This study was done at Machakos District Hospital in the Eastern province of Kenya between May and August 2007.Aim was to find out the role of hormonal contraceptives in HIV infection among antennal mothers. Analytical cross- sectional study design was used. Methodology. The sample size consisted of 144 antenatal mothers visiting the MCH clinic for PMTCT services among other services. The simple random sampling technique included every 8th antenatal mother visiting the PMTCT clinic who had no history of consisted condom use. All antenatal mothers who had not used condoms consistedly both contraceptive and non-contraceptive users who fell in the sampling frame acted as study subjects. This was on condition that they consented to participate in the study. A self

Mentorship programs are offered to support students in program completion, confidence building and transitioning to further education or the work force. However mentoring relationships have been faced by challenges such as inadequate knowledge and negative attitude. This study aimed at evaluating knowledge, attitude and perceived benefits on mentorship among the nursing students in Kenyan universities. The study was conducted in September, 2009.  A descriptive cross sectional survey  used both qualitative and quantitative methods to gather information. The study participants were students from University of Nairobi (U.O.N) and Kenya Methodist University (K.E.M.U). A sample of 188 students was selected from a total population of 403 in both universities. The data were coded, entered and analyzed using statistical package for social sciences (SPSS). Presentation of data was done in form of descriptive statistics, frequency distribution and graphs. Pearsons chi square tests were used to compare the two groups. The tests level of significance was set at 5%. Results showed that there was a significance difference between mentorship programmes in the two institutions ( χ 2= 17.02,  d.f=1 , p < 0.001)           . Fourty four (72%) of the students at K.E.M.U felt that the program had positive impact on students

The study sought to establish the factors affecting the diploma graduates performance in the Nursing registration examination. Necessitated by poor performance recorded in recent years, this study was aimed at seeking to establish the reasons why. This was a descriptive study. Quantitative data was collected using self-administered semi structured questionnaires from 75 KRCHN graduates working at Kenyatta National Hospital. The study areas were purposively selected and the study subjects selected through simple random sampling. Qualitative data was collected using a study from lecturers

Necessitated by poor performance recorded in recent years, this descriptive study sought to establish the impact of students and teacher characteristics on performance in the Nursing registration examination. The study combined both qualitative and quantitative methods. Quantitative data was collected using self-administered semi structured questionnaires from 75 KRCHN graduates working at Kenyatta National Hospital. The study areas were purposively selected and the study subjects selected through simple random sampling. Qualitative data was collected using a study guide from lecturers

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

 Prof. Anna Karani on - Authentic Leadership focus on impact of integrity so that leadership is better prepared to face the toughest challenges, inspire transparency and trust. It requires building in mind the customers served. Behaviour change is essential for long term growth and it avoids peripheral vision. Focused leadership identifies the missing link, addresses priority issues and information that is accurate, complete, economical, flexible, reliable, simple, timely, and verifiable. Nurses have a purpose, a destiny and need to accomplish things. They are trained to make a difference in peoples

 The  research evaluated clinical training provided by the academic institutions that offer Bachelor of Science in Nursing (BScN) program. The purpose of the study was to describe the adequacy of clinical training and the graduates preparedness for nursing practice. The study was conducted from Sept. 2008 to March 2010. Design was cross sectional using questionnaires and focus group interviews (FGI) methods to collect data. The sample comprised of 232 subjects including pre-service BScN graduates and nursing supervisors at four teaching and referral hospitals in Kenya. Results revealed that clinical training provided by academic institutions was adequate but quality of training varied widely among the training institutions. The conclusion was that clinical training provided by BScN programs in Kenya was of high quality. The study recommends that urgent attention was required by nurse educators to address identified gaps in clinical training especially clinical instruction and supervision.   

This paper describes the methodology and presents preliminary results of an economic appraisal of a community based health care project in Kenya. Community health workers, trained for 12 weeks and deployed in two locations in Kenya's Western Province, act as first contact providers of basic health care and promoters of selected health, sanitation and nutrition practices. A Cost Benefit Analysis has been undertaken using the Willingness to Pay approach to compare the costs of the project and its benefits. The benefits are in the form of more easily accessible basic health care and are measured as consumer surplus accruing to the community. Gain in consumer surplus is consequent on the fall of average user costs and rise in utilisation of the project established points of first contact with primary health care. The argument for the economic viability of the project is validated by the large Net Present Value and Benefit Cost Ratio obtained for the whole of the project area and for the two locations separately. Although the evaluation technique used faces the problem of valuation of community time, aggregation of health care services at all points of first contact and the partial nature of cost benefit analysis evaluations, the results are strongly in favour of decentralisation of primary health care on similar lines in the rest of the country.

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

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

The study was conducted to investigate the clinical Competence of Bachelor of Science Nursing graduates working at Kenyatta National Hospital in March 2011. The objective was to assess the perceptions of graduate nurses about the nursing profession and the implications on the development of BScN undergraduates from the University of Nairobi and other Universities with a view to improving their perception about the profession  through continuing education and curriculum review. It was a cross sectional study with a sample size of 50 nurses, total population selected on purpose. A supervised questionnaire and focus group discussion tools were used for data collection.  The findings indicated that majority of the Bachelor of Science Nursing graduates

The old nurse was there during the colonial  era. They were trained mainly by missionaries who were Christians. Therefore, they had the discipline and the Christian foundation principles. The joy of a Christian institution like Kijabe is that it still has that foundation. So all is not lost. We have to make sure that the lost PASSION, LOVE & CARE are back in the nursing profession. We have to restore that passion. That idea or feeling

A leader is one who has the  Vision to see, Faith to believe, Will to learn, Humility to serve, Courage to do, Resilience to rise up in times of knock downs. What  is leadership? The ability to get things done through people.  What challenges have you encountered in leadership as you work? How have you overcome these challenges? What sets you apart from everybody else? What is it that you do differently from the nurse of to-day? It is your leadership. The way you do things for the community you serve. The commitment to serve selflessly. The way you are disciplined. It is not just money.  We all want to learn how to become more effective leaders in providing health care to the  community. We have to prepare for many challenges with the advanced technology, rapid development, and fast changing health systems, emerging diseases, rising poverty, hard economic times, changing social systems, Education , political , environment, climate among many others that affect the communities we serve. Facing Today

 Media resources are critical component in teaching and learning process. Studies indicate that media resources provide the substitute for direct learning experiences during instruction and enable educators to present the learners with the requisite experience necessary for the acquisition of appropriate knowledge, skills and attitudes.The researchers set out to explore the philosophical, psychological and educational basis that provides guidelines on the development of media resources in the effective education and training of health professionals. Methodology was a historical critique of information from books, journals,magazines and internet on media resources in Medical education.  The findings indicate that the process of media resources development and administration is highly creative venture according to Mason (1977).plan, prepare, present, preview and follow up activities after use of equipment. Therefore educators must be able to demonstrate these issues when developing and administering them. 

Authentic Leadership focus on impact of integrity so that leadership is better prepared to face the toughest challenges, inspire transparency and trust. It requires building in mind the customers served. Behaviour change is essential for long term growth and it avoids peripheral vision. Focused leadership identifies the missing link, addresses priority issues and information that is accurate, complete, economical, flexible, reliable, simple, timely, and verifiable. Nurses have a purpose, a destiny and need to accomplish things. They are trained to make a difference in peoples

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

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

Health care professionals are absorbed daily in the practices of their professional areas of specialization. Medical Educators,  spend their time catering to the educational needs of all health care professionals, whatever their specialization. A recent area of concern in the medical education curricula has been the inclusion of the topic

Health care professionals are absorbed daily in the practices of their professional areas of specialization. Pediatricians, for example spend most of their time catering to the needs of children, while nurses, pharmacists and dentists in their own areas. Medical Educators, however, spend their time catering to the educational needs of all health care professionals, whatever their specialization. A recent area of concern in the medical education curricula has been the inclusion of the topic

Health care professionals are absorbed daily in the practices of their professional areas of specialization. Pediatricians, for example spend most of their time catering to the needs of children, while nurses, pharmacists and dentists in their own areas. Medical Educators, however, spend their time catering to the educational needs of all health care professionals, whatever their specialization. A recent area of concern in the medical education curricula has been the inclusion of the topic

This paper is based on narrative performances collected in research by students of the University of Nairobi under the guidance of their lecturers. The fieldwork was conducted in February 2005 among nomadic communities in northern Kenya. The main thrust of the paper is to explore how Magdalene, a woman narrator, subverts the dominant masculine ideology inherent in the structure and orientation of oral narratives. The paper identifies the discrete and subtle ways in which the narrator seeks to undermine the manifest inclination of oral narratives towards male dominance. Considering that oral literature is a crucial tool in shaping the world view of a community (especially children), and bearing in mind that women artists perform many of the oral narratives, the imperceptible but subversive potential of such narration becomes even clearer.

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

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

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

Background: Utrasound  technology continues advancing in techniques and diagnosis. It remains a field of specialists where nurses and other health workers are uneducated on it. Objectives: Determine pattern of ultrasound findings in ectopic pregnancy, involvement of nursing staff, determine medical education implications.Design: Retrospective, prospective and on-going study over 8 year period. Focus group discussions with nursing and medical education analysts. Setting: Memorial Hospital Eldoret, Kenya.Participants - 81 patients with ectopic pregnancy diagnosed by ultrasound.Results: Age range 19-39 years - 34.6% Unruptured ectopic pregnancy - 44.5%, Ruptured 43.2%, chronic leaking 2.3%.Conclusion: Ultrasound aids diagnosis and can grade type of pregnancy. Need to demystify science to nurses, clinical officers and other health workers.Recommendation: Medical education to include ultrasound to existing curriculaspecifying roles by health workers. Use participatory teaching methods for ultrasound technology. 

Description
Adsorption of crystal violet (CV) dye from aqueous solution using dried bark powder of mangrove species Rhizophora mucronata was studied. Characterization of adsorbent was done using FTIR and SEM. Batch experiment was carried out to examine the viability of using mangrove bark for adsorption of CV dye from aqueous solutions under different process conditions. The result revealed that removal of CV increased with contact time, adsorbent dose, initial dye concentration and decreased with increased particle size and ionic strength. pH 7 was the optimum pH for CV dye removal. The adsorption equilibrium for CV dye by Rhizophora mucronata stem-bark was attained within 60 min with removal efficacy of up to 99.8%. Pseudo-second-order kinetic model was best used to describe sorption kinetics while Freundlich isotherm model was appropriate for describing adsorption isotherm. The results demonstrated …

This paper builds a case for a reconsideration of Kenya’s legislation that relates to cultural and societal heritage resources management by briefly revisiting the circumstances that informed the enactment of the related laws. We present the view that existing legislation has tended to serve corporate, multinational and foreign interests at the expense of local and national interests, and that although these Acts may have somewhat served the country in the past, the legislations have turned the cultural heritage management in Kenya into a lame duck framework of abstractions of policy matters, that are irrelevant and unresponsive to changing local and international circumstances. We highlight contradictions between and within varied Acts, and offer suggestions for remedy that are geared toward the development of a cultural management policy with local ownership and universal compatibility.

Background: Alot of research work has been carried out to determine the effectiveness of using atraumatic restorative treatment (ART) in the management of dental caries, but there are still unresolved issues surrounding the use of the technique particularly in very large carious lesions.
Objective: To determine the current survival rates of multi-surface ARTrestorations placed in the primary dentition and any consequences to the restored tooth after premature loss of the restoration.
Study selection: Using a set of specific key words, a Pubmed/Medline search was carried out to retrieve all publications on ARTrestorations placed in primary teeth in the period January 2000 to December 2011. Only publications whose studies had multi-surface ARTrestorations as an item of study were retrieved and relevant data extracted.
Data synthesis: Twelve studies contained in 12 publications fulfilled the selection criteria and were included in the study. The selected publications were analysed by the author to establish the study follow-up period and the survival rate of the multi-surface ARTrestorations for the different follow-up periods. Further information was adduced on any other effects of restoration on the tooth after premature loss of the restoration.
Results: The search findings indicated that the survival rate for most of the multi-surface restorations were generally very low. Further, there were indications that even after the premature loss of the ARTrestorations, most of the affected teeth survived for the period of the study with a number of them having shown no signs of secondary caries or associated dental abscessees.
Conclusion: While the survival rates of multi-surface ARTrestorations in the studies documenetd in the review were low, the ART restorations appeared to provide some beneficial effects to the retention-longevity of the restored tooth even after their premature loss.

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The World Health Organization predicts that 90.0% of the 2.3 million people who die annually due to water-borne diseases come from developing countries. At the same time fluorosis occurrence in the world’s geological fluoride belts has left many people maimed due to drinking highly fluoridated water. This work reports on the use of molasses in making carbon-activated diatomaceous earth waste (DE-waste) ceramic membranes with improved mechanical strength and water purification efficiency. The fabricated diatomaceous membranes were soaked in molasses for 24.0 hours and fired at 600.0 for 3.0 hours. The carbon-activated membranes were used to filter water contaminated with Escherichia coli, Rotavirus, and sodium fluoride. The activated carbon obtained in this work had a bulk density of 450.0 kg/m3 and it reduced the porosity of the DE-waste membranes by 18.0%. The activated carbon improved the modulus of rupture (MOR) of the DE-waste membrane by 47.8% and the average pore size of the active DE-waste membrane was 18.4 nm. The filtration process was found to be dependent on the contaminant’s size, concentration, and the external pressure applied to the water during the filtration process. The filtration efficiency of >99.9 in E. coli was concentration and pressure. Membranes reported efficiency of 97.1% and 98.9% in deflouridation and Rotavirus filtration. Thus, molasses is potential material in fabrication of water membranes

Few interventions exist to address the high burden of stillbirths in apparently healthy pregnant women in low- and middle-income countries (LMICs). To establish whether a trial on the impact of routine Doppler screening in a low-risk obstetric population is warranted, we determined the prevalence of abnormal fetal umbilical artery resistance indices among low-risk pregnant women using a low-cost Doppler device in five LMICs.

To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa.

Nasal nitric oxide (nNO) measurements are used in the assessment of patients suspected of having primary ciliary dyskinesia (PCD), but recommendations for performing such measurements have not focused on children and do not include all current practices. To guide the development of a European Respiratory Society-supported technical standard for nNO measurement in children, an international online survey was conducted to better understand current measurement practices among providers involved in PCD diagnostics. 78 professionals responded, representing 65 centres across 18 countries, mainly in Europe and North America. Nearly all centres measured nNO in children and more than half performed measurements before 5 years of age. The test was often postponed in children with signs of acute airway infection. In Europe, the electrochemical technique was more frequently used than chemiluminescence. A similar proportion of centres performed measurements during exhalation against a resistance (49 out of 65) or during tidal breathing (50 out of 65); 15 centres used only exhalation against a resistance and 15 used only tidal breathing. The cut-off values used to discriminate PCD were consistent across centres using chemiluminescence analysers; these centres reported results as an output (nL·min). Cut-off values were highly variable across centres using electrochemical devices, and nNO concentrations were typically reported as ppb. This survey is the first to determine real-world use of nNO measurements globally and revealed remarkable variability in methodology, equipment and interpretation. These findings will help standardise methods and training.

The global sediment cycle is a fundamental feature of the Earth system, balancing competing factors such as orogeny, physical–chemical erosion and human action. In this Review, values of the magnitudes of several sources and sinks within the cycle are suggested, although the record remains fragmented with uncertainties. Between 1950 and 2010, humans have transformed the mobilization, transport and sequestration of sediment, to the point where human action now dominates these fluxes at the global scale. Human activities have increased fluvial sediment delivery by 215% while simultaneously decreasing the amount of fluvial sediment that reaches the ocean by 49%, and societal consumption of sediment over the same period has increased by more than 2,500%. Global warming is also substantially affecting the global sediment cycle through temperature impacts (sediment production and transport, sea ice cover, glacial ice ablation and loss of permafrost), precipitation changes, desertification and wind intensities, forest fire extent and intensity, and acceleration of sea-level rise. With progressive improvements in global digital datasets and modelling, we should be able to obtain a comprehensive picture of the impacts of human activities and climate warming.

To ensure the long-term sustainable use of African Great Lakes (AGL), and to better understand the functioning of these ecosystems, authorities, managers and scientists need regularly collected scientific data and information of key environmental indicators over multi-years to make informed decisions. Monitoring is regularly conducted at some sites across AGL; while at others sites, it is rare or conducted irregularly in response to sporadic funding or short-term projects/studies. Managers and scientists working on the AGL thus often lack critical long-term data to evaluate and gauge ongoing changes. Hence, we propose a multi-lake approach to harmonize data collection modalities for better understanding of regional and global environmental impacts on AGL. Climate variability has had strong impacts on all AGL in the recent past. Although these lakes have specific characteristics, their limnological cycles show many similarities. Because different anthropogenic pressures take place at the different AGL, harmonized multi-lake monitoring will provide comparable data to address the main drivers of concern (climate versus regional anthropogenic impact). To realize harmonized long-term multi-lake monitoring, the approach will need: (1) support of a wide community of researchers and managers; (2) political goodwill towards a common goal for such monitoring; and (3) sufficient capacity (e.g., institutional, financial, human and logistic resources) for its implementation. This paper presents an assessment of the state of monitoring the AGL and possible approaches to realize a long-term, multi-lake harmonized monitoring strategy. Key parameters are proposed. The support of national and regional authorities is necessary as each AGL crosses international boundaries.

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

bstract
Background: Anatomical variations of lumbar arteries predispose them to iatrogenic injury during endovascular intervention or surgery. Due to limited morphological data on lumbar arteries in our setting, we aimed to determine their variant anatomy among Kenyans.

Methods: We performed the study on 90 cadaveric specimens and 120 computed tomography (CT) scans. Cadavers were dissected to expose the aorta and the lumbar arteries emerging from them. The number, origins, location relative to the vertebral bodies, and relations to aortic bifurcation were determined in cadavers and CT scans. Data were analyzed using SPSS (version 21.0).

Results: On average, 3 (3/90 [3.3%]), 4 (63/90 [70%]) or 5 (24/90 [26.7%]) pairs of lumbar arteries were observed among the cadaveric specimens, whereas 4 (100/120 [83.3%]) or 5 (20/120 [16.7%]) pairs were observed in CTs. Differences in the number of pairs observed in the cadaveric versus CT study were not statistically significant (P = .542). There were no sex differences in the number of lumbar artery pairs observed in CT scans (P = .178). The first 3 lumbar artery pairs had a single-origin, whereas the fourth lumbar artery had a common-stem origin. The first, second, and third lumbar arteries mostly originated at the upper third of their respective vertebral bodies. The fourth lumbar artery predominantly originated at the lower third.

Conclusion: Our study's findings show unique variation in the lumbar arteries' relation to the vertebral bodies and the distances between artery pairs.

Level of evidence: IV (cross-sectional study).

Clinical relevance: Variations in the anatomy of the lumbar arteries should be taken into consideration, especially in surgical or interventional procedures to avoid inadvertent injury of the vessels.

This study reports concentrations of Mn, Fe, Cu and Zn analysed from Kenyan bean grains and leaves using Total Reflection X-ray Fluorescence (TXRF) and Inductively Coupled Plasma – Optical Emission Spectrometry (ICP-OES) methods. Samples of fresh bean leaves and 7 species of dry grains were collected from small scale farmers in Machakos and Kiambu counties. They were delivered to the laboratory where bean grain samples for TXRF analysis were prepared and leaves for both TXRF and ICP-OES. Standard methods of sample preparation successfully tested and used by other authors were used, Average elemental concentrations of the samples were then compared with established sufficiency values mainly given in ranges. Bean leaves from Muguga had sufficient Mn, Ni and Cu concentrations while 6% of the samples had Zn concentrations higher than the sufficiency range. Fe concentrations were consistently high with 97% of the samples having concentrations that were higher than the sufficiency range. No deficiencies were observed from bean leaves from Kyevaluki. For dry bean grains, deficiencies were observed in which four species were found to be deficient in Mn while Zn deficiency was observed in all the species. Fe concentrations were above the sufficiency ranges for all the species but not to toxic levels and 29% of the samples had Cu concentrations that were within the sufficiency range. The obtained data will be essential information for both farmers and policy makers on the nutritional quality of beans in the sampled areas. However, further studies are recommended including soil analysis and elemental bioavailability for full nutritional assessment. Keywords: ICP-OES, hidden hunger, mortality rate, cognitive development, bioavailable

Background: Pneumonia is a major cause of morbidity
and mortality globally. Despite the proven benefits of
guideline concordant antibiotic prescribing, research
has shown that adherence to clinical guideline
recommendations is dismal.
Objectives: The study aims to determine utilization of
Kenyatta National Hospital antibiotic guideline titled
‘The KNH guide to empiric antimicrobial therapy
2018’ in the management of community acquired
pneumonia in the Kenyatta National Hospital medical
wards and the perceived barriers towards the utilization
of this guideline.
Materials and methods: A check list derived from the
Kenyatta National Hospital (KNH) guide to empiric
antimicrobial therapy 2018 was used to assess guideline
concordance based on seven quality indicators:
empiric antibiotic, dose and route of administration,
switch to oral antibiotics, duration of antibiotics (at
least 5 days), collection of microbiological samples
before initiating antibiotics, review of antibiotics at 48
hours and once the culture results are out. Online selfadministered questionnaires were used to determine
attitude and perceived barriers towards utilization
of the KNH guideline among the Internal Medicine
registrars and medical officers.
Analysis: Descriptive statistics were applied in
the representation of each of the seven quality
indicators. These were then compared with the
guideline recommendations and adherence to the
guideline for each parameter was expressed as a
percentage of the total number of patients admitted
with community acquired pneumonia. These were
then graded into the following categories based on the
level of concordance: Good >90%, Intermediate 60-
90%, poor <60%. Questions on the attitude and the
perceived barriers towards KNH guideline utilization
were answered using a 5 point Likert scale. Perceived
barrier statements that were positively formulated
were then recorded so that a lower score meant a
lower level of the perceived barriers and vice versa.
Percentages were then calculated for the total number
of doctors that agreed or strongly agreed that the
barrier was applicable. An open ended question on the
top three barriers to the KNH guideline utilization was
also included in the questionnaire.
Results: For each of the other quality indicators,
adherence to the KNH guideline for patients with
community acquired pneumonia was as follows:
empiric antibiotic choice 48%, collection of samples
for culture prior to antibiotic administration 0%, review
of antibiotics at 48 hours 26.4%, review of antibiotics
with culture results 45.8%, total duration of antibiotics
28.8% and time to switch to oral antibiotics 3.6%. The
top three barriers towards guideline utilization among
the doctors were: unavailability of drugs (52.7%),
inaccessibility of the KNH guideline (45.1%) and lack
of or delay of investigations (34.1%).
Conclusion: This study has demonstrated that the level
of adherence to the seven quality indicators from the
KNH guide is poor with the overall adherence being
35.5%. The recommendation least adhered to was
collection of microbiological samples before initiation
of empiric antibiotics. The most commonly identified
barriers to utilization of the guideline were external
and guideline related barriers.
Key words: Guide to empiric antimicrobial therapy
2018, Guideline Concordance antibiotic prescribing,
Community acquired pneumonia

The data revolution has increased data demands for leveraging on Big Data in the production of statistics. The paper assesses the adoption of Big Data in research institutes in Kenya. Data were collected from 64 data practitioners based in the 24 research institutes that have a mandate to produce and analyse official statistics. The paper establishes the risks and challenges of using Big Data in statistics, identifies the determinants of adoption of Big Data in statistics and validates the relevance of a Technology Adoption Model (TAM) for predicting the adoption. It is the conclusion that there are immense opportunities for Big Data in statistics if the associated risks and challenges are addressed and the identified key determinants prioritized to promote the adoption.

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