The availability of water in the dryland regions is a function of climatic and land conditions, which determine the amount and distribution of atmospheric water and subsequent partitioning of that water into different hydrological components. Rainfall variability in the drylands affects water, food and livelihood security in the sensitive landscapes. For effective water resource management, it is important to quantify the effect of rainfall variability on the available water resource components to support food security, given that a majority of livelihoods in the drylands are dependent on rainfall. This study assessed rainfall variability and its effects on stream flows in the dryland regions of Turkana County in Northern Kenya. The Coefficient of Variation (CV), Standardised Precipitation Anomaly (SPA) and Mann-Kendal test approaches were used to determine variability and trends of rainfall. The Soil and Water Assessment Tool (SWAT), was employed to simulate hydrological components, including surface runoff, interflow, groundwater flow and the eventual water yield in the streams. The model simulations were driven by the Climate Hazards Group InfraRed Precipitation with Station CHIRPS and the Coordinated Regional Climate Downloading Experiment CORDEX projected rainfalls to establish the current and future water availability respectively. From the results, CV values ranging from 20 to 99% were obtained indicating that the region experiences moderate to high rainfall variability, often resulting in moderate to extreme floods and droughts in the area. The model simulations indicated that the stream-flows are increasing towards the 2020s decade compared to what was flowing in the 1980s decade, as observed between 1981 and 2020 using rainfall. This is probably a result of the increased rainfall observed in this region over the las four decades. Using Representative Concentration Pathways RCP 4.5 and RCP 8.5 projected rainfall scenarios, the model indicated that future stream flows will be higher than present. The findings show that, in the face of climate change scenarios, proper land management is required to promote water and food security in the drylands of sub-Saharan Africa in the future

Background Viruses are responsible for a large proportion of acute respiratory tract infections (ARTIs). Human influenza, parainfluenza, respiratory-syncytial-virus, and adenoviruses are among the leading cause of ARTIs. Epidemiological evidence of those respiratory viruses is limited in the East Africa Community (EAC) region. This review sought to identify the prevalence of respiratory syncytial virus, parainfluenza, and adenoviruses among cases of ARTI in the EAC from 2007 to 2020. Methods A literature search was conducted in Medline, Global Index Medicus, and the grey literature from public health institutions and programs in the EAC. Two independent reviewers performed data extraction. We used a random effects model to pool the prevalence estimate across studies. We assessed heterogeneity with the I2 statistic, and Cochran’s Q test, and further we did subgroup analysis. This review was registered with PROSPERO under registration number CRD42018110186. Results A total of 12 studies met the eligibility criteria for the studies documented from 2007 to 2020. The overall pooled prevalence of adenoviruses was 13% (95% confidence interval [CI]: 6–21, N = 28829), respiratory syncytial virus 11% (95% CI: 7–15, N = 22627), and parainfluenza was 9% (95% CI: 7–11, N = 28363). Pooled prevalence of reported ARTIs, all ages, and locality varied in the included studies. Studies among participants with severe acute respiratory disease had a higher pooled prevalence of all the three viruses. Considerable heterogeneity was noted overall and in subgroup analysis. Conclusion Our findings indicate that human adenoviruses, respiratory syncytial virus and parainfluenza virus are prevalent in Kenya, Tanzania, and Uganda. These three respiratory viruses contribute substantially to ARTIs in the EAC, particularly among those with severe disease and those aged five and above.

Transportation infrastructure, such as railways, roads and power lines, contribute to national and regional economic, social and cultural growth and integration. Kenya, with support from the Chinese government, is currently constructing a standard gauge railway (SGR) to support the country’s Vision 2030 development agenda. Although the actual land area affected by the SGR covers only a small proportion along the SGR corridor, a significant proportion of the area supports a wide range of ecologically fragile and important ecosystems in the country, with potential wider impacts. This study used a qualitative content analysis approach to gain an understanding and perceptions of stakeholders on the potential ecological impacts of the interactions between the SGR and the traversed ecological systems in Kenya. Three dominant themes emerged: 1) ecosystem degradation; 2) ecosystem fragmentation; and 3) ecosystem destruction. Ecosystem degradation was the most commonly cited impact at while ecosystem destruction was of the least concern and largely restricted to the physical SGR construction whereas the degradation and fragmentation have a much wider footprint. The construction and operation of the SGR degraded, fragmented and destroyed key ecosystems in the country including water towers, protected areas, community conservancies and wildlife dispersal areas. Therefore, we recommend that project proponents develop sustainable and ecologically sensitive measures to mitigate the key ecosystem impacts.

The first case of COVID-19 was reported in Kenya in March 2020 and soon after non-pharmaceutical interventions (NPIs) were established to control the spread of the disease. The NPIs consisted, and continue to consist, of mitigation measures followed by a period of relaxation of some of the measures. In this paper, we use a deterministic mathematical model to analyze the dynamics of the disease, during the first wave, and relate it to the intervention measures. In the process, we develop a new method for estimating the disease parameters. Our solutions yield a basic reproduction number, R0 = 2.76, which is consistent with other solutions. The results further show that the initial mitigation reduced disease transmission by 40% while the subsequent relaxation increased transmission by 25%. We also propose a mathematical model on how interventions of known magnitudes collectively affect disease transmission rates. The modelled positivity rate curve compares well with observations. If interventions of unknown magnitudes have occurred, and data is available on the positivity rate, we use the method of planar envelopes around a curve to deduce the modelled positivity rate and the magnitudes of the interventions. Our solutions deduce mitigation and relaxation effects of 42.5% and 26%, respectively; these percentages are close to values obtained by the solution of the SIRD system. Our methods so far apply to a single wave; there is a need to investigate the possibility of extending them to handle multiple waves.Competing Interest StatementThe authors have declared no competing interest.Clinical TrialNot a clinical trialFunding StatementNo funding supportAuthor DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:KNH-UoN Ethics and Research Committee https://erc.uonbi.ac.keAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesData sources: All the data used is in the public domain [1, 44, 56, 57]

Background: Cataract is a leading cause of blindness and vision impairment globally. Cataract surgery is one of the most frequently performed operations worldwide, but good quality services are not universally available. This scoping review aims to summarise the nature and extent of published literature on interventions to improve the quality of services for age-related cataract globally.

Methods: We used the dimensions of quality adopted by WHO-effectiveness, safety, people-centredness, timeliness, equity, integration and efficiency-to which we added planetary health. On 17 November 2019, we searched MEDLINE, Embase and Global Health for manuscripts published since 1990, without language or geographic restrictions. We included studies that reported quality-relevant interventions and excluded studies focused on technical aspects of surgery or that only involved children (younger than 18 years). Screening of titles/abstracts, full-text review and data extraction were performed by two reviewers independently. Studies were grouped thematically and results synthesised narratively.

Results: Most of the 143 included studies were undertaken in high-income countries (n = 93, 65%); 29 intervention groups were identified, most commonly preoperative education (n = 17, 12%) and pain/anxiety management (n = 16, 11%). Efficiency was the quality element most often assessed (n = 58, 41%) followed by people-centredness (n = 40, 28%), while integration (n = 4) and timeliness (n = 3) were infrequently reported, and no study reported outcomes related to planetary health.

Conclusion: Evidence on interventions to improve quality of cataract services shows unequal regional distribution. There is an urgent need for more evidence relevant to low- and middle-income countries as well as across all quality elements, including planetary health.

An estimated 1.5 million Kenyans are HIV-seropositive, with 1.1 million on antiretroviral therapy (ART), with the majority of them unaware of their drug resistance status. In this study, we assessed the prevalence of drug resistance to nucleoside reverse transcriptase inhibitors (NRTIs), nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors, and the variables associated with drug resistance in patients failing treatment in Nairobi, Kenya.This cross-sectional study utilized 128 HIV-positive plasma samples obtained from patients enrolled for routine viral monitoring in Nairobi clinics between 2015 and 2017. The primary outcome was human immunodeficiency virus type 1 (HIV-1) drug resistance mutation counts determined by Sanger sequencing of the polymerase (pol) gene followed by interpretation using Stanford's HIV Drug Resistance Database. Poisson regression was used to determine the effects of sex, viral load, age, HIV-subtype, treatment duration, and ART-regimen on the primary outcome.HIV-1 drug resistance mutations were found in 82.3% of the subjects, with 15.3% of subjects having triple-class ART resistance and 45.2% having dual-class resistance. NRTI primary mutations M184 V/I and K65R/E/N were found in 28.8% and 8.9% of subjects respectively, while NNRTI primary mutations K103N/S, G190A, and Y181C were found in 21.0%, 14.6%, and 10.9% of subjects. We found statistically significant evidence (P = .013) that the association between treatment duration and drug resistance mutations differed by sex. An increase of one natural-log transformed viral load unit was associated with 11% increase in drug resistance mutation counts (incidence rate ratio [IRR] 1.11; 95% CI 1.06-1.16; P < .001) after adjusting for age, HIV-1 subtype, and the sex-treatment duration interaction. Subjects who had been on treatment for 31 to 60 months had 63% higher resistance mutation counts (IRR 1.63; 95% CI 1.12-2.43; P = .013) compared to the reference group (<30 months). Similarly, patients on ART for 61 to 90 months were associated with 133% higher mutation counts than the reference group (IRR 2.33; 95% CI 1.59-3.49; P < .001). HIV-1 subtype, age, or ART-regimen were not associated with resistance mutation counts.Drug resistance mutations were found in alarmingly high numbers, and they were associated with viral load and treatment time. This finding emphasizes the importance of targeted resistance monitoring as a tool for addressing the problem.

Background: Simulation-based surgical education (SBSE) can positively impact trainee surgical competence. However, a detailed qualitative study of the role of simulation in ophthalmic surgical education has not previously been conducted.

Objective: To explore the experiences of trainee ophthalmologists and ophthalmic surgeon educators' use of simulation, and the perceived challenges in surgical training.

Methods: A multi-center, multi-country qualitative study was conducted between October 2017 and August 2020. Trainee ophthalmologists from six training centers in sub-Saharan Africa (SSA) (in Kenya, Uganda, Tanzania, Zimbabwe and South Africa) participated in semi-structured interviews, before and after an intense simulation training course in intraocular surgery. Semi-structured interviews were also conducted with experienced ophthalmic surgeon educators. Interviews were anonymized, recorded, transcribed and coded. An inductive, bottom-up, constant comparative method was used for thematic analysis.

Results: Twenty-seven trainee ophthalmologists and 12 ophthalmic surgeon educators were included in the study and interviewed. The benefits and challenges of conventional surgical teaching, attributes of surgical educators, value of simulation in training and barriers to implementing ophthalmic surgical simulation were identified as major themes. Almost all trainees and trainers reported patient safety, a calm environment, the possibility of repetitive practice, and facilitation of reflective learning as beneficial aspects of ophthalmic SBSE. Perceived barriers in surgical training included a lack of surgical cases, poor supervision and limited simulation facilities.

Conclusions: Simulation is perceived as an important and valuable model for education amongst trainees and ophthalmic surgeon educators in SSA. Advocating for the expansion and integration of educationally robust simulation surgical skills centers may improve the delivery of ophthalmic surgical education throughout SSA.

is widely used in Sub-Saharan Africa for treating many diseases, including HIV-1 infection. We have recently described the chemical structures of 28 compounds isolated from an alcoholic crude extract of barks and roots of , and showed that six bioactive compounds inhibit HIV-1 infection. In the present study, we demonstrate that the six compounds block HIV-1 entry into cells: oleanolic acid, palmitic acid, taxifolin, piceatannol, guibourtinidol-(4α→8)-epiafzelechin, and a novel compound named as cassiabrevone. We report, for the first time, that guibourtinidol-(4α→8)-epiafzelechin and cassiabrevone inhibit HIV-1 entry (IC of 42.47 µM and 30.96 µM, respectively), as well as that piceatannol interacts with cellular membranes. Piceatannol inhibits HIV-1 infection in a dual-chamber assay mimicking the female genital tract, as well as HSV infection, emphasizing its potential as a microbicide. Structure-activity relationships (SAR) showed that pharmacophoric groups of piceatannol are strictly required to inhibit HIV-1 entry. By a ligand-based in silico study, we speculated that piceatannol and norartocarpetin may have a very similar mechanism of action and efficacy because of the highly comparable pharmacophoric and 3D space, while guibourtinidol-(4α→8)-epiafzelechin and cassiabrevone may display a different mechanism. We finally show that cassiabrevone plays a major role of the crude extract of by blocking the binding activity of HIV-1 gp120 and CD4.

Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adolescents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance.

Theileria parva infections in cattle causes huge economic losses in the affected African countries, directly impacting the livelihood of the poor small-holder farmers. The current immunization protocol using live sporozoites in eastern Africa, is among the control measures designed to limit T. parva infections in cattle. However, the ability of the immune protection induced by this immunization to protect against field parasites has been compromised by the diversity of the parasite involving the schizont antigen genes. Previous studies have reported on the antigenic diversity of T. parva parasites from southern and eastern Africa, however, similar reports on T. parva parasites particularly from cattle from southern Africa remains scanty, due to the self-limiting nature of Corridor disease. Thus, we evaluated the diversity of CD8+ T-cell regions of ten schizont antigen genes in T. parva parasites associated with Corridor disease and East Coast fever (ECF) from southern and eastern Africa respectively. Regions of schizont antigen (TpAg) genes containing the CD8+ T-cell epitopes (CTL determinants) were amplified from genomic DNA extracted from blood of T. parva positive samples, cloned and sequenced. The results revealed limited diversity between the two parasite groups from cattle from southern and eastern Africa, defying the widely accepted notion that antigen-encoding loci in cattle-derived parasites are conserved, while in buffalo-derived parasites, they are extensively variable. This suggests that only a sub-population of parasites is successfully transmitted from buffalo to cattle, resulting in the limited antigenic diversity in Corridor disease parasites. Tp4, Tp5, Tp7 and Tp8 showed limited to absence of diversity in both parasite groups, suggesting the need to further investigate their immunogenic properties for consideration as candidates for a subunit vaccine. Distinct and common variants of Tp2 were detected among the ECF parasites from eastern Africa indicating evidence of parasite mixing following immunization. This study provides additional information on the comparative diversity of TpAg genes in buffalo- and cattle-derived T. parva parasites from cattle from southern and eastern Africa.

Introduction: Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews.

Methods and analysis: The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration.

Ethics and dissemination: The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal.

Background: There is limited access to eye health services in many low-income and middle-income populations. We aimed to assess the effectiveness in increasing service utilisation of the Peek Community Eye Health (Peek CEH) system, a smartphone-based referral system comprising decision support algorithms (Peek Community Screening app), SMS reminders, and real-time reporting.

Methods: In this cluster-randomised controlled trial of eye health in Kenya, community unit clusters were defined as one health centre and its catchment population. Clusters were randomly allocated (1:1) to receive Peek CEH and referral (intervention group) or standard care via periodic health centre-based outreach clinics and onward referral (control group). Individuals in the intervention group were assessed at home by screeners and those referred were asked to present for triage assessment in a central location. They received regular SMS reminders. In both groups, community sensitisation was done followed by a triage clinic at the cluster health centre 4 weeks after sensitisation. During triage, individuals in both groups were assessed and treated and, if necessary, referred to a specific hospital. Individuals in the intervention group received further SMS reminders. The primary outcome was the mean attendance rate (the number of people per 10 000 population) at triage of those with confirmed eye conditions, as assessed at 4 weeks after sensitisation in the intention-to-treat population. We estimated the intervention effect using a Student's t-test on cluster-level rates. This trial is registered with Pan African Clinical Trial Registry, number 201807329096632.

Findings: Between Nov 26, 2018, and June 7, 2019, of the 85 community units in Trans Nzoia County, Kenya, 49 were excluded. We randomly allocated 18 community units each to the intervention group (68 348 individuals) and the control group (60 243 individuals). 9387 individuals from the intervention group and 3070 from the control group attended triage assessment. The mean attendance rate at triage by individuals with eye problems was 1429 (92% CI 1228-1629) in the intervention group and 522 (418-625) in the control group (rate difference 906 per 10 000 [95% CI 689-1124; p<0·0001]).

Interpretation: The Peek CEH system increased primary care attendance by people with eye problems compared with standard approaches, indicating the potential of this mobile health package to increase service uptake and guide appropriate task sharing.

Background/aim: Glaucoma accounts for 8% of global blindness and surgery remains an important treatment. We aimed to determine the impact of adding simulation-based surgical education for glaucoma.

Methods: We designed a randomised controlled, parallel-group trial. Those assessing outcomes were masked to group assignment. Fifty-one trainee ophthalmologists from six university training institutions in sub-Saharan Africa were enrolled by inclusion criteria of having performed no surgical trabeculectomies and were randomised. Those randomised to the control group received no placebo intervention, but received the training intervention after the initial 12-month follow-up period. The intervention was an intense simulation-based surgical training course over 1 week. The primary outcome measure was overall simulation surgical competency at 3 months.

Results: Twenty-five were assigned to the intervention group and 26 to the control group, with 2 dropouts from the intervention group. Forty-nine were included in the final intention-to-treat analysis. Surgical competence at baseline was comparable between the arms. This increased to 30.4 (76.1%) and 9.8 (24.4%) for the intervention and the control group, respectively, 3 months after the training intervention for the intervention group, a difference of 20.6 points (95% CI 18.3 to 22.9, p<0.001). At 1 year, the mean surgical competency score of the intervention arm participants was 28.6 (71.5%), compared with 11.6 (29.0%) for the control (difference 17.0, 95% CI 14.8 to 19.4, p<0.001).

Conclusion: These results support the pursuit of financial, advocacy and research investments to establish simulation surgery training units and courses including instruction, feedback, deliberate practice and reflection with outcome measurement to enable trainee glaucoma surgeons to engage in intense simulation training for glaucoma surgery.

Trial registration number: PACTR201803002159198.

Access to quality, effective lifesaving uterotonics in low and middle-income countries (LMICs) remains a major barrier to reducing maternal deaths from postpartum haemorrhage (PPH). Our objective was to assess the costs of care for women who receive different preventative uterotonics, and with PPH and no-PPH so that the differences, if significant, can inform better resource allocation for maternal health care.

Trypanosoma brucei species are motile protozoan parasites that are cyclically transmitted by tsetse fly (genus Glossina) causing human sleeping sickness and nagana in livestock in sub-Saharan Africa. African trypanosomes display digenetic life cycle stages in the tsetse fly vector and in their mammalian host. Experimental work on insect-stage trypanosomes is challenging because of the difficulty in setting up successful in vitro cultures. Therefore, there is limited knowledge on the trypanosome biology during its development in the tsetse fly. Consequently, this limits the development of new strategies for blocking parasite transmission in the tsetse fly.

Tick-borne diseases (TBDs) constitute a major constraint for livestock development in sub-Saharan Africa, with East Coast fever (ECF) being the most devastating TBD of cattle. However, in Burundi, detailed information is lacking on the current prevalence of TBDs and on the associated economic losses from mortality and morbidity in cattle as well as the costs associated with TBD control and treatment. The aim of this study was, therefore, to assess the prevalence and spatial distribution of tick-borne pathogens (TBPs) in cattle across the major agro-ecological zones (AEZs) in Burundi.

To assess the utility of a femtosecond laser-assisted stromal channel to assist the creation of a big bubble (BB) for deep anterior lamellar keratoplasty (DALK) surgery in cadaveric corneas.

Importance: Cataracts account for 40% of cases of blindness globally, with surgery the only treatment.

Objective: To determine whether adding simulation-based cataract surgical training to conventional training results in improved acquisition of surgical skills among trainees.

Design, setting, and participants: A multicenter, investigator-masked, parallel-group, randomized clinical educational-intervention trial was conducted at 5 university hospital training institutions in Kenya, Tanzania, Uganda, and Zimbabwe from October 1, 2017, to September 30, 2019, with a follow-up of 15 months. Fifty-two trainee ophthalmologists were assessed for eligibility (required no prior cataract surgery as primary surgeon); 50 were recruited and randomized. Those assessing outcomes of surgical competency were masked to group assignment. Analysis was performed on an intention-to-treat basis.

Interventions: The intervention group received a 5-day simulation-based cataract surgical training course, in addition to standard surgical training. The control group received standard training only, without a placebo intervention; however, those in the control group received the intervention training after the initial 12-month follow-up period.

Main outcomes and measures: The primary outcome measure was overall surgical competency at 3 months, which was assessed with a validated competency assessment rubric. Secondary outcomes included surgical competence at 1 year and quantity and outcomes (including visual acuity and posterior capsule rupture) of cataract surgical procedures performed during a 1-year period.

Results: Among the 50 participants (26 women [52.0%]; mean [SD] age, 32.3 [4.6] years), 25 were randomized to the intervention group, and 25 were randomized to the control group, with 1 dropout. Forty-nine participants were included in the final intention-to-treat analysis. Baseline characteristics were balanced. The participants in the intervention group had higher scores at 3 months compared with the participants in the control group, after adjusting for baseline assessment rubric score. The participants in the intervention group were estimated to have scores 16.6 points (out of 40) higher (95% CI, 14.4-18.7; P < .001) at 3 months than the participants in the control group. The participants in the intervention group performed a mean of 21.5 cataract surgical procedures in the year after the training, while the participants in the control group performed a mean of 8.5 cataract surgical procedures (mean difference, 13.0; 95% CI, 3.9-22.2; P < .001). Posterior capsule rupture rates (an important complication) were 7.8% (42 of 537) for the intervention group and 26.6% (54 of 203) for the control group (difference, 18.8%; 95% CI, 12.3%-25.3%; P < .001).

Conclusions and relevance: This randomized clinical trial provides evidence that intense simulation-based cataract surgical education facilitates the rapid acquisition of surgical competence and maximizes patient safety.

Trial registration: Pan-African Clinical Trial Registry, number PACTR201803002159198.

While Doppler ultrasound screening is beneficial for women with high-risk pregnancies, there is insufficient evidence on its benefits and harms in low- and unselected-risk pregnancies. This may be related to fewer events of abnormal Doppler flow, however the prevalence of absent or reversed end diastolic flow (AEDF or REDF) in such women is unknown. In this systematic review, we aimed to synthesise available data on the prevalence of AEDF or REDF.

Staphylococcus aureus cause diseases both in humans and animals. These diseases range from mild to fatal infections thus necessitating development of a specific molecular method for detection of pathogenic S. aureus.

To evaluate the association between obstetric and medical risk factors and stillbirths in a Kenyan set-up.

Three new (-) and 25 known compounds were isolated from the crude extract of . The chemical structures of new compounds were established by extensive spectroscopic analyses including 1D and 2D NMR and HRESIMS. Cassiabrevone () is the first heterodimer of guibourtinidol and planchol A. Compound was a new chalcane, while was a new naphthalene. Cassiabrevone (), guibourtinidol-(4α→8)-epiafzelechin (), taxifolin (), oleanolic acid (), piceatannol (), and palmitic acid (), exhibited potent anti-HIV-1 activity with IC values of 11.89 µM, 15.39 µM, 49.04 µM, 7.95 µM, 3.58 µM, and 15.97 µM, respectively.

Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.

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

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

Infections are among the leading causes of maternal mortality and morbidity. The Global Maternal Sepsis and Neonatal Initiative, launched in 2016 by WHO and partners, sought to reduce the burden of maternal infections and sepsis and was the basis upon which the Global Maternal Sepsis Study (GLOSS) was implemented in 2017. In this Article, we aimed to describe the availability of facility resources and services and to analyse their association with maternal outcomes.

Transrenal urine cell-free DNA (cfDNA) is a promising tuberculosis (TB) biomarker, but is challenging to detect because of the short length (<100 bp) and low concentration of TB-specific fragments. We aimed to improve the diagnostic sensitivity of TB urine cfDNA by increasing recovery of short fragments during sample preparation. We developed a highly sensitive sequence-specific purification method that uses hybridization probes immobilized on magnetic beads to capture short TB cfDNA (50 bp) with 91.8% average efficiency. Combined with short-target PCR, the assay limit of detection was ≤5 copies of cfDNA in 10 ml urine. In a clinical cohort study in South Africa, our urine cfDNA assay had 83.7% sensitivity (95% CI: 71.0 to 91.5%) and 100% specificity (95% CI: 86.2 to 100%) for diagnosis of active pulmonary TB when using sputum Xpert MTB/RIF as the reference standard. The detected cfDNA concentration was 0.14 to 2,804 copies/ml (median 14.6 copies/ml) and was inversely correlated with CD4 count and days to culture positivity. Sensitivity was nonsignificantly higher in HIV-positive (88.2%) compared to HIV-negative patients (73.3%), and was not dependent on CD4 count. Sensitivity remained high in sputum smear-negative (76.0%) and urine lipoarabinomannan (LAM)-negative (76.5%) patients. With improved sample preparation, urine cfDNA is a viable biomarker for TB diagnosis. Our assay has the highest reported accuracy of any TB urine cfDNA test to date and has the potential to enable rapid non-sputum-based TB diagnosis across key underserved patient populations.

Prematurity is the leading cause of global neonatal and infant mortality. Many babies could survive by the provision of essential newborn care. This qualitative study was conducted in order to understand, from a family and professional perspective, the barriers and facilitators to essential newborn care. The study will inform the development of an early warning score for preterm and low birthweight infants in low and middle income countries (LMICs).

About 2.6 million stillbirths per year occur globally with 98% occurring in low- and middle-income countries including Kenya, where an estimated 35 000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden.

The World Health Organization's (WHO) Labour Care Guide (LCG) is a "next-generation" partograph based on WHO's latest intrapartum care recommendations. It aims to optimize clinical care provided to women and their experience of care. We evaluated the LCG's usability, feasibility, and acceptability among maternity care practitioners in clinical settings.

Complications of respiratory infections including pleural effusion (PE) are associated with a high morbidity. Differentiating between PE caused by (Mtb) infection and other bacterial infections in endemic areas is difficult in children, thus, impacting treatment.

Tropical Africa experienced large changes in hydroclimatic conditions since the Last Glacial Maximum (LGM), ∼26.5 to 19 thousand years (ka or kyr) ago. The hydrogen isotopic composition of fossil leaf waxes (δDwax), assumed to record past variations in the hydrogen isotopic composition of precipitation (δDprecip), is increasingly being used to study past hydroclimatic change in Africa, and are commonly interpreted to reflect variation in the amount of precipitation through time (i.e., the amount effect). Although there are now many such δDprecip records from tropical Africa, there are few robust δDprecip records from easternmost equatorial Africa of sufficient length and resolution to evaluate the mechanisms governing hydroclimate variation during and since the LGM. We produced a new δDprecip record based on analyses of δDwax in sediment cores collected from Lake Rutundu, situated at an elevation of 3,078 meters above sea level (m asl) on Mt. Kenya. This record displays large variations in δDprecip corresponding with known climate events over the past 25 kyr, including D-enrichment during the Heinrich 1 stadial (H1) and the Younger Dryas (YD), and D-depletion during the Holocene portion of the African Humid Period (AHP). We also observe D-depletion during the LGM relative to the late Holocene, which, considering the amount effect, could be interpreted to imply that LGM climate conditions were wetter than today. However, because other hydroclimate proxies at this site indicate a drier LGM climate at Lake Rutundu, and since precipitation isotopes at this high-elevation site are likely influenced by different processes than at low elevations, we used a single-column Rayleigh distillation model to evaluate temperature and altitude-related effects on high-elevation δDprecip. This revealed that a change in the temperature lapse rate exerts strong control on δDprecip in this high-elevation setting, and that a steeper lapse rate could explain the observed D-depletion during the LGM at our site. Comparison of the Lake Rutundu δDprecip record with other leaf-wax based δDprecip records from East Africa indicates that changes in the meridional precipitation gradient associated with the mean annual position and intensity of the tropical rain belt, in turn driven by precessional insolation forcing, were likely a primary control on East African hydroclimate over the past 25 kyr, thereby contributing to overall regional drying during the LGM.

Tropical Africa experienced large changes in hydroclimatic conditions since the Last Glacial Maximum (LGM), ∼26.5 to 19 thousand years (ka or kyr) ago. The hydrogen isotopic composition of fossil leaf waxes (δDwax), assumed to record past variations in the hydrogen isotopic composition of precipitation (δDprecip), is increasingly being used to study past hydroclimatic change in Africa, and are commonly interpreted to reflect variation in the amount of precipitation through time (i.e., the amount effect). Although there are now many such δDprecip records from tropical Africa, there are few robust δDprecip records from easternmost equatorial Africa of sufficient length and resolution to evaluate the mechanisms governing hydroclimate variation during and since the LGM. We produced a new δDprecip record based on analyses of δDwax in sediment cores collected from Lake Rutundu, situated at an elevation of 3,078 meters above sea level (m asl) on Mt. Kenya. This record displays large variations in δDprecip corresponding with known climate events over the past 25 kyr, including D-enrichment during the Heinrich 1 stadial (H1) and the Younger Dryas (YD), and D-depletion during the Holocene portion of the African Humid Period (AHP). We also observe D-depletion during the LGM relative to the late Holocene, which, considering the amount effect, could be interpreted to imply that LGM climate conditions were wetter than today. However, because other hydroclimate proxies at this site indicate a drier LGM climate at Lake Rutundu, and since precipitation isotopes at this high-elevation site are likely influenced by different processes than at low elevations, we used a single-column Rayleigh distillation model to evaluate temperature and altitude-related effects on high-elevation δDprecip. This revealed that a change in the temperature lapse rate exerts strong control on δDprecip in this high-elevation setting, and that a steeper lapse rate could explain the observed D-depletion during the LGM at our site. Comparison of the Lake Rutundu δDprecip record with other leaf-wax based δDprecip records from East Africa indicates that changes in the meridional precipitation gradient associated with the mean annual position and intensity of the tropical rain belt, in turn driven by precessional insolation forcing, were likely a primary control on East African hydroclimate over the past 25 kyr, thereby contributing to overall regional drying during the LGM.

BackgroundManagement and control of the COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus SARS-CoV-2 is critically dependent on quick and reliable identification of the virus in clinical specimens. Detection of viral RNA by a colorimetric reverse transcription loop-mediated isothermal amplification (RT-LAMP) is a simple, reliable and cost-effective assay, deployable in resource-limited settings (RLS). Our objective was to evaluate the intrinsic and extrinsic performances of RT-LAMP in RLS.
Methods
This is a multicenter prospective observational study of diagnostic accuracy, conducted from October 2020 to February 2021 in four African Countries: Cameroon, Ethiopia, Kenya and Nigeria; and in Italy. We enroled 1657 individuals who were either COVID-19 suspect cases, or asymptomatic and presented for screening. RNA extracted from pharyngeal swabs was tested in parallel by a colorimetric RT-LAMP and by a standard real time polymerase chain reaction (RT-PCR).
Findings
The sensitivity and specificity of index RT LAMP compared to standard RT-PCR on 1657 prospective specimens from infected individuals was determined. For a subset of 1292 specimens, which underwent exactly the same procedures in different countries, we obtained very high specificity (98%) and positive predictive value (PPV = 99%), while the sensitivity was 87%, with a negative predictive value NPV = 70%, Stratification of RT-PCR data showed superior sensitivity achieved with an RT-PCR cycle threshold (Ct) below 35 (97%), which decreased to 60% above 35.
Interpretation
In this field trial, RT-LAMP appears to be a reliable assay, comparable to RT-PCR, particularly with medium-high viral loads (Ct < 35). Hence, RT-LAMP can be deployed in RLS for timely management and prevention of COVID-19, without compromising the quality of output.

Delayed cord clamping (DCC) is a placental to new-born transfusion strategy recommended by obstetric and gynaecological societies. Though not widely adopted, umbilical cord milking (UCM) may achieve faster transfusion when DCC cannot be performed such as when a neonate requires resuscitation.

The Maasai pastoralists inhabiting Kajiado County have been known for their rich cultural values which have sustained their livelihoods. However, these cultural practices are evolving under the swift development context with the private holding of land becoming more prevalent. Before these disturbances, customary land was available for the Maasai pastoralists to carry out traditional production systems. The disturbance in their social-cultural ways following land fragmentation has rendered their traditional governance system untenable. Moreover, the Maasai pastoralists have been dispossessed from their customary land and social institutions which have shaped their customs. Thus, concerns have been raised over the sustenance of pastoralism considering that the required resources are either unavailable or not enough. To address this gap, there was the need to understand cultural adjustments and their impacts on the Maasai pastoralists’ societal needs. The study employed a cross-sectional design which consisted of 195 Household survey questionnaires, 8 Focus Group Discussions and 18 Key Informant Interviews. The qualitative and quantitative data from the study were summarized and thematic perceptions generated. The results of this study revealed the uniqueness of the Maasai pastoralists’ traditional social structures. Also highlighted by the study was the erosion of the traditional social relations exposing the Maasai pastoralists to increasing vulnerability. These findings support the need for external support to supplement the traditional coping strategies to balance the ecological, social and economic systems of the Maasai pastoralists.

Tuberculosis (TB) is the leading cause of mortality as a single infectious agent globally with increasing numbers of case notification in developing countries. This study seeks to investigate the clinical and socio-demographic factors of time to TB treatment interruption among Tuberculosis patients in Kiambu County, 2016-2019. We retrospectively analyzed data for all treatment outcomes patients obtained from TB tracing form linked with the Tuberculosis Information Basic Unit (TIBU) of patients in Kiambu County health facilities using time to treatment interruption as the main outcome. Categorical variables were presented using frequency and percentages. Kaplan-Meir curve was used to analyze probabilities of time to treatment interruptions between intensive and continuation phases. Log-rank test statistics was used to compare the equality of the curves. Cox proportion model was used to determine determinants of treatment interruption. A total of 292 participants were included in this study. Males were 68%, with majority (35%) of the participants were aged 24-35 years; 5.8% were aged 0-14 years and 5.1% aged above 55 years. The overall treatment success rate was 66.8% (cured, 34.6%; completed 32.2%), 60.3% were on intensive phase of treatment. Lack of knowledge and relocation were the major reasons of treatment interruptions. Patients on intensive phase were 1.58 times likely to interrupt treatment compared to those on continuation phase (aHR: 1.581; 95%CI: 1.232-2.031). There is need to develop TB interventions that target men and middle aged population in order to reduce treatment interruption and increase the treatment success rates in the County and Country.

HIV-related stigma, lack of disclosure and social support are still a hindrance to HIV testing, care, and prevention. We evaluated the influence of these socio-phycological status on nevirapine (NVP) and efavirenz (EFV) plasma concentrations among HIV patients in Kenya. Blood samples were obtained from 254 and 312 consenting HIV patients on NVP and EFV based first-line Antiretroviral therapy (ART) respectively and a detailed structured questionnaire was administered. The NVP and EFV plasma level was measured by liquid chromatography - tandem mass spectrometry (LC-MS/MS). The median duration of living with HIV infection was 5 years (IQR = 1–11years) and a median duration since ART initiation was 3 years (IQR = 1–8 years). There were 68.1% and 65.4% of the patients on NVP and EFV respectively who did not feel guilty for being HIV positive. The disclosure rate was about 96.1% and 94.6% of patients on NVP and EFV respectively. About 85% and 78.2% of patients on NVP and EFV respectively who got social support as much as needed. The non-adherence to ART in the past 30 days was 64.6% and 66.3% patients on NVP and EFV respectively. The median (IQR) plasma concentration were [6237.5 ng/mL, IQR 45188–8964 ng/mL] for NVP and [2739.5 ng/mL, IQR 1878 –4891.5 ng/mL] for EFV. There were 14.2% and 4.5% patients on NVP and EFV respectively with suboptimal plasma concertation associated with poor viral suppression. Multivariate linear regression analysis showed feeling guilty for being HIV positive (adjusted β = 954 , 95% CI = 192.7 to 2156.6 ; p =0.014) or feeling worthless for being HIV positive (adjusted β = 852 , 95% CI = 64.3 to 1639.7 ; p =0.034); being certain of telling the primary sexual partner about HIV positive status (adjusted β 363, 95% CI, 97.9 to 628.1; p = 0.007); disclosing HIV status to neighbors (adjusted β = 1731 , 95% CI = 376 to 3086 ; p =0.012) and getting transportation to hospital whenever needed (adjusted β = -1143.3, 95% CI = -1914.3 to -372.4 ; p =0.004) were associated with NVP/EFV plasma levels. The NVP and EFV plasma level was highly heterogenous with a significant proportion of patients reporting levels correlated with poor viral suppression. The patient’s stigma, lack of disclosure and social support contributes significantly on the overall ART treatment outcome. Taking these factors into consideration, HIV treatment may be personalized to achieve optimal treatment success

A recent research study on prevalence of tick-borne pathogens in Burundi reported high prevalence and endemicity of Theileria parva, Anaplasma marginale and Babesia bigemina infections in cattle. Detailed information about tick species infesting animals, their distribution and genetic diversity in Burundi is outdated and limited. This study therefore assessed the prevalence and genetic diversity of tick species infesting cattle across agroecological zones (AEZs) in Burundi. A cross-sectional study on the occurrence of tick species was conducted in 24 districts of Burundi between October and December 2017. Differential identification and characterization of ticks collected was conducted using tick morphological keys and molecular tools (cox1 and 12S rRNA gene). Chi-square test was used to test for association between agroecological zones and the prevalence of tick species. Phylogenetic relationships were inferred using bayesian and maximum likelihood algorithms. A total of 483 ticks were collected from the five AEZs sampled. Six tick species comprising of Rhipicephalus appendiculatus, R. sanguineus, R. evertsi evertsi, R. microplus, R. decoloratus and Amblyomma variegatum were observed. Rhipicephalus appendiculatus were the most prevalent ticks (~45%). A total of 138 specimens (28%) were found to be Rhipicephalus microplus, suggesting an emerging threat for cattle farmers. Twelve R. appendiculatus cox1 haplotypes were obtained from 106 specimens that were sequenced. Two cox1 haplotypes of R. microplus which clustered into previously reported Clade A were observed. Rhipicephalus sanguineus and R. evertsi evertsi ticks, the vectors of numerous zoonotic pathogens, were collected from cattle, which constitute a high risk for public health. These findings reveal an overlapping distribution of tick vectors in Burundi. The design of ticks and tick-borne diseases control strategies should consider the distribution of different vectors across the AEZs particularly the presence of the highly invasive R. microplus tick in Burundi and the potential risk of introducing the pathogenic Babesia bovis.

This study aimed at determining the tick species infesting dairy cattle in Nairobi, Kenya, and the pathogens they harbour. While ticks are well-known vectors of major bacterial pathogens of both veterinary importance and public health importance, few studies have investigated the range of the tick species and the associated pathogens, especially present in unique dairy production systems, which compromise animal welfare, such as those in peri-urban areas. A cross-sectional study was undertaken involving 314 randomly selected dairy cattle in 109 smallholder farms. Each animal was examined for attached ticks followed by morphological tick identification at the species level. Genomic DNA was extracted from each of the ticks, and 16S rDNA gene was amplified for pathogen identification. Sequencing of the amplicons and subsequent BLASTn analysis, multiple sequence alignment, and phylogenetic reconstruction were performed to confirm the species of the pathogens. Sixty-six (21.0%) of the cattle examined had ticks. A total of 94 adult ticks were found on the cattle, and of these, 63 (67.0%), 18 (19.1%), and 13 (13.8%) were in the genera Rhipicephalus, Amblyomma, and Hyalomma, respectively. Twelve tick species in Rhipicephalus genus and two in Amblyomma and Hyalomma genera were identified. Although Rh. decoloratus was the most prevalent tick (24.5% (23/94)), the emerging Rh. microplus (6.4% (6/94)) was also identified. The DNA of Rickettsia was detected in the ticks, with Rickettsia conorii in H. rufipes and A. variegatum, and Rickettsia aeschlimannii in Rh. microplus and H. rufipes, while Ehrlichia ruminantium and E. canis were in A. variegatum. In conclusion, the study reported a wide range of tick species present in the study area including Rhipicephalus microplus, which is an emerging tick species in parts of Kenya. The ticks harboured DNA of Rickettsia and Ehrlichia, highlighting possible animal and human health concerns. Hence, effective tick control strategies remain paramount to prevent potential diseases associated with the harboured pathogens.

{In the age of climate change, the efficient allocation, distribution and use of water raises complex issues for water management, with far-reaching and often contentious consequences. As water becomes scarcer, water-related tensions are imminent on different scales. It is the interplay of these tensions with a number of socioeconomic, political, environmental and cultural factors that determine the probability of conflict. Lamu, found in the coastal part of Kenya, is a unique location in that access to water is already a major challenge. Combined with the negative impacts of climate change, and the ongoing large infrastructural development in the region, Lamu is on the verge of a water crisis. As such, there is a need for research into the context-specific factors that play a part in heightening the potential for water-related conflict amidst increasing water scarcity. The focus of this study was to identify and evaluate the context-specific factors that will amplify the potential for water-related conflict in Lamu. The findings suggest religion, migration, and poverty are factors that would heighten the potential for water-related conflict in the region amidst increasing water scarcity. The study recommends that these factors need to be addressed urgently and should be part of any water management mechanism in Lamu, in order to avoid water-related conflicts. Additionally, the findings imply that anticipating the stressors for water-related conflict in Lamu will play a significant role in managing conflict and facilitating negotiations over the region's water resources.}

Self-regulated learning is attracting tremendous researches from various communities such as information communication technology. Recent studies have greatly contributed to the domain knowledge that the use self-regulatory skills enhance academic performance. Despite these developments in SRL, our understanding on the tools and instruments to measure SRL in online learning environments is limited as the use of traditional tools developed for face-to-face classroom settings are still used to measure SRL on e-learning systems. Modern learning management systems (LMS) allow storage of datasets on student activities. Subsequently, it is now possible to use Educational Data Mining to extract learner patterns which can be used to support SRL. This chapter discusses the current tools for measuring and promoting SRL on e-learning platforms and a conceptual model grounded on educational data mining for implementation as a solution to promoting SRL strategies.

The focus of this study was to review and evaluate the effectiveness of gamification within e-learning platforms. The study deployed systematic literature review methodology to evaluate how effective gamification has been used within e-learning platforms. The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Approach (PRISMA), starting with 366 articles, shifting to a final 34 articles for consideration. It was established that gamification positively influences and enhances learning within the e-learning platform. Therefore, the study recommends policy makers, designers, and implementers of e-learning platforms to consider incorporating gamification elements in order to increase user motivation and engagement for enhanced learning.

Key messages
Effective training is a key determinant for adopting online learning in educational institutions.
Transformational leadership characteristics are important in managing change that is required in learning
institutions during the COVID-19 pandemic and beyond.
Modelling the way is a necessity in university management of online teaching and learning through COVID-19 Season

Purpose
The study aims to estimate the rates of exposure to, and adoption of, rural bank credit programs by smallholder farmers in rural Ghana and the factors responsible for those rates.

Design/methodology/approach
The study used a random sample of 300 smallholder farmers in the Fanteakwa District of Ghana, obtained through the multistage sampling technique. The study also employed the average treatment effects approach to estimate the average treatment effect of farmers’ exposure to rural bank credit programs, on their adoption of such programs.

Findings
The actual adoption rate is approximately 41%, and the potential, conditional on the whole population being aware of rural bank credit programs, is approximately 61%. Accordingly, there is a gap of about 20% in the adoption of rural bank credit programs, and is due to the incomplete exposure of smallholder farmers to the rural bank credit programs. Age of the household head, access to extension services, membership in farmer-based organizations and active savings accounts with a rural bank are the major contributors to smallholder farmer exposure to and the adoption of rural bank credit programs.

Originality/value
The current study is the first of its kind to be conducted in Ghana on rural bank credit programs. It takes into account the extent to which smallholder farmers are exposed to such credit programs and how it influences their decisions to access or adopt.

This book chapter aims at exploring the preparation, characterization and applications of plant/animal fiber-reinforced polymer composites. The book addresses several key research work that have been happening as well as some of the drawbacks that affect the application of these composites in real-life applications. Each chapter begins with an overview of the various forms of plant/animal fiber-reinforced polymer composites, followed by examples of composites made up of plant/animal fibers and their promising future in terms of research and development and application in domestic and engineering products. Today, man has realized that if the environment is not preserved, the over-consumption of naturally existing resources and a drastic reduction in the amount of fresh air generated in the world would endanger him. Forest conservation and the efficient use of agricultural as well as other renewable resources such as solar, wind and tidal energy have already become critical issues globally.With this kind of concern, the utilization of renewable materials such as plant/animal fiber-reinforced polymeric composites is slowly becoming a key design requirement for the design and development of parts for a wide range of industrial products. An extensive research into such composites can, to an extent, lead to an even greener and healthier environment

The global use of alcohol-based hand sanitizers (ABHS) as an important means of controlling the transmission of infectious disease has increased significantly as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. This paper discusses the interplay between ABHS input (formulation) factors and output (product performance) factors in the context of a multidimen-sional perspective using a novel representative paradigm. In the model, represented in the form of a three-dimensional tetrahedron, each of the faces represents inputs in the manufacturing of the ABHS product, which are the type and amount of alcohol, the inactive ingredients, the formulation and the manufacturing practices. The four corners of the tetrahedron represent the product per-formance factors which include product efficacy, sensory characteristics, usage and compliance and product safety. The multidimensional approach to the formulation and evaluation of ABHS shows that several factors contribute to the effectiveness and utility of these products. The paradigm provides a useful framework for manufacturers of ABHS and related healthcare products.

A new iboga-vobasine-type isomeric bisindole alkaloid named voacamine A (1), along with eight known compounds—voacangine (2), voacristine (3), coronaridine (4), tabernanthine (5), ibox-ygaine (6), voacamine (7), voacorine (8) and conoduramine (9)—were isolated from the stem bark of Voacanga africana. The structures of the compounds were determined by comprehensive spec-troscopic analyses. Compounds 1, 2, 3, 4, 6, 7 and 8 were found to inhibit the motility of both the microfilariae (Mf) and adult male worms of Onchocerca ochengi, in a dose-dependent manner, but were only moderately active on the adult female worms upon biochemical assessment at 30 μM drug concentrations. The IC50 values of the isolates are 2.49–5.49 µM for microfilariae and 3.45–17.87 µM for adult males. Homology modeling was used to generate a 3D model of the O. ochengi thioredoxin reductase target and docking simulation, followed by molecular dynamics and binding free energy calculations attempted to offer an explanation of the anti-onchocercal struc-ture–activity relationship (SAR) of the isolated compounds. These alkaloids are new potential leads for the development of antifilarial drugs. The results of this study validate the traditional use of V. africana in the treatment of human onchocerciasis.

Description
Introduction:
Macaranga species are traditionally used for the treatment and management of coughing, fungal infection, and wounds. In this study, the phytochemical screening and antibacterial activities of nine crude extracts from Macaranga conglomerata, Macaranga kilimandscharica and Macaranga capensis were determined against 13 bacterial strains expressing multi-drug resistance (MDR) phenotypes.
Methods:
Phytochemical screening of the extracts were carried out according to the standard methods, while the iodonitrotetrazolium chloride (INT) colorimetric assay was used to determine the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) of the plants extracts.
Results:
Flavonoids, terpenoids, saponins and coumarins were the major secondary metabolites found in all the plant extracts. The results of antibacterial studies revealed that all the plant extracts displayed good activities with MIC values ranging from 4–128 µg/mL against the tested micro-organisms. Most of the extracts exhibited a bactericidal effect against E. coli, E. aerogenes, K. pneumoniae, P. stuartii, P. aeruginosa, and

Description
In this study, the antileishmanial and cytotoxic activities of secondary metabolites isolated from Tabernaemontana ventricosa Hochst. ex A. DC., Aloe tororoana Reynolds, and Aloe schweinfurthii var. labworana Reynolds were investigated. Overall, nineteen known compounds were isolated from the three plant species. The compounds were characterized based on their spectroscopic data. Voacristine and aloenin were the most active compounds against promastigotes of antimony-sensitive Leishmania donovani (IC50 11 ± 5.2 μM and 26 ± 6.5 µM, respectively) with low toxicity against RAW264.7, murine monocyte/macrophage-like cells. The in silico docking evaluation and in vitro NO generation assay also substantially support the antileishmanial effects of these compounds. In a cytotoxicity assay against cancer and normal cell lines, ursolic acid highly inhibited proliferation of lung cancer cells, A549 …

Background: Africa has one of the highest incidences of gonorrhea. Neisseria gonorrhoeae is gaining resistance to most of the available antibiotics, compromising treatment across the world. Whole-genome sequencing (WGS) is an efficient way of predicting AMR determinants and their spread in the population. Recent advances in next-generation sequencing technologies like Oxford Nanopore Technology (ONT) have helped in the generation of longer reads of DNA in a shorter duration with lower cost. Increasing accuracy of base-calling algorithms, high throughput, error-correction strategies, and ease of using the mobile sequencer MinION in remote areas lead to its adoption for routine microbial genome sequencing. To investigate whether MinION-only sequencing is sufficient for WGS and downstream analysis in resource-limited settings, we sequenced the genomes of 14 suspected N. gonorrhoeae isolates from Nairobi, Kenya.

Methods: Using WGS, the isolates were confirmed to be cases of N. gonorrhoeae (n = 9), and there were three co-occurrences of N. gonorrhoeae with Moraxella osloensis and N. meningitidis (n = 2). N. meningitidis has been implicated in sexually transmitted infections in recent years. The near-complete N. gonorrhoeae genomes (n = 10) were analyzed further for mutations/factors causing AMR using an in-house database of mutations curated from the literature.

Results: We observe that ciprofloxacin resistance is associated with multiple mutations in both gyrA and parC. Mutations conferring tetracycline (rpsJ) and sulfonamide (folP) resistance and plasmids encoding beta-lactamase were seen in all the strains, and tet(M)-containing plasmids were identified in nine strains. Phylogenetic analysis clustered the 10 isolates into clades containing previously sequenced genomes from Kenya and countries across the world. Based on homology modeling of AMR targets, we see that the mutations in GyrA and ParC disrupt the hydrogen bonding with quinolone drugs and mutations in FolP may affect interaction with the antibiotic.

Conclusion: Here, we demonstrate the utility of mobile DNA sequencing technology in producing a consensus genome for sequence typing and detection of genetic determinants of AMR. The workflow followed in the study, including AMR mutation dataset creation and the genome identification, assembly, and analysis, can be used for any clinical isolate. Further studies are required to determine the utility of real-time sequencing in outbreak investigations, diagnosis, and management of infections, especially in resource-limited settings.

Description
Five known compounds (1–5) were isolated from the extract of Mundulea sericea leaves. Similar investigation of the roots of this plant afforded an additional three known compounds (6–8). The structures were elucidated using NMR spectroscopic and mass spectrometric analyses. The absolute configuration of 1 was established using ECD spectroscopy. In an antiplasmodial activity assay, compound 1 showed good activity with an IC50 of 2.0 μM against chloroquine-resistant W2, and 6.6 μM against the chloroquine-sensitive 3D7 strains of Plasmodium falciparum. Some of the compounds were also tested for antileishmanial activity. Dehydrolupinifolinol (2) and sericetin (5) were active against drug-sensitive Leishmania donovani (MHOM/IN/83/AG83) with IC50 values of 9.0 and 5.0 μM, respectively. In a cytotoxicity assay, lupinifolin (3) showed significant activity on BEAS-2B (IC50 4.9 μM) and HePG2 (IC50 10.8 μM …

One highly undesirable characteristic of mature assets that inhibits oil recovery is high
water production. Polymer gel treatment is a popular conformance improvement technique applied
in this regard due to its cost effectiveness and proved efficiency. Despite this popularity, optimum
performance of polymer hydrogels in water shut off is inhibited by excessive aggregation, difficulty
in controlling gelation, and their instability at high temperature and high salinity reservoir conditions.
To address these shortcomings, research on the application of nanoparticles (NPs) in polymer
hydrogels to manage thermal stability and salinity sensitivity has significantly increased in the recent
past. By incorporating metal-based NPs, silica or graphene at nanoscale; the gel strength, storage
modulus, salinity tolerance and thermal stability of commonly used polymers have been greatly
enhanced. In this paper, the advances in experimental studies on polymer-based nanocomposites are
discussed and field experiences from adoption of polymer composites reviewed.

Abstract
Sulal River is a victim of nutrient pollution as it crosses different small-scale tea farms in Bureti Sub County, Kericho County. A study was conducted to evaluate different physicochemical parameters and major chemical fertilizer’s nutrients levels in water and sediments from Sulal River. In order to understand the degree of pollution in the river due to inflow of agricultural chemical fertilizer residue levels from its catchment, the samples were collected in the dry (February 2019) and wet seasons (November 2019). The ten chosen sampling sites stretched a length of 12 Km. Samples were analyzed for pH, dissolved oxygen (DO), total dissolved solids (TDS), electrical conductivity (EC), sediment and water content (WC), nitrate-nitrogen (NO3-N), phosphorous (PO3-P) and potassium (K) using standard methods. Results were analyzed using IBM SPSS 20. The average results during dry and wet seasons in water samples for pH were 6.72±0.05 and 6.38±0.21, DO 6.78±0.59 and 9.58±0.64 mg/L, EC 174±5.02 and 205±20.14 µS /cm, TDS 92±4.59 and 120.70±19.57 mg/L, NO3-N 0.58±0.21 and 1.19±0.22 mg/L, PO3-P 0.00±0.00 and 0.13±0.84 mg/L and K 0.26±0.08 and 0.84±0.19 mg/L respectively. The average results during dry and wet seasons in sediment samples for pH were 6.62±0.20 and 6.75±0.17, EC, 67±6.66 and 52±10.19 µS /cm, WC 16.96±3.95 and 129.84±5.00%, NO3-N 0.70±0.35 and 0.42±0.23 mg/kg, PO3-P 0.49±0.25 and 1.14±0.40 mg/kg and K 1.53±0.45 and 2.86±0.31 mg/kg respectively. The levels of P in water during wet season and in sediments samples in both seasons were however, above the WHO (0.025 mg/L) and KEBS (0.030 mg/L) recommended limit for drinking and domestic use and WASREB (0.005 mg/L) level for the likelihood of eutrophication. Availability of excess phosphorus can accelerate eutrophication. The diversity of cancers has also been associated with drinking water containing phosphorous levels. The water from Sulal River may be used for irrigation purposes but not for drinking and domestic purposes. Significant seasonal variations were observed in all parameters analyzed except NO3-N in sediments. This indicates that rainfall had a great effect on some soil physicochemical properties.

Description
The study was carried out to evaluate the levels of heavy metals in groundwater samples from ten selected boreholes in Ongata Rongai town, Kajiado County. The selected heavy metals analyzed were: Zn, Pb, Hg, Mn, Cd and Cr in the dry and wet seasons. The effect of the proximity of septic tanks distance to borehole was also determined. The statistical analyses of the data using a 2-way ANOVA showed 95% confidence level (p< 0.05) interdependence of the distance from the boreholes and contaminant levels. The study showed that heavy metals were below the maximum recommended level and the guideline values of World Health Organization and Kenya Bureau of Standards. The analyses of the selected heavy metals, by Flame Atomic Absorption Spectroscopy, revealed that the detected levels of Mn (0.03±0.01-0.26±0.01 mgl-1) were higher than those recommended by WHO and KEBS of 0.01 mgl-1, while Zn (0.11±0.02-0.73±0.01 mgl-1) are within acceptable levels of WHO (3.0 mgl-1) and KEBS (5.0 mgl-1). There was no strong correlation between the distance of borehole from septic tanks and heavy metal levels in water samples. The low detected values should not be overlooked as the heavy metals are capable of bio-accumulating in body tissues.

Bacground: Anemia is a major public health problem in Africa with an increasing number of children under 5
years getting infected. Guinea is one of the most affected countries. In 2018, the prevalence rate was 75% in
children under 5 years. This study sought to identify the factors associated with anemia and to map spatial
variation of anemia across the eight (8) regions in Guinea for children under 5 years, which can provide
guidance for control programs for the reduction of the disease.
Methods: Data from the Guinea Multiple Indicator Cluster Survey (MICS5) 2016 was used for this study. A
total of 2609 children under 5 years who had full covariate information were used in the analysis. Spatial
binomial logistic regression methodology was undertaken via Bayesian estimation based on Markov chain
Monte Carlo (McMC) using WinBUGS software version 1.4.
Results: Our findings revealed that 77% of children under 5 years in Guinea had anemia and the prevalence in
the regions ranged from 70.32% (Conakry) to 83.60% (N’Zerekore) across the country. After adjusting for non
spatial and spatial random effects in the model, older children (48–59 months) (OR: 0.47, CI [0.29 0.70]) were
less likely to be anemic compared to those who are younger (0-11 months). Children whose mothers have
completed secondary education or more had a reduced chance of anemia infection by 33% (OR: 0.67, CI [0.49
0.90]) and Children from household heads from Kissi ethnic group are less likely to have anemia than their
counterparts whose leader is from Soussou (OR: 0.48, CI [0.22 0.91]).
Conclusion: The spatial analysis allowed the identification of high-risk areas as well as the identification of
socio-economic and demographic factors associated with anemia among children under 5 years. Such an
analysis is important in helping policy makers and health practitioners in developing programs geared towards
control and management of anemia among children under 5 years in the country.

Abstract
Hemorrhage is the main cause of Maternal Mortality (MM) (27%) followed by hypertensive disorders and sepsis (12%). Septic abortion is considered an intermediate risk factor for the development of Massive Obstetric Hemorrhage (MOH). The algorithm for the management of postpartum hemorrhage due to uterine atony that includes systematic pelvic devascularization has been described, but this management is really planned for resolution of the pregnancy after the 20th week of gestation, since an HMO due to abortion is un usual. We present the case of a 21-year-old patient who self-medicates a prostaglandin analog at 2 months of pregnancy, achieving only a threat of abortion, goes to the emergency room 3 months later with a diagnosis of septic shock, USG and MRI are performed with altered results, only of hepatomegaly, delayed abortion of 8 weeks of evolution and gestational trophoblastic disease. Emergency MVA was performed due to profuse bleeding, placement of a Bakri balloon and clamping of the uterine arteries without results, for which an emergency exploratory laparotomy (LAPE) was performed with ligation of the anterior trunk of the internal iliac artery, being a successful procedure, without the need for Obstetric Hysterectomy (HO). The patient is managed in intensive care and in the end the diagnosis of TSG is ruled out. Bilateral Hypogastric Artery Ligation (BHAL) in the case of Massive Obstetric Hemorrhage (MOH) secondary to delivery or cesarean section is commonly used, however it is not a technique to report when bleeding is secondary to abortion. In these cases, it is also a viable, successful, fertility-preserving surgical procedure, and an alternative to Obstetric Hysterectomy (OH) when other less invasive methods such as uterine artery clamping or Bakri balloon have failed.

Abstract: Civil conflict in Somalia is considered one of the major and worst crisis in Africa’s recent history. Due to this, Somalia had
operated with an unstable functioning government for now over twenty years. This state of affairs has led to majority of the civilian
population acquiring arms illegally for their protection. The study sought to explore the key challenges facing AMISOM in its bid to
restore peace in Somalia. The study was based on the theory of conflict transformation. The study utilized primary data, which was
collected using structured questionnaires and interview schedules. The unit of analysis constituted a sample size of 100 respondents
drawn from the military, police, and civilian components of AMISOM and Somali civilian population working within Halane Base
Camp, with a combined target population of 24,643. Quantitative data was descriptively analyzed using the percentages and qualitative
data was analyzed using themes emerging from the data. The study found out thatclan dynamics in the conflict torn Somalia remains
the biggest hindrance to the achievement of peace and stability. This is coupled by the weak government structures that underpin
inadequacy of support to AMISOM operations. The study recommends that there isneed for AMISOM to increase involvement with
civilians as they stand important in peace building initiatives, intelligence, mediation and prevention of conflict.