term carriage of P. multocida following infection.
This study has demonstrated the spread of P. multocida in different tissues in chickens and distribution of lesions associated with chronic fowl cholera, and pointed to a decrease of pathology in immune-suppressed birds. Since dexamethasone mostly affects heterophils, the study suggests that these cells play a role in the development of lesions associated with chronic fowl cholera in chickens.

of satellite observations is that measurements are readily collected and shared across
political boundaries. In contrast, many countries refuse to share ground-based hydrologic
measurements for socioeconomic and political reasons, whereas others simply lack the
capacity to centralize and digitize what data are collected. This impedes investigations on a
continental-to-global scale, as well as efforts to avert food and water crises. Because
satellites can monitor water resources at scales relevant to effective transboundary water
management and because data are often provided through freely accessible digital
archives, policies of international data denial may ultimately become obsolete (17).
Governments around the world are now instructing their water management agencies to
plan for the uncertain hydrologic future that satellite observations have helped reveal.

Twelve-week-old indigenous chickens, either immune-suppressed using dexamethasone (IS) or non-immunesuppressed (NIS), were challenged with a low virulent strain, Pasteurella multocida strain NCTC 10322T, and developed clinical signs and pathological lesions typical of chronic fowl cholera. NIS birds demonstrated much more severe signs of fowl cholera than IS birds. With few exceptions, signs recorded in IS and NIS birds were of the same types, but significantly milder in the IS birds, indicating that immune suppression does not change the course of infection but rather the severity of signs in fowl cholera. P. multocida signals by fluorescent in situ hybridization (FISH) were observed between 1 h and 14 days in the lungs, trachea, air sacs, liver, spleen, bursa of Fabricius and caecal tonsils, while signals from other organs mostly were observed after 24 h. More organs had FISH signals in NIS birds than in IS birds and at higher frequency per organ. Many organs were positive by FISH even 14 days post infection, and it is suggested that these organs may be likely places for long-term carriage of P. multocida following infection. The present study has demonstrated the spread of P. multocida in different tissues in chickens and distribution of lesions associated with chronic fowl cholera, and pointed to a decrease of pathology in IS birds. Since dexamethasone mostly affects heterophils, the study suggests that these cells play a role in the development of lesions associated with chronic fowl cholera in chickens.

The implementation of the participatory forest management (PFM) starting 2005 was meant to help in forest management and also assist the forest adjacent communities to benefit from these forest based resources through agreement with Kenya forest Service (KFS). Analysis of socio-economic reports and associated participatory forest management plan (PFMPs) undertaken between 2005 and 2013, indicate sizeable income generating projects (IGP) as part of social function of forest such as recreation have not been realised by community forest association (CFA). It is notable that several facilitating factors such as proximity to major urban areas and significant tourism circuits, necessary for development of these sites have had no impact. In some sites development of business plan did not manage to take IGP to the desired level. This failure leaves the CFA in the same status prior to the implementation of PFM in spite of huge resources invested in mapping and detailing resources potential. The CFA stakeholder’s composition, a structural weakness that failures to include more able and literate local stakeholders (business and professionals) is a major obstacle to enabling exploitation of forest ecosystems potential, thereby remaining localised and a closed unit. Thus, there is need for paradigm shift in terms CFA empowerment for exploitation of social functions of forest resources

Home Help Thesaurus Okeyo AM Advanced Search Tools Marked records Mark this record Search History Print this record Email this record Export citation Download MARC21 Record Related literature •Other articles by these authors on Google Scholar •Search Google for related articles • Order from the British Library (Artweb-registered users) •Order from the British Library (public order form) •Find this book on Amazon •Search for this title in NRC-CISTI •Add to … Tag in Delic.io.us Tag in Connotea Document details TitleAssessing stated preferences through the use of choice experiments: valuing (re)production versus aesthetics in the breeding goals of Ugandan Ankole cattle breeders. AuthorsWurzinger, M.; Ndumu, D.; Baumung, R.; Drucker, A. G.; Okeyo, A. M.; Semambo, D. K.; Sölkner, J. Book chapter; Conference paperProceedings of the 8th World Congress on Genetics Applied to Livestock Production, Belo Horizonte, Minas Gerais, Brazil, 13-18 August, 2006 2006 pp. 31-09 Conference TitleProceedings of the 8th World Congress on Genetics Applied to Livestock Production, Belo Horizonte, Minas Gerais, Brazil, 13-18 August, 2006. ISBN85-60088-01-6 URLhttp://www.wcgalp8.org.brRecord Number20063170234 Abstract In this study 240 cattle keepers in four regions in Southwestern Uganda were interviewed and a hypothetical choice experiment was conducted. Each choice-set consisted of 2 profiles with 6 attributes with 2 levels. The attributes for cows were horns, coat colour, size, fertility, milk yield and price. The attributes for bulls were horns, colour, muscularity, temperament, dam's performance and price. Each person got 6 choice-sets for bulls and 6 for cows. Differences in the production systems were reflected in the varying selection criteria. In cows production traits were very important and in bull

n/a

Wildlife managers can only effectively manage wildlife resources for posterity using
sound scientific data. Aerial counts of large mammals are major source of these data.In
Kenya, the counts have been carried out in various ecosystems since the 1960’s
(Thoulesset al., 2008). As of 2002, Kenya Wildlife Service (KWS) began undertaking
aerial counts of elephants and other large mammals in key ecosystems (e.g., Tsavo,
Samburu-Laikipia-Marsabit, Maasai Mara, Amboseli, and Meru) after every three years
(Thoulesset al., 2008; Litorohet al., 2008; Ngeneet al., 2011; Mwangiet al., 2007; Kiambiet
al., 2010). Therefore, the 2012 aerial count of elephants, Grevy’s zebra and other large
mammals in Laikipia-Samburu-Marsabit ecosystem is part of the 3 years’ monitoring
cycle adopted by KWS.
Five factors made the 2012 aerial count in Laikipia-Samburu-Marsabit ecosystem
important. First, the impact of the 2009 severe drought needed to be assessed. Second,
there was need to establish the impact of increased poaching of elephantsbetween 2008
and 2012 on the ecosystem’s population status. Third, notably also is habitat loss
emanating from sedentary settlements around major elephant migratory corridors and
former elephant rangeswhich has compressed the elephant range. This is a key elephant
conservation and management issue in the ecosystem. Fourth, human-elephant conflict is
currently the greatest problem associated with loss of elephant range as a result of land
use change and increasing settlements in formerly unsettled areas. Fifth, currently, the
area has the second largest elephant population and the largest (about 90%) in-situ
Grevy’s Zebra population in the world. It is therefore important to continue to monitor
the population of elephants and Grevy’s Zebra in the ecosystem to provide continuous
long term data for sound management. The aerial count was undertaken by staff
(research scientists, pilots, GIS officers, research assistants, and drivers) from different
conservation agencies.
The 2012 aerial count wascarried out by staff from KWS, LewaDown Wildlife
Conservancy, Laikipia Wildlife Forum, Northern Rangeland Trust (NRT), African
Wildlife Foundation (AWF), Mpala Research Center (MRC), OlPejeta Conservancy
(OPC), Space for Giants (SG), OlJogi Game Ranch, Borana Ranch, Department of
Resource Surveys and Remote Sensing(DRSRS) andMwaluganje Elephant Sanctuary,
Tsavo Elephant Trust, International Union for Conservation of Nature (IUCN), and
Save the Elephants.

n/a

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

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

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

Availability of electronic resources, textual or otherwise, is a first step towards language technology research and development. This paper describes the acquisition and processing of a multi-dialectal speech and text corpora for the Igbo language. The compiled corpus provides the key resource for the denition of a machine-readable dialectal dictionary for Igbo. The work centres around an online portal that facilitates collaborative acquisition, denition and editing of the dialectal dictionary. The complete dictionary, which includes features such as phonetic pronounciation, syllabication, synthesized pronounciation as well as GIS locations, is then made available via a website.

Background
There is a need for a clear and actionable definition of maternal sepsis, in order to better assess the burden of this condition, trigger timely and effective treatment and allow comparisons across facilities and countries. The objective of this study was to review maternal sepsis definitions and identification criteria and to report on the results of an expert consultation to develop a new international definition of maternal sepsis.

Methods
All original and review articles and WHO documents, as well as clinical guidelines providing definitions and/or identification criteria of maternal sepsis were included. A multidisciplinary international panel of experts was surveyed through an online consultation in March-April 2016 on their opinion on the existing sepsis definitions, including new definition of sepsis proposed for the adult population (2016 Third International Consensus Definitions for Sepsis and Septic Shock) and importance of different criteria for identification of maternal sepsis. The definition was agreed using an iterative process in an expert face-to-face consensus development meeting convened by WHO and Jhpiego.

Results
Standardizing the definition of maternal sepsis and aligning it with the current understanding of sepsis in the adult population was considered a mandatory step to improve the assessment of the burden of maternal sepsis by the expert panel. The literature review and expert consultation resulted in a new WHO consensus definition “Maternal sepsis is a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, child-birth, post-abortion, or post-partum period”. Plans are in progress to validate the new WHO definition of maternal sepsis in a large international population.

Conclusion
The operationalization of the new maternal sepsis definition requires generation of a set of practical criteria to identify women with sepsis. These criteria should enable clinicians to focus on the timely initiation of actionable elements of care (administration of antimicrobials and fluids, support of vital organ functions, and referral) and improve maternal outcomes.

The United Nations and the African Union considers a person aged 65
years and above as a geriatric person. The graying population over the past decades
is showing an exponential growth rate compared to the declining fertility rate. This
population in the developing countries is not boastful of active ageing (successful,
independent ageing) as they are challenged by various health issues and
psychosomatic conditions. They require constant care and in some cases, specialized
care in familiar environments (their homes with relatives) or nursing homes (called
Nyumba za Wazee in Kenya). The researchers with support from literature believe
that technology can offer this specialized care (E-monitoring). This would be offered
in the comfort of their homes through continuous assessment of the geriatric person
relaying information to both the formal and informal caregivers. The objective of this
paper is to explore, summarize and analyse the various technologies in gerontology,
acceptance and adoption models, with the aim of identifying a suitable deployment
model that could be adopted in the context of a developing country.

OBJECTIVE: To study infections complicating ventriculoperitoneal (VP) shunt surgery in children with non-tumour hydrocephalus at the Kenyatta National Hospital, Nairobi. DESIGN: A retrospective survey. SETTING: Kenyatta National Hospital, Nairobi between January 1982 and December 1991. SUBJECTS: Three hundred and forty five patients who underwent V-P shunt placement for non-tumour hydrocephalus. RESULTS: Three hundred and forty five patients underwent V-P shunt placement for non-tumour hydrocephalus. There were 107 infection episodes involving 85 patients. The ages of these patients ranged from three months to 12 years. Most of the patients had congenital hydrocephalus. The infection rate was high (24.6%) although comparable to infection rates reported for clean surgery in the hospital. Fever, septic wounds and features of shunt malfunction were the main presenting features. Bacteriological studies confirmed Staphylococcus aureus and coagulase negative staphylococci as the two most commonly isolated micro-organisms. CONCLUSION: This study emphasises need to reduce infection rate in ventriculoperitoneal shunt surgery at the Kenyatta National Hospital. Definitive surgical treatment for hydrocephalus was in most cases delayed and this problem was also observed during revision of infected shunts. Late presentation was often due to ignorance and the fact that many patients went for traditional forms of treatment first before going to hospital.

Although early diagnosis and treatment are key factors in the effective control of human African trypanosomiasis (HAT), many cases of the disease delay taking appropriate action, leading to untold suffering. As a better understanding of treatment-seeking behaviour should help in identifying the obstacles to early diagnosis and effective treatment, the treatment pathways followed by 203 former HAT cases in western Kenya and eastern Uganda have recently been explored. About 86% of the HAT cases had utilized more than two different healthcare options before being correctly diagnosed for HAT, with about 70% each using more than three different health facilities. Only about 8% of the cases reported that they had been correctly diagnosed the first time they sought treatment. Just over half (51%) of the HAT cases had been symptomatic for >2 months before being correctly diagnosed for HAT, and such time lags in diagnosis contributed to 72% of the cases receiving their first appropriate treatment only in the late stage of the disease. The likelihood of a correct diagnosis increased with the time the case had been symptomatic. These observations indicate an urgent need to build the diagnostic capacity of the primary healthcare facilities in the study area, so that all HAT cases can be identified and treated in the early stage of the disease.

The quality of indoor air inside offices, schools, other workplaces and homes is important not only for human comfort but also for their health. Poor indoor air quality (IAQ) has been tied to symptoms like headaches, fatigue, trouble concentrating, and irritation of the eyes, nose, throat and lungs. Also, some specific diseases have been linked to specific air contaminants or indoor environments, like asthma with damp indoor environments. Many factors affect IAQ. These factors include poor ventilation (lack of outside air), problems controlling temperatures, high or low humidity, recent remodeling, and other activities in or near a building that can affect the fresh air coming into the building. The quantification of IAQ is therefore necessary.
Hourly data for CO and O3 and daily wind and temperature from Chiromo Environmental Monitoring station was used in this study. Stability Indices were obtained using the Hysplit Model. Time series analysis was used to obtaining the temporal variation of pollutants, meteorological variables and atmospheric stability. The relationship between pollutants, their interaction with meteorological variables and atmospheric stability was determined through correlation analysis.
Minimum concentrations are observed between 0630hrs and 0730hrs and between 2030hrs and 2130hrs when highest concentrations are observed. During the early daylight and evening hours, pollutant concentration rises mainly due to the increase in traffic and acts as catalyst in the breakdown of O3. At midday (between 1300hrs and 1400hrs) maximum ozone concentrations are observed whereas CO depicts low level concentrations .During this period the atmosphere experienced a lot of conversion due to the thermal heating. Changes in day to day weather, is seen as a factor affecting the diurnal variation of indoor CO and O3 as weather determines how quickly pollutants are dispersed away from an area.

n/a

The  study found out that Masinga Dam has adversely affected the public health in the communities around the dam. malaria was the most prevalent ailment followed by typhoid fever. Bilharzia has also increased since the dam was constructed.

n/a

n/a

n/a

In order to map suitable areas for weather modification in East Africa Community (EAC), investigations were performed to determine spatio-temporal variability and relationship of aerosol, clouds and precipitation during March- April-May (MAM) and October-November-December (OND). Principal Component Analysis (PCA), Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) and Multivariate Regression Analysis (MRA) were used. Identification of near homogeneous zones of Aerosol Optical Depth (AOD), Fine Mode Fraction (FMF), Cloud Top and 3B42 Tropical Rainfall Measuring Mission (TRMM) yielded 13 (14), 20 (18), 11 (10) and 16 (17) significant Principal Components (PCs) for MAM (OND) with explained variance greater than 57%. Aerosols and clouds had positive relationship with precipitation in areas with strong factor loadings. MRA indicated independence of variables used and normality in the model residuals. Backward trajectory analysis indicated differences in origins of transported particles in the atmosphere with strong vertical mixing inlands with mixed aerosols resulting due to mountain blocking systems accounted for enhanced rainfall. Enhanced rainfall was attributed to highly varied AOD and unaffected FMF in the atmosphere. Locations east and west EAC with mean temperatures greater than -10°C were unsuitable for cloud seeding while central EAC region along the great rift-valley and coastal Tanzania exhibited optimal temperatures suitable for cloud seeding. Successful precipitation enhancement will increase available fresh water sources and thus alleviate existing and projected water stress.

n/a

The study investigated potential of enhancing precipitation through cloud seeding during October-November-December (OND) season. Rainfall, cloud top temperature (CTT), aerosol optical depth (AOD) and wind data were used. Short-Cut Bartlett correlation, composite wind and time series analysis, and HYSPLIT backward trajectory analysis were used to achieve
the objectives of study. Precipitation showed decreasing patterns with peaks between pentad 65 and 68. Delineated dry years (18) exceeded wet years (9). Low level winds were predominantly north-easterly during dry years characterized by continental trajectory. AOD values increased in all stations during dry year with aerosol load being higher in areas characterized by depressed rainfall. Pollutants suspended 1000 above mean sea level (AMSL) originated from Arabian and India subcontinent and pollutants suspended below 1000 AMSL were predominantly south easterly during wet years originated from Western Indian Ocean and characterized by maritime trajectory. Mean CTT during dry/wet years were positve over coastal areas while central, Rift-valley and Lake Victoria basin
showed negative values, indicating presence of seedable conditions and thus potential cloud seeding to enhance rainfall and alleviate existing water stress.

The study investigated potential of enhancing precipitation through cloud seeding during October-November-December (OND) season. Rainfall, cloud top temperature (CTT), aerosol optical depth (AOD) and wind data were used. Short-Cut Bartlett correlation, composite wind and time series analysis, and HYSPLIT backward trajectory analysis were used to achieve the objectives of study. Precipitation showed decreasing patterns with peaks between pentad 65 and 68. Delineated dry years (18) exceeded wet years (9). Low level winds were predominantly north-easterly during dry years characterized by continental trajectory. AOD values iincreased in all stations during dry year with aerosol load being higher in areas characterized by depressed rainfall. Pollutants suspended 1000 above mean sea level (AMSL) originated from Arabian and India subcontinent and pollutants suspended below 1000 AMSL were predominantly south easterly during wet years originated from Western Indian Ocean and characterized by maritime trajectory. Mean CTT during dry/wet years were positve over coastal areas while central, Rift-valley and Lake Victoria basin showed negative values, indicating presence of seedable conditions and thus potential cloud seeding to enhance rainfall and alleviate existing water stress.

n/a

Coffee Berry Disease which affects green Arabica coffee (Coffea arabica) berries is caused by the fungus Colletotrichum kahawae and is a major problem in Arabica coffee production in African countries. Breeding for resistance to this disease is therefore to a major priority in these countries avoid intensive chemical usage for its control. Recently, microsatellite and Amplified Fragment Length Polymorphisms (AFLP) markers for a gene conferring resistance to the disease were identified and mapped onto the chromosomal region carrying the gene. To improve the repeatability of the AFLP markers, four of the marker bands were selected for cloning and sequencing to facilitate specific primers to be designed. Three of the resultant primers did not amplify products that exhibited polymorphism characteristic of the parent AFLP bands; but one primer pair amplified a product that dominantly identified the presence of the parent AFLP marker at an optimum temperature of 62°C followed by electrophoresis in agarose. The reliability of the designed primers was confirmed by analysis in 95 plants from a F2 population previously used to map the chromosomal fragment carrying the resistance. The importance of the results in enhancing the utility of the parent AFLP marker in relation to analytical costs and position on the chromosomal fragment is discussed.

Two agro-ecological zones in Kenya were selected to compare the distribution in maize of Aspergillus spp. and their toxigenicity. These were Nandi County, which is the main maize growing region in the country but where no human aflatoxicoses have been reported, and Makueni County where most of the aflatoxicosis cases have occurred. Two hundred and fifty-five households were sampled in Nandi and 258 in Makueni, and Aspergillus was isolated from maize. Aspergillus flavus and A. parasiticus isolates were tested for the presence of aflD and aflQ genes. Positive strains were induced to produce aflatoxins on yeast extract sucrose and quantified using liquid chromatography-tandem mass spectrometry (LCMSMS). Aspergillus flavus was the most common contaminant, and the incidence of occurrence in Nandi and Makueni was not significantly different (82.33% and 73.26%, respectively). Toxigenic strains were more prevalent than non-toxigenic strains. All the toxigenic strains from Makueni were of the S-type while those from Nandi belonged to the L-type. Quantitative differences in aflatoxin production in vitro between isolates and between strains were detected with S strains producing relatively larger amounts of total aflatoxins, B toxins and lower values for G toxins. This was in accord with the frequent aflatoxicosis outbreaks in Makueni. However some L strains produced considerable amounts of B toxins. Given the widespread distribution of toxigenic strains in both regions, the risk of aflatoxin poisoning is high when favorable conditions for toxin production occur.

Objectives: To establish the types of E. coli isolates that are found in river water around Nairobi and assess the potential risk of use of this water to human health. Design: Multiple stratified sampling was carried out. Surface sampling was used in the entire study. Setting: The study was carried out on river waters surrounding Nairobi, Kenya. Subjects: Forty Escherichia coli strains isolated from river water. Main outcome measures: Serotyping, toxin gene tests and susceptibility to tetracyclines, ampicillin, chloramphenicol and kanamycin were analysed. Results: None of the isolates could be specifically serotyped using the available antisera. Toxin gene detection tests using the colony hybridization technique revealed that nine (22.5%) of the strains were positive for heat stable (ST) toxin gene, seven(17.5%) to the heat labile(LT) toxin gene and two (5%) to both genes. Using the agar disk diffusion technique, eighty percent of the strains were susceptible to all four antibiotics, while twenty percent of the strains showed multiple resistance. None of the strains was resistant to all four antibiotics while no strain showed resistance to kanamycin. Conclusion: None of the E. coli isolates was serotypable and it was therefore not possible to determine whether serologically identical strains of ETEC were haboured by man or animals. Toxin gene tests results showed that there is some risk of infection by diarrhea causing ETEC to man and animals. Toxin gene tests showed that there is some risk of infection by diarrhea causing ETEC to man and animals if they consume this water untreated and there is evidence to show resistance of bacteria to antibiotics, hence appropriate health measures should be adhered to.

Loop-mediated isothermal amplification (LAMP) method amplifies DNA with high specificity, sensitivity and rapidity. In this study, we used a conserved sequence in the 200- to 300-fold repetitive 529 bp gene of Toxoplasma gondii to design primers for LAMP test. Detection limit of T. gondii LAMP assay with the primers is 1 pg/μL of T. gondii DNA, which was evaluated using 10-fold serially diluted DNA of cultured parasites. Furthermore, LAMP and conventional PCR methods were applied for amplification of the T. gondii DNA extracted from the lymph nodes taken from pigs which were suspected to be Toxoplasma infection. As a result, 76.9% (70/91) and 85.7% (78/91) of the samples were positive on PCR and LAMP analyzes, respectively. Therefore, the LAMP has a potential to be applied as an alternative molecular diagnostic tool for detection of T. gondii infection from veterinary samples. This is the first study, which applies the LAMP method to diagnose Toxoplasma from veterinary samples.

We describe the development of TparvaDB, a comprehensive resource to facilitate research towards development of an East Coast fever vaccine, by providing an integrated user-friendly database of all genome and related data currently available for Theileria parva. TparvaDB is based on the Generic Model Organism Database (GMOD) platform. It contains a complete reference genome sequence, Expressed Sequence Tags (ESTs), Massively Parallel Signature Sequencing (MPSS) expression tag data and related information from both public and private repositories. The Artemis annotation workbench provides online annotation functionality. TparvaDB represents a resource that will underpin and promote ongoing East Coast fever vaccine development and biological research.Database URL: http://tparvadb.ilri.cgiar.org

Kituyi, E. and Kirubi, C. ()

The Trade and Global Value Chains Initiative seeks to test whether investments in social upgrading (better working conditions and access to better work) can lead to business and development gains, and also ensure that better skilled, younger workers enter the sector and work more productively. Previous research indicated that companies do not invest in social upgrading because they lack both sufficient incentive to act on their own and convincing evidence of the benefits. Investment with other stakeholders in social upgrading could deliver business benefits and help to ensure the longer-term profitability and sustainability of corporate supply chains. A catalytic fund is the delivery mechanism (a modified challenge fund with technical advice provided to grantees), making public funds available to successful coalition applicants and leveraging private sector investment. The aim is to facilitate corporate behavioural change, benefitting workers/smallholders (social upgrading) and suppliers and retailers (economic upgrading). The TGVCI focuses on Ready Made Garments, Bangladesh, and horticulture in South Africa and Kenya.
This report presents the Mid-Term Evaluation (MTE) of the TGVCI conducted by the Evaluation Management Unit (EMU). Twenty projects have been funded in two rounds. The Round 1 projects are nearing completion and Round 2 projects are still on-going. This slightly delayed implementation means that the evidence available and the analysis feasible at this stage are necessarily limited. The projects do nevertheless allow reasonable conclusions to be drawn on relevance, effectiveness and plausible impacts, provide initial findings on cost-effectiveness and indications on sustainability.

Aim of the study: This study was conducted to document herbal medicines used in the treatment of malaria as well as the existing knowledge, attitudes and practices related to malaria recognition, control and treatment in South Coast, Kenya. Methods: Data was collected using semistructured questionnaires and interviews. A focused group discussion held with the community members, one in each of the study villages supplemented the interview and questionnaire survey. Results: The respondents were found to have a good understanding of malaria and could distinguish it from other fever types. They were also aware that malaria was spread by mosquitoes. Malaria prevalence was high, and affected individuals an average of four times a year. Community members avoided mosquito bites by using mosquito nets, clearing bushes around their homesteads and burning plant parts to generate smoke. They prevented and treated malaria by taking decoctions or concoctions of traditional herbal remedies. Forty plant species in thirty-five genera distributed in twenty-four families were used as antimalarials in the study area. Five plant species, namely; Heeria insignis Del. (Anacardiaceae), Rottboelia exaltata L.F (Gramineae), Pentanisia ouranogyne S. Moore (Rubiaceae), Agathisanthenum globosum (A. Rich) Hiern (Rubiaceae), and Grewia trichocarpa Hochst ex A. Rich (Tiliaceae) are documented for the first time in South Coast, Kenya, for the treatment of malaria. Conclusions: The plants documented in the current study are a potential source for new bioactive compounds of therapeutic value in malaria treatment. The results provide data for further pharmacological and toxicological studies and development of commercial antimalarial phytotherapy products.

AIM OF THE STUDY:
This study was conducted to document herbal medicines used in the treatment of malaria as well as the existing knowledge, attitudes and practices related to malaria recognition, control and treatment in South Coast, Kenya.

METHODS:
Data was collected using semistructured questionnaires and interviews. A focused group discussion held with the community members, one in each of the study villages supplemented the interview and questionnaire survey.

RESULTS:
The respondents were found to have a good understanding of malaria and could distinguish it from other fever types. They were also aware that malaria was spread by mosquitoes. Malaria prevalence was high, and affected individuals an average of four times a year. Community members avoided mosquito bites by using mosquito nets, clearing bushes around their homesteads and burning plant parts to generate smoke. They prevented and treated malaria by taking decoctions or concoctions of traditional herbal remedies. Forty plant species in thirty-five genera distributed in twenty-four families were used as antimalarials in the study area. Five plant species, namely; Heeria insignis Del. (Anacardiaceae), Rottboelia exaltata L.F (Gramineae),
Pentanisia ouranogyne S. Moore (Rubiaceae), Agathisanthenum globosum (A. Rich) Hiern (Rubiaceae), and Grewia trichocarpa Hochst ex A. Rich (Tiliaceae) are documented for the first time in South Coast, Kenya, for the treatment of malaria.

CONCLUSIONS:
The plants documented in the current study are a potential source for new bioactive compounds of therapeutic value in malaria treatment. The results provide data for further pharmacological and toxicological studies and development of commercial antimalarial phytotherapy products.

Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
PMID:20600756
[PubMed - indexed for MEDLINE]

The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients. METHOD: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes. RESULTS: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders. CONCLUSION: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments

Kenya government developed vision 2030 with the aim of transforming Kenya into a middle-income industrialized country. This vision is likely to be an illusion unless Kenya invests in education and training. Countries that have succeeded in harnessing the potential of ICT have been said to have taken a positive step towards a greatly expanded economic growth, improved human welfare and stronger forms of democratic governance. ICT has been correlated with enhanced human development and a major driving force of national growth. Kenya government has invested a lot of funds in the development of ICT infrastructure. This investment is likely not to bear fruits unless the training of teachers is put on the forefront. There should therefore be an emphasis of training teachers in ICT because they are the central forces in tapping the learning potentials created by ICT. Teachers for all levels from pre-primary to university must be trained in ICT if the vision is to be realized. Support for the pre-school education from the government is a recent phenomenon especially in curriculum development. This is because this level of education has been taught by untrained teachers for a long time therefore resulting to poor quality of education. The first effort noted towards this end was the experimental preschool education project that was carried out by the Ministry of education Science and Technology and the Bernard Van Leer Foundation between 1972 and 1982. A later development was on the National Early Childhood Development Policy Framework of 2006 which provided coordination of the different stakeholders in ECD at all levels. As the government continues to support this level of education, it is important to find out the part that it is playing in ensuring that this education is relevant to the changing needs of the students. This will only be possible if the government ensures that teachers have effective techniques, tool and assistance that can help them develop ICT activities that are able to improve student learning. The purpose of this study was to explore the ICT skills possessed by the ECD teachers. Further, the study explored the integration of ICT in teaching and learning of preschool children in selected Kenyan preschools. A researcher developed questionnaire was used to gather the required information from the ECD teachers who were in their training sessions. The sample consisted of 395 pre-school teachers. The findings indicated that only (39.17%) of the teachers had any knowledge in ICT. Most of the teachers (86.99) reported that there they had not attended any government sponsored ICT workshop during their teaching professions. All the teachers felt that their teaching would be highly enhanced by ICT integration in teaching and learning. They also expressed their interest in availing themselves for ICT training should an opportunity arise. Based on these findings, it was recommended that there is need for the government to invest more in the training of pre-school teachers in ICT integration.
Key words: information and communication technology (ICT), pre-school children, Pre-school teachers, Teacher training

{ OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers. METHODS: A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994. RESULTS: With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, had similar feeding practices and similar growth status and patterns. However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their husband's first wife (79% vs. 91%

Over the last six years there has been a tremendous development of infrastructure projects in virtually all corners of Kenya. This has taken the form of Road Improvement Project, Water and sewerage improvement project and the Electricity Transmission Improvement Project as envisioned in the Kenya Vision 2030. The purpose of this paper is to investigate the principles of compulsory land acquisition and way leaves in the three sectors in Kenya by looking at the current legislative framework governing the entire process of acquisition. In considering the process, the paper explores the various provisions of the relevant act which governs the particular utility envisaged for improvement project component in the Kenya Vision 2030. A critical evaluation of the procedures adopted is outlined in each case and the general public apprehensions towards such acquisitions. The second part of the paper focuses on suggestions on the choice of valuation methodology in making claims for compensation for land for various infrastructure projects in Kenya. This is borne out of the fact that there appear to be very little standardization in the methods adopted by the various bodies. The paper cites several cases under the Electricity Transmission Improvement Project where a large proportion of way leaves are dealt with at local level, with little consistency. Coupled to this is the public concern that electricity lines have potentially serious health effects that continue to attract research and media interest. The paper concludes with a description of the various cases on how to improve compensation paid to those affected by compulsory acquisition in cases of land and way leaves.

Training is a key component of building capacity for public health surveillance and response, but has often been difficult to quantify. During fiscal 2009, the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supported 18 partner organizations in conducting 123 training initiatives in 40 countries for 3,130 U.S. military, civilian and host-country personnel. The training assisted with supporting compliance with International Health Regulations, IHR (2005). Training activities in pandemic preparedness, outbreak investigation and response, emerging infectious disease (EID) surveillance and pathogen diagnostic techniques were expanded significantly. By engaging local health and other government officials and civilian institutions, the U.S. military's role as a key stakeholder in global public health has been strengthened and has contributed to EID-related surveillance, research and capacity-building initiatives specified elsewhere in this issue. Public health and emerging infections surveillance training accomplished by AFHSC-GEIS and its Department of Defense (DoD) partners during fiscal 2009 will be tabulated and described.

To determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, since its inception in 1967. DESIGN: This was a retrospective (1975-1987) and prospective study (1988-1999). SETTING: Kenyatta National Hospital, a National Referral Hospital and University of Nairobi Teaching Hospital. SUBJECTS: All surgeons trained by the Department of Surgery of the University of Nairobi for postgraduate MMed in general surgery, anaesthesia, ENT surgery and ophthalmology from 1975 to March 1999. RESULTS: Two hundred and eighty-five surgeons with Master of Medicine degree were trained by the Department of Surgery of the University of Nairobi between 1975 and March 1999. They included 181 (63.51%) general surgeons; 46 (16.14%) anaesthetists; 35 (12.28%) ophthalmologists and 23 (8.07% ear, nose and throat (ENT) surgeons. One hundred and seventy-six, (61.75%) were from retrospective studies; 94 (32.98%) were from prospective studies while 15 (5.26%) were from both retrospective and prospective studies. Two hundred and thirty-two (81.40%) surgeons were Kenyans while 53 (18.60%) were foreigners. The majority, 42 (79.24%) of the foreigners were from other African countries. Thirty one (58.50%) were from neighbouring Uganda, Sudan, Tanzania, Ethiopia and Zambia. There was also one PhD in anaesthesia and one MD in urology during the same period. CONCLUSION: The University of Nairobi, Department of Surgery based at Kenyatta National Hospital has played a very significant and leading role in the training of surgeons for Kenya and even other African and foreign countries since its inception. Of the forty surgeons who constitute the academic staff in the Departments of General Surgery, Orthopaedic Surgery and Ophthalmology of the University of Nairobi, thirty-five surgeons (87.50%) have been trained by the Faculty of Medicine at KNH. PIP: This study was carried out as a retrospective (1975-87) and prospective study (1988-99) to determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya, since its inception in 1967. Over the 25-year period (1975-99), the Department of Surgery of the University of Nairobi trained a total of 285 surgeons with a Master of Medicine degree. These included 181 (63.51%) general surgeons, 46 (16.14%) anesthetists, 35 (12.28%) ophthalmologists, and 23 (8.07%) ear, nose, and throat surgeons. 176 of the dissertations (61.75%) were from retrospective studies, 94 (32.98%) were from prospective studies, and 15 (5.26%) were from combined prospective and retrospective studies. 53 (18.60%) of these surgeons were foreigners, with the majority (79.24%) coming from other African countries. The neighboring countries of Uganda, Sudan, Tanzania, Ethiopia, and Zambia accounted for 31 (58.50%) of the foreign surgeons. There was also one Doctor of Philosophy in anesthesia and one Master's Degree in urology during the same period.

OBJECTIVE: To determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, since its inception in 1967.
DESIGN: This was a retrospective (1975-1987) and prospective study (1988-1999).
SETTING: Kenyatta National Hospital, a National Referral Hospital and University of Nairobi Teaching Hospital.
SUBJECTS: All surgeons trained by the Department of Surgery of the University of Nairobi for postgraduate MMed in general surgery, anaesthesia,
ENT surgery and ophthalmology from 1975 to March 1999. RESULTS: Two hundred and eighty-five surgeons with Master of Medicine degree were trained by the Department of Surgery of the University of Nairobi between 1975 and March 1999. They included 181 (63.51%) general surgeons; 46 (16.14%) anaesthetists; 35 (12.28%) ophthalmologists and 23 (8.07% ear, nose and throat (ENT) surgeons. One hundred and seventy-six, (61.75%) were from retrospective studies; 94 (32.98%) were from prospective studies while 15 (5.26%) were from both retrospective and prospective studies. Two hundred and thirty-two (81.40%) surgeons were Kenyans while 53 (18.60%) were foreigners. The majority, 42 (79.24%) of the foreigners were from other African countries. Thirty one (58.50%) were from neighbouring Uganda, Sudan, Tanzania, Ethiopia and Zambia. There was also one PhD in anaesthesia and one MD in urology during the same period.
CONCLUSION: The University of Nairobi, Department of Surgery based at Kenyatta National Hospital has played a very significant and leading role in the training of surgeons for Kenya and even other African and foreign countries since its inception. Of the forty surgeons who constitute the academic staff in the Departments of General Surgery, Orthopaedic Surgery and Ophthalmology of the University of Nairobi, thirty-five surgeons (87.50%) have been trained by the Faculty of Medicine at KNH.
PIP: This study was carried out as a retrospective (1975-87) and prospective study (1988-99) to determine the number of surgeons trained by the Department of Surgery, Faculty of Medicine, College of Health Sciences, University of Nairobi, Kenya, since its inception in 1967. Over the 25-year period (1975-99), the Department of Surgery of the University of Nairobi trained a total of 285 surgeons with a Master of Medicine degree. These included 181 (63.51%) general surgeons, 46 (16.14%) anesthetists, 35 (12.28%) ophthalmologists, and 23 (8.07%) ear, nose, and throat surgeons. 176 of the dissertations (61.75%) were from retrospective studies, 94 (32.98%) were from prospective studies, and 15 (5.26%) were from combined prospective and retrospective studies. 53 (18.60%) of these surgeons were foreigners, with the majority (79.24%) coming from other African countries. The neighboring countries of Uganda, Sudan, Tanzania, Ethiopia, and Zambia accounted for 31 (58.50%) of the foreign surgeons. There was also one Doctor of Philosophy in anesthesia and one Master's Degree in urology during the same period.

n/a

Transcultural psychiatry, whose scientific founder Emil Kraepelin is considered as, in its 100 years of tradition has not only developed a varied range of methods but has also brought about a change in the respective scientific questions as well as in related research and clinical applications. Whereas transcultural research on the psychopathology of depression contributed to the further development of psychiatric nosology, transcultural psychiatry has recently been increasingly faced with issues concerning phenomena of social change and globalization. One region, where such conditions can be observed in particular is Africa, where the dissolving of traditional standards and support systems and growing economic insecurity causes a considerable burden especially on women. As an example, results from a cross-sectional study on East African women using a two step design as well as qualitative and quantitative, standardized psychiatric methods are discussed concerning the association of social change, psycho-social risk factors and the development of depressive disorders. Efficient clinical methods towards diagnosis and treatment of new risk groups will have to be developed, of which an important aspect will be crisis intervention

Cryptosporidium was conducted with 20 farmers randomly selected from the 29 farmers in the wider survey who were considered at high risk because of farming system. We found that around 1 in 80 urban households kept dairy cattle with an average of three cattle per household. Cross-breeds of exotic and local cattle predominate. Heads of dairykeeping households were significantly less educated than the heads of non-dairy neighbours, had lived in Dagoretti for significantly longer and had significantly larger households. There was a high turnover of 10 % of the cattle population in the 3-month period of the study. Cattle were zero grazed, but productivity parameters were sub-optimal as were hygiene and husbandry practices. In conclusion, dairy keeping is a minor activity in urban Nairobi but important to households involved and their community. Ecohealth approaches are well suited to tackling the complex problem of assessing and managing emerging zoonoses in urban settings. Keywords Urban dairy . Cryptosporidiosis . Ecohealth . Kenya

Cryptosporidium was conducted with 20 farmers randomly selected from the 29 farmers in the wider survey who were considered at high risk because of farming system. We found that around 1 in 80 urban households kept dairy cattle with an average of three cattle per household. Cross-breeds of exotic and local cattle predominate. Heads of dairykeeping households were significantly less educated than the heads of non-dairy neighbours, had lived in Dagoretti for significantly longer and had significantly larger households. There was a high turnover of 10 % of the cattle population in the 3-month period of the study. Cattle were zero grazed, but productivity parameters were sub-optimal as were hygiene and husbandry practices. In conclusion, dairy keeping is a minor activity in urban Nairobi but important to households involved and their community. Ecohealth approaches are well suited to tackling the complex problem of assessing and managing emerging zoonoses in urban settings. Keywords Urban dairy . Cryptosporidiosis . Ecohealth . Kenya

n/a

An ecosystem approach was applied to study the links between malaria and agriculture in Mwea Division, Kenya. The study was organized into five phases. Phase I had two components including a stakeholder workshop conducted with community representatives and other key stakeholders, and the collation of data on common diseases from outpatient service records at the local hospital. Phase I aimed at an a priori needs-assessment in order to focus the research agenda. Workshop participants directly contributed to the selection of two villages with rice irrigation and two non-irrigated villages for detailed health studies. In Phase II, various Participatory Rural Appraisal (PRA) tools were used to gather more detailed qualitative information from the study villages. The qualitative results indicated that Mwea residents considered malaria and lack of clean drinking water to be their most important health problems, and this was corroborated by local hospital records. Phase III consisted of a comprehensive household survey developed with inputs from Phases I and II. Phase IV involved a comparative evaluation of entomological and parasitological aspects of malaria in the villages with and without rice irrigation. The malaria parasitological survey found an average Plasmodium falciparum parasite rate of 23.5% among children up to 9 years of age. Results of the entomological evaluation showed a 30-300-fold increase in the number of the local malaria vector, Anopheles arabiensis, in villages with rice irrigation compared to those without irrigation yet malaria prevalence was significantly lower in these villages (0-9% versus 17-54%). The most likely explanation of this 'paddies paradox' in Mwea appeared to be the tendency for A. arabiensis in irrigated villages to feed overwhelmingly on cattle. The results suggested that zooprophylaxis was potentially a practical option for long-term malaria control in the rice irrigated areas, in spite of the large number of A. arabiensis. Phase V consisted of end-of-project workshops for the dissemination of research results and participatory decision-making regarding follow-up actions. Owing to the utilization of a transdisciplinary and participatory approach to research, it was possible to identify opportunities for maintaining zooprophylaxis for malaria in Mwea, through the integration of agroecosystem practices aimed at sustaining livestock systems within a broader strategy for rural development.

Kenya’s Vision 2030 requires a functionally literate adult population which can effectively contribute to economic production and participate in the democratic processes of the country. It is unfortunate that the 7.8 million (38.5%) of Kenya’s adult population is still illiterate (Kenya literacy survey 2007). With this current situation, adult learner retention should hold the attention of all adult educators in every type of program. The rate of relapsing into illiteracy is also high. An estimated 33.6% of those surveyed who indicated to have completed primary level education were found to be illiterate at the time of the survey. According to the Kenya National Adult Literacy Survey (2007) only 29.6% of the 61.5% literate adults had attained the desired mastery level of literacy and would therefore be considered able to participate effectively in the realization of this Vision. This study examined the fit of the transformational/transactional leadership paradigm to voluntary adult educators in Eastern Province, Kenya. The study also sort to establish whether the leadership style had any effect on the rate of drop out among adult learners in the same province. The sample consisted of 104 voluntary adult educators of the certificate in adult education and community development class of the University of Nairobi (Meru class) The Multifactor Leadership Questionnaire Form 5X was administered to the sample during the face to face session that took place at a Mulanthakari multi-purpose hall to determine the effect of perceived District Adult Educator leadership on the outcome variables of effectiveness, satisfaction and adult learners drop out rate in the district. Multivariate statistical techniques were used to analyze the transformational leadership variables: idealized influence (attributed), idealized influence (behavioral), inspirational motivation, intellectual stimulation, and individual consideration. The results of the study were consistent with previously published studies and demonstrates the applicability of the transformational leadership paradigm to adult education in eastern province.

It is undisputed that success or failure of any organization depends on its leadership. School efficiency that is measured by factors such as students’ academic performance and discipline is not an exception. A lot of blame has been attributed to the leadership styles used by the secondary school principals. This has created disharmony between the principals and other stakeholders. Scholars have tried to establish the kind of leadership behaviour that would enhance efficiency in organizations. One kind of leadership behaviour that has been a topic of debate among scholars for the past decade is transformational leadership. Whether or not this kind of leadership is present in principals who have been in the profession for long or less years would be of interest to many scholars. This study endeavoured to establish the differences between transformational leadership practices by school principals based on their professional experience in selected secondary schools in Kenya. The participants were administered Kouzes and Posner’s leadership Practices Inventory which identified the principal leadership practices in each of the five dimensions of “challenging the process”, “inspiring a shared vision”, “enabling others to act”, “modeling the way” and “encouraging the heart”. The sample consisted of 387 participants from 49 secondary schools in Kenya. Leadership behaviour was measured using the Leadership Practices Inventory-(“Self” and “others”). The findings indicated that principals who had professional experience of less than one year scored higher in three transformational leadership practices (modeling the way, enabling others to act, and encouraging the heart) than their counterparts who had over 9 years of professional experience. Pearson correlation showed a positive statistical significant correlation professional experience of principals and their LPI scores. It was recommended that there is need for retraining of practicing principals in transformational leadership so that they can match the changing trends in the modern society.

Key words: transformational leadership, challenging the process, inspiring a shared vision, enabling others to act, modeling the way, encouraging the heart, professional experience

Kenya through its vision 2030 aims to become a middle-income industrialized country. In this vision, education and training has been isolated as a supreme vehicle that will take the country to the desired level of development. Although the government of Kenya has invested a lot of funds in education, it is sad that many schools do not provide teaching and learning in the most efficient way. A lot of blame has been attributed to the leadership styles used by the secondary school principals. This has created disharmony between the principals and other stakeholders. Scholars have tried to establish the kind of leadership behaviour that would enhance efficiency in organizations. School leaders have tried many leadership approaches with the aim of improving school efficiency. In the last two decades, Instructional and Transformational leadership theories have been frequently mentioned and researched in educational leadership. In the 1980s and early 1990s, Instructional leadership paradigm was thought to have served the schools well. Although this theory was said to have been the most popular in educational leadership, modern demands for educational reforms have made school leaders to look for an alternative. Just as societal and school demographics have changed in recent decades, so has the type of leadership needed to successfully lead the rapidly changing schools. A recent theory that has been embraced by many school leaders is transformational leadership. This study sought to establish the extent to which public school principals have embraced “modeling the way” characteristic of transformational leadership in comparison to the private school principals in Kenya. The study further investigated the relationship between this transformational leadership characteristic to students academic performance in both categories of schools. The sample consisted of 387 participants from 49 secondary schools in Kenya. Co relational research design was employed in data analysis. The findings indicated that principals in private schools scored higher (53.63) than the principals who were in public schools (51.79). The analyses indicated a negative correlation between “Modeling the way” transformational characteristic of principals in public schools and in private schools. Pearson correlation analysis also showed a significant correlation between Modeling the way" characteristic and students’ academic performance. Based on these findings, it is important to ensure that the principals feel totally in control of their institutions.

Key words: Transformational leadership, Principals, modeling the way, school ownership

Leadership is an area that many would not want to take for granted because of established correlations between success or failure of any organization and its leadership. Scholars have tried to establish the kind of leadership behaviour that would enhance efficiency in organizations. One kind of leadership behaviour that has been a topic of debate among scholars for the past decade is transformational leadership. This study endeavoured to establish the effect of transformational leadership on academic performance in selected secondary schools in Kenya. The participants were administered Kouzes and Posner’s leadership Practices Inventory which identified the principal leadership practices in each of the five dimensions of “challenging the process”, “inspiring a shared vision”, “enabling others to act”, “modeling the way” and “encouraging the heart”. The sample consisted of 387 participants from 49 secondary schools in Kenya. Leadership behaviour was measured using the Leadership Practices Inventory-(“Self” and “others”). Co relational research design was employed in data analysis. Pearson correlations were used to establish if there was a relationship between transformational leadership practices and academic performance. Pearson correlation indicated statistical significance between total LPI scores and students’ academic performance. A further analysis of the leadership domains showed there was a positive correlation between three transformational characteristics (Inspiring a Shared Vision, Challenging the process and Encouraging the Heart) and Students’ academic performance. There was however a weak but not statistically significant correlation between transformational leadership in two characteristics (Modeling the way and Enabling Others to Act) and students’ academic performance. The principals whose schools obtained the minimum university entry mark (Above C+) scored higher in LPI scores than the principals whose schools obtained less than the university entry marks (Below C+). It was recommended that all learners undertaking their teacher training should be trained on transformational leadership since they are the ones that take over leadership roles in their career as teachers. All practicing school principals should learn and practice transformational leadership for effective learning and teaching in their schools.

ICT is a critical tool for expanding human skills and rests largely on a system of producing, distributing and utilising information and knowledge that in turn plays a great role in driving productivity and economic prosperity. Kenya as a developing country realizes this importance and has a ministry specifically dealing with ICT. The vision statement of the ministry of information and Technology as stated in its strategic plan 2013-2018 is to make Kenya a globally competitive knowledge-based economy. This vision aims at shifting the current industrial development path towards innovation where creation, adoption, adaptation and use of knowledge remain the key source of economic growth. Research has shown that countries which have invested a lot in their human capital are far ahead of others in development. This development is likely to be an illusion unless Kenya is able to achieve its educational goals. Education and training has been isolated in the vision 2030 as the only mechanism that will translate Kenya into a middle-income economy. This is because education is fundamental to development of human resource capacities for sustainable economic growth and development. Through impartation of new skills and knowledge in people, education is able to improve human capabilities and labour productivity. It is in this regard that the Kenyan government has invested a lot of funds in ICT infrastructure including digitization of educational materials through Kenya Institute of curriculum Development. Kenya’s vision of education service provision is to have a globally competitive quality education, training and research for Kenya’s sustainable development. This study focused on the influence of secondary school managers on integration of ICT in teaching and learning in Githunguri subcounty, Kiambu County in Kenya. The study targeted 40 schools with a total population of 245 male teachers and 282 female teachers. teachers. A researcher developed questionnaire was issued to all the 40 school managers and to 100 teachers for triangulation purposes. Data analysis was done using statistical package for social sciences (SPSS).The study sort to establish if there is a relationship between management support and ICT integration in teaching and learning. Pearson correlation coefficient was used in the analysis. A positive correlation coefficient of 0.560 was obtained between the level of school management support and the use of ICT in teaching and learning. The findings indicated that school managers influenced integration of ICT in teaching and learning. The study therefore suggested that effort should be made by all stakeholders to ensure that school managers come up with policies on ICT integration in their schools which should be in line with the National ICT policy. KEY word: ICT integration, Teaching and learning, school managers, transformational leadership, challenging the process, secondary schools

n/a

n/a

The progression of HIV-related disease from infection to death is represented as a staged Markov model. Transitions between stages are considered reversible. The model is fitted to data from a cohort of African prostitutes by means of maximum likelihood. It appears that the progression to symptomatic disease (Centers for Disease Control stage IV) in this population is considerably more rapid than that reported from studies in Western countries. PIP: Identifying the incubation period of HIV infection is important for individual prognoses, for developing and testing intervention strategies, for determining the reproductive rate of the disease, and for prevalence of the disease. Mathematical modeling of HIV infection in Africa is necessitated because the disease is more widespread and the immune system is constantly active due to the exposure to diseases such as malaria and tuberculosis. The Markov model for this analysis was selected because parametric estimation is not based on the time a stage is entered, but on the duration between observations and the stages at the time of observation. The HIV infected female prostitutes in the Pumwani area of Nairobi, Kenya (a population primarily of Tanzanian origin) have been identified as a study population since 1985, and seen every 6 months in clinic, or as needed. Data are constricted by the movement out of the area in the end stage of disease, which is only partially solved by tracking with community health workers. The stages identified in incubation estimation are stage 1: seropositive but symptom free (CDC stage II); stage 2: generalized lymphadenopathy (CDC stage III); stage 3: symptomatic disease (CDC stage IV); and stage 4: death. Data reflect the movement back and forth between stage 1 and 2, between 2 and 3, so the model is not a pure Longini model but rather a timed homogeneous staged model with reversible stages called transition parameters computed in a numerical differentiation. The Fortran computer program for the analyses is available from the authors. The results suggest a quick transition between seroconversion and lymphadenopathy (2.4 months) and unlikely reversal, with the mean waiting time until passage to stage 3 is approximately 2.6 years and conversions are common. Since opportunistic infections are treatable, this makes sense. Assuming a correct model, the estimation of the transition time of 20 months of h34 value of .01 and .05, the mean passage time from stage 1, 2, 3 to 4 (death) is 9.1, 8.9, and 6.2 years 12.9, 12.7, and 10.1 years respectively. The implications are that 1) when infectiousness is hypothesized to be not uniform, peak infectivity occurs earlier in Africa than in the West at least among prostitutes, or 2) if infectivity is constant throughout the incubation period, then HIV transmission must be higher in Africa to explain the high rate of infection

A 28 year old male was screened, investigated and diagnosed as a case of true gender dysphoria. Subsequently he was operated and transsexual surgery successfully carried out. Four years after surgery, the patient has been followed up and found to be living a normal life as a female

To determine the prevalence and pattern of occurrence of traumatic injuries to permanent anterior teeth. Design: A descriptive cross-sectional survey. Setting: Public primary schools in the City of Nairobi. Subjects: A sample of 1382 children (672 males and 710 females) were interviewed and examined. Results: Among the 1382 children examined, 222(16.1%) had experienced traumatic dental injuries (TDIs). Males had experienced a significantly higher prevalence of trauma 126(18.8%) than females 96(13.5%) p=0.008. Falls were the leading cause of TDIs as reported by 78(35.1%) children. Amongst the, male children, falls were the leading cause of traumatic injuries to the permanent anterior teeth 47(37.3%). Approximately half 43(44.8%) of the females did not remember the cause of injury while 31 (36.5%) had sustained TDIs due to falls. One hundred and seventy two (77.5%) children who had experienced TDIs had no symptoms associated with the traumatised teeth. Ninety six (43.2%) of the children were injured while in the home environment. The maxillary central incisors were the most commonly traumatised teeth accounting for 220(73.5%) out of 299 injured teeth. The most frequently observed type of dental trauma was enamel fracture 206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%) children had not sought treatment for TDIs. Conclusion: Overall traumatised permanent incisors were found to occur fairly frequently with males having experienced significantly more TDIs than females. The prevalence of TDIs was 16.1%; enamel fractures were the most frequently observed injury and falls were the leading cause of trauma.

To determine the prevalence and pattern of occurrence of traumatic injuries to permanent anterior teeth. Design: A descriptive cross-sectional survey. Setting: Public primary schools in the City of Nairobi. Subjects: A sample of 1382 children (672 males and 710 females) were interviewed and examined. Results: Among the 1382 children examined, 222(16.1%) had experienced traumatic dental injuries (TDIs). Males had experienced a significantly higher prevalence of trauma 126(18.8%) than females 96(13.5%) p=0.008. Falls were the leading cause of TDIs as reported by 78(35.1%) children. Amongst the, male children, falls were the leading cause of traumatic injuries to the permanent anterior teeth 47(37.3%). Approximately half 43(44.8%) of the females did not remember the cause of injury while 31 (36.5%) had sustained TDIs due to falls. One hundred and seventy two (77.5%) children who had experienced TDIs had no symptoms associated with the traumatised teeth. Ninety six (43.2%) of the children were injured while in the home environment. The maxillary central incisors were the most commonly traumatised teeth accounting for 220(73.5%) out of 299 injured teeth. The most frequently observed type of dental trauma was enamel fracture 206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%) children had not sought treatment for TDIs. Conclusion: Overall traumatised permanent incisors were found to occur fairly frequently with males having experienced significantly more TDIs than females. The prevalence of TDIs was 16.1%; enamel fractures were the most frequently observed injury and falls were the leading cause of trauma.

To determine the prevalence and pattern of occurrence of traumatic injuries to permanent anterior teeth. Design: A descriptive cross-sectional survey. Setting: Public primary schools in the City of Nairobi. Subjects: A sample of 1382 children (672 males and 710 females) were interviewed and examined. Results: Among the 1382 children examined, 222(16.1%) had experienced traumatic dental injuries (TDIs). Males had experienced a significantly higher prevalence of trauma 126(18.8%) than females 96(13.5%) p=0.008. Falls were the leading cause of TDIs as reported by 78(35.1%) children. Amongst the, male children, falls were the leading cause of traumatic injuries to the permanent anterior teeth 47(37.3%). Approximately half 43(44.8%) of the females did not remember the cause of injury while 31 (36.5%) had sustained TDIs due to falls. One hundred and seventy two (77.5%) children who had experienced TDIs had no symptoms associated with the traumatised teeth. Ninety six (43.2%) of the children were injured while in the home environment. The maxillary central incisors were the most commonly traumatised teeth accounting for 220(73.5%) out of 299 injured teeth. The most frequently observed type of dental trauma was enamel fracture 206(68.9%) followed by enamel-dentin fracture 71(23.8%). Two hundred (90%) children had not sought treatment for TDIs. Conclusion: Overall traumatised permanent incisors were found to occur fairly frequently with males having experienced significantly more TDIs than females. The prevalence of TDIs was 16.1%; enamel fractures were the most frequently observed injury and falls were the leading cause of trauma.

Increasing resistance of Haemophilus ducreyi to antimicrobials necessitates further trials of new antimicrobial agents for treating chancroid. Enoxacin has excellent in vitro activity against H ducreyi, and a randomised clinical trial of three doses of enoxacin 400 mg at intervals of 12 hours compared with a single dose of trimethoprim/sulphametrole (TMP/SMT) 640/3200 mg was therefore conducted. Of 169 men enrolled in the study, 86 received enoxacin and 83 received TMP/SMT. Ulcers were improved or cured in 65/73 men treated with enoxacin and 57/70 men treated with TMP/SMT. This difference was not significant. At 72 hours after treatment, H ducreyi was eradicated from ulcers of 72/77 men treated with enoxacin and of 67/74 of those treated with TMP/SMT. Patients with buboes responded equally well to both treatments. Of 100 H ducreyi strains tested, all were susceptible to both 0.25 mg/l enoxacin and the combination of 0.25 mg/l TMP and 5 mg/l SMT. Although most men treated with either regimen were cured, neither regimen appeared to be the optimum treatment for chancroid. This study shows the efficacy of enoxacin for a soft tissue infection caused by Gram negative organisms.

Treatment interruption (TI) has been safe and durable in some pediatric studies but none have compared TI to continued antiretroviral treatment (ART) following ART initiation in early HIV. The objective of this study was to compare outcomes in TI versus continued ART among early-treated infants.

Treatment interruption has been well tolerated and durable in some pediatric studies but none have compared treatment interruption with continued antiretroviral treatment (ART) following ART initiation in early HIV. The objective of this study was to compare outcomes in treatment interruption versus continued ART among early-treated infants.

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

To determine the incidence of treatment interruption among head and neck cancer patients undergoing radical radiotherapy. Design: Prospective study Setting: Kenyatta National Hospital (KNH), Nairobi. Subjects: Twenty six (M=16, F=10) patients undergoing radiotherapy for head and neck cancer between March and June 2006. Main outcome measures: Frequency of radiation morbidities and treatment interuptions. Results: There were 26 patients consisting of 16 males and 10 females aged between 21 and 70 years (mean = 49.6 years). Among these patients 12 (46.2%) had tumours in the oral cavity, six (23.1%) had nasopharyngeal tumours, two (7.7%) had pharyngeal tumours, and six (23.1%) had laryngeal tumours. All tumours were primary carcinomas except two pharyngeal tumours which were metastatic. Among the 26 patients, 13(50%) completed the course of radiotherapy within the prescribed duration while another 13(50%) had treatment interruption. Of the 13 patients who had treatment interruption, one patient had a treatment gap of four days, seven patients had treatment gaps ranging between six and ten days, and five patients had treatment gaps of over ten days. The duration of treatment gaps ranged between four and 30 days. At the time of treatment interruption the cumulative radiation dose ranged from 22 to 58 Grey with a mean of 38 Grey (Mode = 44 Grey). The most common side effect was xerostomia (92%). This was closely followed by mucositis (88.5%), skin reactions (88.5%) dysphagia (84.5%) pain and suffering (76.9%). Loss of taste (61.5%), trismus (34.6%) and voice change (30.89%) were relatively less common. Conclusion: Our findings show that the probability of cancer control and cure among head and neck cancer patients treated at KNH could be severely eroded by treatment interruptions as a result of severe radiation morbidity.

Prior to the introduction of the International Network for Cancer Treatment and Research (INCTR) protocol INCTR 03-06, survival of patients with Burkitt lymphoma at four tertiary care centres in equatorial Africa was probably no more than 10-20%. The results reported here for 356 patients have demonstrated marked improvement in survival through the use of a uniform treatment protocol consisting of cyclophosphamide, methotrexate, vincristine, and intrathecal therapy, and the introduction of non-cross resistant second-line (salvage) therapy, consisting of ifosfamide, mesna, etoposide and cytarabine, when patients failed to achieve a complete response to first-line therapy or relapsed early. Overall survival rates of 67% and 62% were observed at 1 and 2 years (relapse is rare after 1 year of remission). Of interest was the small impact of cerebrospinal fluid (CSF) and bone marrow involvement on outcome. However, the presence or absence of abdominal involvement clearly defined two prognostic groups. An additional finding was the association between CSF pleocytosis and orbital tumours, suggesting that spread of tumour cells to the central nervous system may sometimes occur via direct involvement of cranial nerves in the orbit. Survival rates may be increased in patients with abdominal involvement by combining first- and second-line therapy, but verification will require a further clinical study.

n/a

This study investigated the effectiveness of three physical-chemical methods namely; pH adjustment, precipitation with alum and the use of polyelectrolytes. In the treatment of diary wastewater from Brookeside milk processing plant. It also investigated the drainability of the sludge produced by each of the three methods. Laboratory tests were carried out in three different batches, one for each of the three methods. In the alum method enough alum was added to the wastewater samples to cause precipitation by sweep floc. In the pH adjustment method, the pH of samples were lowered to the iso-electric point of the casein proteins of approximately pH 4.5 leading to their precipitation as a result of solubility changes. The polyelectrolytes method involved the use of two polyelectrolytes, Sudfloc 3820 and Sudfloc 3860 each of which was used to coagulate the dirty wastewater. For each of the three methods, the samples were taken in one-litre beakers and subjected to Jar tests to determine the optimum dosages. After one hour of settling the supernatants were decanted and subjected to standard Chemical Oxygen Demand (COD) tests, turbidity and pH measurements. The settled sludge was subjected to drainability studies. Results showed the treatment of dairy wastewater by the three physical-chemical methods to be effective. There were COD removals of between 60% and 90% and turbidity reduction of over 90%. The use of the sudfloc polyelectrolytes was found to be the least demanding in terms of effluent quality control as no pH adjustments of either the wastewater or the effluent was required. The use of polyelectolytes produced the least volumes of sludge and also the better drainability and solids concentration. Sudfloc 3820 was found to achieve better results than Sudfloc 3860 in terms of COD reduction and the drainability of sludge produced although both achieved the same drainability studies. This study showed that each of the three physical-chemical methods can be used effectively to remove the white colour of dairy wastewater as well as the bulk of the proteins and fats, hence, enabling the discharge of the effluents into natural waters to be of good assimilative capacity.

Thirty-eight patients in diabetic coma from four different centres were treated with a continuous low-dose intravenous infusion of insulin at an average dose of 7.2 IU/hr. All patients recovered rapidly except for one profoundly shocked patient who died. The mean fall in plasma glucose was 58% four hours after the start of insulin. Blood ketone bodies and plasma free fatty acids showed a similar response. There was no significant difference in plasma glucose response according to severity of acidosis or previous treatment with insulin. Hypokalaemia was uncommon. In the treatment of diabetic coma this technique has proved simple, safe, and effective.

The efficacy of a single 2.5-g dose of thiamphenicol against infection with penicillinase-producing strains of Neisseria gonorrhoeae (PPNG) or non-penicillinase-producing strains (non-PPNG) was studied in a two-phase clinical trial in Nairobi. The first phase included men who had had a urethral discharge for less than seven days, were infected with either PPNG or non-PPNG, and had not received previous treatment. The second phase included men with PPNG infections that had not responded to treatment with penicillin. The overall cure rate (determined by follow-up examinations and cultures three and ten days after treatment) was 90.6% in the first phase of the study and 92.1% in the second phase. A second 2.5-g dose of thiamphenicol was administered to four of the six patients in the second phase whose cultures yielded gonococci after the initial dose; the infections of all four patients were cured. The results of disk diffusion tests of gonococcal isolates did not correlate well with the outcome of treatment.

Although early diagnosis and treatment are key factors in the effective control of human African trypanosomiasis (HAT), many cases of the disease delay taking appropriate action, leading to untold suffering. As a better understanding of treatment-seeking behaviour should help in identifying the obstacles to early diagnosis and effective treatment, the treatment pathways followed by 203 former HAT cases in western Kenya and eastern Uganda have recently been explored. About 86% of the HAT cases had utilized more than two different healthcare options before being correctly diagnosed for HAT, with about 70% each using more than three different health facilities. Only about 8% of the cases reported that they had been correctly diagnosed the first time they sought treatment. Just over half (51%) of the HAT cases had been symptomatic for >2 months before being correctly diagnosed for HAT, and such time lags in diagnosis contributed to 72% of the cases receiving their first appropriate treatment only in the late stage of the disease. The likelihood of a correct diagnosis increased with the time the case had been symptomatic. These observations indicate an urgent need to build the diagnostic capacity of the primary healthcare facilities in the study area, so that all HAT cases can be identified and treated in the early stage of the disease.

The objective of this study was to test the hypothesis that sexual risk behaviour would increase following initiation of antiretroviral therapy (ART) in Kenyan female sex workers (FSWs). Design—Prospective cohort study. Setting—FSW cohort in Mombasa, Kenya, 1993-2008. Subjects—898 women contributed HIV-1-seropositive follow-up visits, of whom 129 initiated ART. Intervention—Beginning in March 2004, ART was provided to women qualifying for treatment according to Kenyan National Guidelines. Participants received sexual risk reduction education and free condoms at every visit. Main Outcome Measures—Main outcome measures included unprotected intercourse, abstinence, 100% condom use, number of sexual partners, and frequency of sex. Outcomes were evaluated at monthly follow-up visits using a one week recall interval. Results—Compared to non-ART-exposed follow-up, visits following ART initiation were not associated with an increase in unprotected sex (adjusted odds ratio [AOR] 0.86, 95% confidence interval [CI] 0.62-1.19, P=0.4). There was a non-significant decrease in abstinence (AOR 0.81, 95% CI 0.65-1.01, P=0.07), which was offset by a substantial increase in 100% condom use (AOR 1.54, 95% CI 1.07-2.20, P=0.02). Numbers of sex partners and frequency of sex were similar before versus after starting ART. A trend for decreased sexually transmitted infections following ART initiation provides additional support for the validity of the self-reported behavioural outcomes (AOR 0.67, 95% CI 0.44-1.02, P=0.06). Conclusions—In the setting of ongoing risk reduction education and provision of free condoms, initiation of ART was not associated with increased sexual risk behaviour in this cohort of Kenyan FSWs.

n/a

The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya.

n/a

Sulphadoxine-pyrimethamine (SP), an antifolate, was replaced by artemether-lumefantrine as the first-line malaria drug treatment in Kenya in 2004 due to the wide spread of resistance. However, SP still remains the recommended drug for intermittent preventive treatment in pregnant women and infants (IPTP/I) owing to its safety profile. This study assessed the prevalence of mutations in dihydrofolate reductase (Pfdhfr) and dihydropteroate synthase (Pfdhps) genes associated with SP resistance in samples collected in Kenya between 2008 and 2012.