No abstract available.

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JASPA Working Paper, ILO, Addis Ababa

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45 Kenyan traditional healers were interviewed with respect to the diagnosis and treatment of eye diseases. Traditional management of eye diseases is based on the healers' concept of the disease causation as well as their knowledge of the herbal, animal and chemical substances that possess (or are reported to possess) remedial effect on the disease. While many of the healers interviewed failed to give a clear distinction between the various eye conditions, diseases such as cataract, foreign bodies and injuries were recognized easily. In almost all cases the medicinal substances were first diluted in water before they were applied to the eyes. Human milk, blood and the white of the egg were the animal substances listed as medicinal to various eye conditions. A solution of sugar was one of the chemical substances used in the treatment of specific eye conditions. Given correct information, some of these healers could f

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No abstract available.

The safety and immunogenicity of plasmid pTHr DNA, modified vaccinia virus Ankara (MVA) human immunodeficiency virus type 1 (HIV-1) vaccine candidates were evaluated in four Phase I clinical trials in Kenya and Uganda. Both vaccines, expressing HIV-1 subtype A gag p24/p17 and a string of CD8 T-cell epitopes (HIVA), were generally safe and well-tolerated. At the dosage levels and intervals tested, the percentage of vaccine recipients with HIV-1-specific cell-mediated immune responses, assessed by a validated ex vivo interferon gamma (IFN-gamma) ELISPOT assay and Cytokine Flow Cytometry (CFC), did not significantly differ from placebo recipients. These trials demonstrated the feasibility of conducting high-quality Phase 1 trials in Africa.

No abstract available.

It is well known that levels of HIV prevalence tend to be appreciably higher inurban areas. This article considers the reasons for this and shows that within world regions that are relatively homogeneous with respect to their experience of HIV/AIDS, variation in the level of urbanization corresponds to about one-third of variation in estimated HIV prevalence. Furthermore, for populations in the world's worst-affected area—eastern and southern Africa—there are signs that, partly by differentially raising urban death rates and depressing urban birth rates, HIV/AIDS is slowing the pace of urbanization. Finally, in countries with very high levels of HIV infection and relatively low birth rates, such as in South Africa, the urban sector will soon constitute a “demographic sink”—with death rates exceeding birth rates.

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

No abstract yet

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

Transport workers (n = 504) in Mombasa, Kenya, were screened for urethral infection by history, clinical examination, and laboratory testing of urethral swabs and first-catch urine specimens. The prevalence of Neisseria gonorrhoeae was 3.4%, Chlamydia trachomatis, 3.6%, and Trichomonas vaginalis, 6.0%; more than two-thirds of infections were asymptomatic. A complaint of urethral discharge, dysuria, or both was twice as sensitive as the sign of discharge on physical examination (34.5% vs. 15.5%) in identifying infection. A positive leukocyte esterase dipstick (LED) test on urine predicted infection with a sensitivity of 95.0% and a specificity of 59.3% in symptomatic men and with a sensitivity of 55.3% and a specificity of 82.8% in asymptomatic men. Demographic and behavioral factors were not independent predictors of infection. In resource-poor settings with high prevalences of urethral infection, an effective screening and management strategy would be to treat symptomatic men, as well as asymptomatic men with a positive LED test, for all three infection

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

No abstract available yet.

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

One hundred and twenty six patients diagnosed as having AIDS had their urinalysis and electrolyte profiles studied. The commonest electrolyte abnormalities were a low serum bicarbonate in 56% of the patients and hyponatraemia in 48%. Possible aetiological factors are discussed. Significant pyuria was found in 10% of the patients and significant bacteriuria in 13%. Escherichia coli was the commonest isolated organism (56% of all the culture positive cases). Proteinuria above the upper limit of normal was detectable in 13% of the patients; of these, 25% had proteinuria in the nephrotic range. Of the patients 3% had clinical and biochemical evidence of renal insufficiency. It is concluded that significant bacteriuria occurs commonly in AIDS and that renal insufficiency and nephrotic syndrome may be associated with the disease. It is also noted that other electrolyte and acid-base abnormalities, in particular hyponatraemia and low bicarbonate levels may contribute to the morbidity and mortality in patients suffering from AIDS.

Pathological changes due to infection with Schistosoma haematobium include cytokine-mediated urinary tract inflammation. The involved cytokines may be excreted in urine and their presence in urine may therefore reflect S. haematobium-related urinary tract pathology. The present study, for the first time, reports on the relationship between selected cytokines in urine and infection with S. haematobium in children from an area highly affected by this parasite.

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This pilot project studies the prevalence of hypertension among unique social groups in Kenya, as well as the hormonal profiles accompanying the hypertensive and normotensive states in these populations. The purpose of this report is to enlarge and improve upon the statistical data currently available concerning the prevalence, etiology and prognosis of hypertensive disease in this region. In this study, the urinary concentrations of three vasoactive metabolites were measured in hypertensive and normotensive outpatients. The excretion values for the metabolites were ultimately tabulated as the quantity excreted per milligram of creatinine. The results demonstrate that the subjects with elevated blood pressures (>140/90 mm Hg) excreted double the concentrations (ng/mg creatinine) of cortisol and aldosterone excreted by normotensives. There were no apparent differences in urinary catecholamines between hypertensives and normotensives.

At the Kenyatta National Hospital (KNH) and other private hospitals in Nairobi urinary stone disease is not being correctly diagnosed. Over a 15 year period (1980-1995) only 56 patients have been confirmed to have urinary tract stones out of the expected number of 220 patients. The age range was 10-60 years. The peak age was 30-40 years. Pain and haematuria were the commonest presenting symptoms. Ultrasonography and plane abdominal radiology were the commonest methods of diagnosis. Open surgery and endoscopic stone removal were the commonest modes of management. Extracorporeal shortwave lithotripsy (ESWL) has recently been introduced into the Nairobi Hospital, but was not functional at the time of this study. Percutaneous nephrolithotomy (PCNL) is possible but has not been adequately used due to lack of correct equipment. Septicaemia and haemorrhage were the commonest complications of the open surgery

At the Kenyatta National Hospital (KNH) and other private hospitals in Nairobi urinary stone disease is not being correctly diagnosed. Over a 15 year period (1980-1995) only 56 patients have been confirmed to have urinary tract stones out of the expected number of 220 patients. The age range was 10-60 years. The peak age was 30-40 years. Pain and haematuria were the commonest presenting symptoms. Ultrasonography and plane abdominal radiology were the commonest methods of diagnosis. Open surgery and endoscopic stone removal were the commonest modes of management. Extracorporeal shortwave lithotripsy (ESWL) has recently been introduced into the Nairobi Hospital, but was not functional at the time of this study. Percutaneous nephrolithotomy (PCNL) is possible but has not been adequately used due to lack of correct equipment. Septicaemia and haemorrhage were the commonest complications of the open surgery.

Background: Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI; yet, there is a paucity of data about its use in term neonates with perinatal asphyxia. Methods A prospective cohort study was conducted on 108 term babies in the new-born unit of Pumwani Maternity Hospital and Kenyatta National Hospital. Urine NGAL and serum creatinine were measured in 108 term asphyxiated neonates on days 1 and 3 of life.
Results: One-hundred and eight patients were recruited (male:female 1.4:1). At a cut-off of 250 ng/ml, urine NGAL had an acceptable discriminative capability of predicting AKI (area under the curve 0.724). The sensitivity, specificity, positive and negative predictive value and likelihood ratios were 88, 56, 30, 95 %, 2 and 0.2 respectively. Urine NGAL levels were significantly higher in patients with AKI compared with those without AKI. An NGAL level greater than 250 ng/ml on day 1 was significantly associated with severe hypoxic ischaemic encephalopathy (HIE); odds ratio=8.9 (95 % CI 1.78– 37.69) and mortality; odds ratio=8.9 (95 % CI 1.78–37.69).
Conclusion: Urine NGAL is a good screening test for the early diagnosis of AKI. It is also a predictor of mortality and severity of HIE in asphyxiated neonates.

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

A retrospective study of the hospital records revealed that 39 cases of mandibular fractures presented at Kisii District Hospital during a two-year period. 27 cases were due to interpersonal violence while road traffic accidents and accidental falls accounted for 9 and 3 of the cases respectively. The male ratio was 2.9:1. Majority (26 cases) of the patients were aged between 20 and 39 years. The commonly involved fracture site was the left body of the mandible accounting for 20 of the fractures.

Background: Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practiced
Objective: To review the presentation and management of patients presenting with urolithiasis in Nairobi, Kenya
Design: A retrospective study Setting: The Nairobi hospital and Upper Hill Medical Centre a day care facility next to the Nairobi hospital
Subjects: One hundred and twenty five males and fifty three females aged 9 to 75 years
Results: One hundred and seventy eight patients were treated for urolithiasis over a five-and- half year period. Their mean age was 44.8 years, and the median was 45 years The 178 patients required 262 procedures to achieve stone clearance. One hundred and two patients had ESWL, with an overall stone clearance rate of 95%. Twentythree
patients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopic
Management: Fourty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval.
Conclusions: This study demonstrates a higher annual incidence of urolithiasis in Nairobi than earlier literature. Study demonstrates that ESWL and ureteroscopic methods are highly effective in the treatment of renal and ureteral calculi as day care procedures.

Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practiced OBJECTIVE: To review the presentation and management of patients presenting with urolithiasis in Nairobi, Kenya DESIGN: A retrospective study SETTING: The Nairobi hospital and Upper Hill Medical Centre a day care facility next to the Nairobi hospital SUBJECTS: One hundred and twenty five males and fifty three females aged 9 to 75 years RESULTS: One hundred and seventy eight patients were treated for urolithiasis over a five-and- half year period. Their mean age was 44.8 years, and the median was 45 years The 178 patients required 262 procedures to achieve stone clearance. One hundred and two patients had ESWL, with an overall stone clearance rate of 95%. Twenty-three patients had PCNL; 18 as the first procedure and 5 after failed ESWL. Fifty-one patients had ureteroscopic management. Forty seven had laser or pneumatic lithotripsy while four had stone removal by Dormia basket. Seven patients had bladder calculi managed by either cystolitholapaxy or forceps retrieval. CONCLUSIONS: This study demonstrates a higher annual incidence of urolithiasis in Nairobi than earlier literature. Study demonstrates that ESWL and ureteroscopic methods are highly effective in the treatment of renal and ureteral calculi as day care procedures.

Urolithiasis is an emerging problem in Kenya previously thought to be very rare and in which the use of modern methods of treatment has not been widely practiced

Inguinal varicocelectomy was performed on 27 selected infertile males with Grade III varicoceles. Follow up was effected for eighteen months. 18 (66%) patients recorded improvement in sperm count to above (20 X 10(6)/ML). 17 (63%) patients recorded improvement in active sperm mortility to above 40%. 15 (55%) patients showed diminution in the level of abnormal sperms to less than 30% abnormal forms. A pregnancy rate of 33.3% was recorded. These findings indicate that varicocelectomy is effective in the management of carefully selected infertile males with varicoceles in conformity with the findings of previous other studies.

The main thrust of my Urological research has been on genital cancer (penis, prostate and testis), torsion of the testis and erectile dysfunction. This lecture will focus on these although I have also researched on many other Urological topics in this locality including chronic prostititis (Magoha, 1996), Scrotal gangrene (Ayumba and Magoha 1998), renal transplantation (Rowe and Magoha 1987, Magoha and Ngumi 2001) and autologous blood transfusion (Magoha et al 2001 among others. The immediate environmental impact of my research works on genital cancer and dysfunction has resulted not only the free flow of water, but the free flow of knowledge from one doctor to another within this country and beyond. These are my Urological footprints in Kenya which I hope have made modest but significant contribution to the surgical history of this country and locality 'that water may flow'.

JASPA Working Paper, ILO, Addis Ababa

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.

Introduction
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.

Methods
Mixed‐methods evaluation with doctors, midwives, and nurses in 12 health facilities across Argentina, India, Kenya, Malawi, Nigeria, and Tanzania. Purposively sampled and trained practitioners applied the LCG in low‐risk women during labor and rated experiences, satisfaction, and usability. Practitioners were invited to focus group discussions (FGDs) to share experiences and perceptions of the LCG, which were subjected to framework analysis.

Results
One hundred and thirty‐six practitioners applied the LCG in managing labor and birth of 1,226 low‐risk women. The majority of women had a spontaneous vaginal birth (91.6%); two cases of intrapartum stillbirths (1.63 per 1000 births) occurred. Practitioner satisfaction with the LCG was high, and median usability score was 67.5%. Practitioners described the LCG as supporting precise and meticulous monitoring during labor, encouraging critical thinking in labor management, and improving the provision of woman‐centered care.

Conclusions
The LCG is feasible and acceptable to use across different clinical settings and can promote woman‐centered care, though some design improvements would benefit usability. Implementing the LCG needs to be accompanied by training and supportive supervision, and strategies to promote an enabling environment (including updated policies on supportive care interventions, and ensuring essential equipment is available).

The world is today faced with the global pandemic of HIV/AIDS that has evolved rapidly since it was first described. The pandemic has been termed the greatest development challenge for sub Saharan Africa and is rapidly evolving in the Asian continent. The pandemic ha had a significantly negative impact on individual families through loss of loved ones, communities by increasing the burden of caring for the ill, and countries through reduced productivity.     As we look forward to the 21st century, the human population is reminded that even in an age where drugs to treat most ailments are available, human behaviour and individual aspirations are critical in the control of disease. Factors that affect human and social behaviour, such as poverty, discrimination and disenfranchisement have to be addressed on a global basis if the HIV/AIDS epidemic is to be controlled. The HIV/AIDS epidemic presents special challenges and new frontiers for public health interventions and research. HIV/AIDS has revealed the gaps in the understanding of how human behaviour is motivated and how it can be changed.     In this publication we present a review of some of the programs that are specifically targeting the youth with HIV/AIDS prevention activities in the countries of   This publication records the stories of men and women in Eastern Africa, who have tremendous commitment to the work they do even with minimal resources, because they have a vision for the youth of the African continent. It is a story of innovation, creativity, determination and partnership between adults and youth, communities and governments, countries, aid agencies and NGOSs.

The negative appendicectomy rates have remained high. The integration of clinical scores into the diagnostic process in acute appendicitis has had the purposes of improving decision making and reducing the negative rates in this common condition. The performance of these score systems have however, not been uniform.

A reliable rapid and inexpensive laboratory procedure is needed to screen native African forage grass species for forage quality. This study determined the potential of using a prepared cellulase solution to assess in vitro dry matter solubility of 22 native Kenyan forage grasses and 18 native warm season grasses from Missouri, USA. A prepared cellulase solution was used for screening the grass species for digestibility using two procedures. One procedure involved digesting grass samples in prepared cellulose solution without any pre-treatment (CSD), and the other procedure used an acid pepsin pretreatment prior to digestion in the prepared cellulose solution (APCS). The CSD procedures in comparison to APCS generally underestimated in vitro dry matter solubility by a rand of up to 23%. The variations were highly species dependent. Although the APCS procedure more time consuming, it made it possible to identify a group of species resolvable into high (42.6-61.4%), medium (36-40%) and low (29-34%) digestibility. With intensified efforts it is possible for one person to obtain in vitro dry matter solubility estimates on up to 200 samples in 30 days with minimal expense. Results of this investigation points to the end need for further research on the potential of the two digestibility procedures for rationalizing numbers in germplasm collection for initial screening

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The Rose-Bengal plate test (RBPT) was performed on 488 patients with flu-like symptoms from Narok district. There was poor agreement between RBPT results from four health facilities in Narok and from the central veterinary laboratory (CVL). Agreement was poorer for the three rural dispensaries than for the District Hospital. On the other hand, for tests conducted at the CVL, there was good agreement between RBPT, serum agglutination test (SAT) and complement fixation test (CFT) results, indicating that all these tests were probably performing well. Better training and quality control and the use of white rather than a clear background surface for judging agglutination results are recommended to improve the performance of test results in Narok District health facilities.

Objective: To determine the pattern of breast disease at Kenyatta National Hospital (KNH) Study design:    Retrospective descriptive study Study setting:    Kenyatta National Hospital, a University teaching and National Referral Hospital Patients: Records of 1172 patients were reviewed. Results: An average 469 new patients per year or 11 new patients per clinic visit were seen at the clinic over a two and a half year period. Females predominated (98.9%) in this series. The mean age was 34.71 years (range 1 to 96 years). The average age at menarche was 14.49 years and the mean duration of symptoms was 6.86 months. Only 2.6% of 843 patients had a positive family history of breast disease. Fibroadenoma was the commonest diagnosis made (33.2%) followed by ductal carcinoma (19.7%). Gynaecomastia was the most common lesion seen in males. Two thirds of patients presenting with tumors had masses measuring more than 5cm.  Overall five conditions (fibroadenoma, ductal carcinoma, breast abscesses, fibrocystic disease and mastalgia) accounted for over 85% of all breast ailments. Surgery formed the main stay of care in over 80% of patients. Conclusions: The pattern of breast diseases at KNH closely mirrors those reported in other studies in the region and beyond. This study indicates that a large proportion of patients presenting with breast disease are treated initially by surgery. It may be wise to consider other alternative forms of therapy where appropriate. The Annals of African Surgery: 2008 June; Vol 2, pg 97-101.

Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.

Basmati rice (Oryza sativa L.) is preferred by consumers over other varieties because of its aroma and good cooking traits. However, its yield is genetically low compared to other pure bred lines. To increase yield of Basmati per hectare, it has become necessary to adopt hybrid rice technology that has been reported to increase yield by up to 30% above pure dwarf lines. Photoperiod-sensitive genic male sterile (PGMS) and Thermosensitive genic male sterile (TGMS) rice lines contain genes that confer male sterility under long day light-length and high temperature growth conditions, respectively. Pollination of these lines, in their male sterile period, with a viable male parent pollen produce hybrid seeds. The problem of using PGMS or TGMS is that in the tropics, day-light length is 12hours and diurnal temperature range is high, making induction of complete male-sterility in these lines difficult. The result is contamination of hybrid seeds with self-bred pure line seeds. The objective of this research work was to produce pure hybrid Basmati seeds. Hypothesis to be tested is that anthocyanin markers can be used to differentiate hybrid F1s from pure inbred seedlings. This tool can be used in selection of Basmati hybrid seedlings free from contamination with self-bred parents before transplanting and therefore save on the associated losses. The F1 seeds from a cross between PGMS or TGMS and Basmati were sown in greenhouse at KARI Mwea- Kimbibi station. Hybrid seeds were scored for anthocynanin morphological marker, by observation, to differentiate them from the pure bred lines. All hybrids involving Basmati370 and Basmati217 had very conspicuous incidence of anthocyanin which made them distinct from the parents. The conclusion is that anthocyanin can be used as a marker to separate F1 hybrid plants from the parents.

Key words: Anthocyanins, Morphological marker, Basmati, Hybrid rice seed

Derivatives of the Chinese herbal remedy ginghaosu (artemisinin) are useful in the treatment of multiple-drug resistant malaria. This review covers the discovery, development, clinical pharmacology and toxicology of these compounds, with emphasis on those derivatives currently in use in parts of Africa

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A field experiment was conducted over two cropping seasons to investigate the effectiveness of cereal border crops in managing potato aphids and the associated viruses during seed potato production. Potato plots were surrounded with maize, sorghum or wheat borders. Aphid population was monitored on leaves and on yellow sticky traps. Other data collected included viral disease incidence and tuber yield. The border crops reduced aphid population on leaves compared to non-bordered potato plots. More alate aphids were caught on yellow sticky traps placed inside potato plots than on traps placed inside the border crops. In addition, viral disease incidence was reduced in all plots surrounded by the border crops. However, plots surrounded by border crops had reduced tuber yield, although the yield of seed grade was increased. Thus use of border crops is beneficial in management of viral diseases during seed potato production.

A field experiment was conducted over two cropping seasons to investigate the effectiveness of cereal border crops in managing potato aphids and the associated viruses during seed potato production. Potato plots were surrounded with maize, sorghum or wheat borders. Aphid population was monitored on leaves and on yellow sticky traps. Other data collected included viral disease incidence and tuber yield. The border crops reduced aphid population on leaves compared to non-bordered potato plots. More alate aphids were caught on yellow sticky traps placed inside potato plots than on traps placed inside the border crops. In addition, viral disease incidence was reduced in all plots surrounded by the border crops. However, plots surrounded by border crops had reduced tuber yield, although the yield of seed grade was increased. Thus use of border crops is beneficial in management of viral diseases during seed potato production.

reatment of cervical incompetence by cerclage and other methods has yet to be standardized, as its diagnosis is not uniformly accepted. Its diagnosis, particularly in the African setting, is mostly based on past obstetric history of pregnancy losses, while in developed centres; ultrasound diagnosis is increasingly being used. The mainstay of treatment in developing countries is cervical cerclage, although the indications and contraindications of this mode of treatment are not documented. Our aim was to appraise this practice in terms of patient characteristics, the diagnostic process and management at the Kenyatta National Hospital, Nairobi, Kenya. This was a descriptive retrospective study over 9 years. Predesigned questionnaires were employed to collect data on patient’s socio-demographic profile, presentation, risk factors, diagnosis and management of cervical incompetence. Chisquared test and student’s t-test were used to correlate variables. A total of 199 patients were treated for cervical incompetence, with the patient mean age being 27.97. 87.4% of the patients (p=0.02) were in the 20 to 35 years category. Most of the patients (60.1%) were of low socio-economic status. Cervical cerclage was employed in all the patients, although ultrasound investigation was not employed in 65.8% of them. Diagnosis of cervical incompetence still relies on history of previous pregnancy losses, with the standard transvaginal ultrasound relatively unemployed. There is need to intensify investigations for this condition, standardize the indications for cerclage, and diversify management to other newer modalities.

To determine the effectiveness of Paracetamol and low dose Ketamine in controlling burn pain during dressings. Setting: The burns ward of Moi Teaching and Referral Hospital, a 750 bed capacity tertiary centre in Western Kenya. Subjects: Consenting patients were recruited to the study on admission. Babies and minors had consent given by their parents or guardians. Results: Of the Fifty nine patients who were recruited into the study, seventy percent of them were children. Male to Female ratio was 1.2:1. There was statistically significant change in the pain score on both FLACC and VAS (both p<0.001) after the introduction of low dose Ketamine with Paracetamol. The patients and healthcare providers were satisfied with the new mode of pain management during change of dressings for burn wounds. Conclusion: The use of oral Paracetamol combined with the low dose intravenous Ketamine, is effective in controlling burn pains during change of dressings. It is a safe and cheap alternative, that can be applied in remote and resource limited medical facilities.

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Abstract
Development has greatly been associated with the level of technology. Countries that have succeeded in harnessing the potential of ICT have been said to have taken a positive step towards a greatly expanded economic growth, improved human welfare and stronger forms of democratic governance. There are however a lot of imbalances between countries that have access to ICT hence the notion of digital divide. In developing countries, this divide can be found in the preliminaries of being able to reap the advantages of ICT. In Kenya, there are not just discrepancies in the availability of resources but also in the ability to use the few available resources. This digital divide is even wider in that investment of ICT seems to be more biased towards the formal sector than other sectors of education. Although there is a lot of effort made like digitization of educational materials for the formal sector, it is important to find out how this is realized in adult literacy classes. The purpose of this study was to explore the use of computers by the ECD student teachers and adult education learners. The study further explored the integration of ICT in teaching and learning in the two categories of learners. Two researcher developed questionnaires were used to gather the required information: one for the ECD teachers who were in their training sessions and the other for adult learners in session in all parts of country. The paper stresses the indisputable need for use of computers to promote education whether in formal or non-formal sector. The sample consisted of 395 pre-school teacher trainees and 200 adult learners. The findings indicated that only (39.17%) ECD teacher trainers and (90%) of adult learners had not acquired any computer skills. All the learners in ECD training and 88% of the respondents felt that computer skills would greatly improve their learning and help them to engage better with their environment which is full of ICT related gadgets. Based on these findings, it was recommended that there is need for the government to invest more in computers which should be made available in all centres in Kenya.

Keywords: Computer literacy, computer, information and communication technology, digital divide, teaching and learning

Scaffolds are a good method of implementing self-regulated learning. Use of prior knowledge makes the
learner to understand a topic better. Learner adaptation enables a learner to be presented with content that
matches his/her level of understanding.
The main aim of this project is to use the adaptive scaffolds in form of concept maps in web-based elearning
systems to play the role of learner guide. The learner creates a concept map from prior knowledge
to show how he/she understands a certain domain of knowledge. The concept map takes into account the
knowledge of the learner in that topic, and uses it to adapt to the user level. This is done by integrated
evaluation where the learner is presented with a concept map that matches his level of understanding as
he/she draws the concept map. The scaffolding and the adaptation are implemented using production rules.
Categories and Subject Descriptions: H.5.2 [Information Interfaces and Presentation]: User Interfaces –
User Centered Design; H.5.4 [Information Interfaces and Presentation]: Hypertext/Hypermedia –
Navigation, User issues; I.2.6 [Artificial Intelligence]: Learning – Concept learning; Induction; K.3.1
[Computers and Education]: Computer Uses in Education – Distance Learning, Computer Assisted
Instruction (CAI); J.4 [Social and Behavioral sciences]: Psychology
General Terms: Algorithms, Human Factors, Experimentation, Measurement, Performance
Additional Key Words: Scaffold, adaptation, prior knowledge, learner evaluation, concept maps,
cognition, adaptive e-learning systems, adaptive scaffolds, integrated assessment.

Initial observations of a two-phase trial on the use of Mucuna deeringianum [M. deeringiana] to improve soil productivity are presented. In phase one, 42 seeds were sown at Kabete, Kenya, in October 1990 with 89% germination rate. By September 1991, 4 kg of beans had been harvested. The second phase studied the effects of M. deeringiana on improving crop cover and reducing soil loss at Mbooni and Kabete, resp. Initial observations show that the crop preformed fairly well, providing a cover of up to 25cm uncompressed thickness. Treatments on the runoff plots at Kabete include: bare ground (control), M. deeringiana; maize; the two crops intercropped and sown at the same time; intercropping with M. deeringiana sown one week after the maize; or intercropped with M. deeringiana sown two weeks after the maize. The highest soil loss was found on the bare plot (65 t/ha), followed by the intercropped plot with two weeks between sowing (50 t/ha). Soil loss was lowest in runoff plots with a pure stand of M. deeringiana (11 t/ha). Intercropping and sown at the same time provided highest percentage cover.

Prostate cancer has been on the rise in the past years and alarming cases being
found in men in their 20’s. The problem is that most of the cases are diagnosed in their late
stages thus the mortality rate being high. In recent years data driven analytic studies have
become a common complement with novel research where different tools and algorithms
are taking a centre stage in cancer research. In this research, the main objective was to use
data mining to derive patterns which were used in building a prognostic tool that helps in
identification of the Gleason score once screened and deciding the treatment technique. In
this research, we used two popular data mining tools (R Environment and WEKA) which
exhibited almost same results .The dataset contained around 485 records and 7 variables. In
WEKA, a 10-fold cross-validation was used in model building and comparison between
ANN and J48. The results showed that ANN is the most accurate predictor compared to
J48 in all the instances displaying varying levels in the different zones created. This study
contributes to society, academics and cancer research which ultimately assist in reduction
of mortality rates by use of pattern recognitions which leads to better decision making.
Furthermore, this is a potential impact in helping the GOK (Government of Kenya) in
establishing where they should correctly place the cancer diagnosis and treatment
equipment that were rolled out by the National government early 2015.

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

Atrial fibrillation (AF) is the most common sustained arrhythmia, particularly in the elderly population. It is well recognised that AF is a major cause of stroke, even in the absence of underlying heart disease. Although AF and atrial flutter share many causes and may be seen in the same patient, there are differences between these arrhythmias: atrial flutter is less common, and the risk of stroke associated with it is less than that with AF. In addition to stroke, both AF and atrial flutter may cause cardiomyopathy, which may be fully reversible with effective treatment of the arrhythmia. Both AF and atrial flutter can result in severe symptoms and may precipitate heart failure, ischaemia and syncope. Recent research indicates that AF is a self-perpetuating arrhythmia, and that the longer it is left untreated the less likely it is that effective cardioversion will be possible. Drugs are an attractive option for the cardioversion of AF and atrial flutter because their use does not require anaesthesia. Antiarrhythmic drugs in class III of the Vaughan-Williams classification are effective in the treatment of AF, but they have adverse effects; several new 'pure' class III agents are under development. The first of these to be made available is ibutilide, a methanesulphonamide derivative. Initial results are encouraging, particularly for atrial flutter. However, the drug has the potential for proarrhythmic effects and physicians who use it will need to be aware of these.

This study was conducted to determine the potential of incorporating Prosopis juliflora seed pods into typical dry land livestock production systems to minimize feed scarcity during the dry seasons and avoiding weight losses and poor performance. The study evaluated supplementation of weaner Galla goats with increasing amounts of Prosopis juliflora seedpods that is widely distributed in arid and semi arid areas of Kenya. This species is drought tolerant and with high productivity of seed pods whole year round. The overall aim of this study was therefore, to assess the feasibility of incorporating P. juliflora seedpods into a typical dry land livestock production system. The study further sought to find out the optimum supplementation level for improved performance. The experiment involved 20 weaner Galla goats of similar age (6 months) and weights (11-14 kg) which were randomly assigned to four treatments of 5 weaners each. The treatments were No P. juliflora (PJP0), 100 g/goat/day P. juliflora (PJP100), 200 g/goat/day P. juliflora (PJP200), 400 g/goat/day P. juliflora (PJP400). Supplementation involved providing the goats with their respective diets in the morning before mixed species range grass hay was offered as basal diet. The animals were weighed on weekly basis and weight gains calculated as difference in previous week’s weight and current week’s weight. The experiment lasted for 70 days. Overall, all the treatment groups exhibited higher average weekly weight gains than the control group throughout the experimental period. However, for the first 3 weeks, this was not statistically significant (p<0.05). From the 5th week up to the 10th week, there was significant difference (p<0.05) in the growth rates for the treatments except for the control group. Overall, treatment PJP200 exhibited highest total weight gain (3.960c) followed by PJP400 (2.700 kg). Group PJP0 had the lowest weight gain by the end of the experiment. The supplemented groups showed good weight gains, body condition and retained nitrogen levels compared to the un-supplemented groups.

Abstract: This study was conducted to determine the potential of incorporating Prosopis juliflora seed pods into typical dry land livestock production systems to minimize feed scarcity during the dry seasons and avoiding weight losses and poor performance. The study evaluated supplementation of weaner Galla goats with increasing amounts of Prosopis juliflora seedpods that is widely distributed in arid and semi arid areas of Kenya. This species is drought tolerant and with high productivity of seed pods whole year round. The overall aim of this study was therefore, to assess the feasibility of incorporating P. juliflora seedpods into a typical dry land livestock production system. The study further sought to find out the optimum supplementation level for improved performance. The experiment involved 20 weaner Galla goats of similar age (6 months) and weights (11-14 kg) which were randomly assigned to four treatments of 5 weaners each. The treatments were No P. juliflora (PJP0), 100 g/goat/day P. juliflora (PJP100), 200 g/goat/day P. juliflora (PJP200), 400 g/goat/day P. juliflora (PJP400). Supplementation involved providing the goats with their respective diets in the morning before mixed species range grass hay was offered as basal diet. The animals were weighed on weekly basis and weight gains calculated as difference in previous week’s weight and current week’s weight. The experiment lasted for 70 days. Overall, all the treatment groups exhibited higher average weekly weight gains than the control group throughout the experimental period. However, for the first 3 weeks, this was not statistically significant (p<0.05). From the 5th week up to the 10th week, there was significant difference (p<0.05) in the growth rates for the treatments except for the control group. Overall, treatment PJP200 exhibited highest total weight gain (3.960c) followed by PJP400 (2.700 kg). Group PJP0 had the lowest weight gain by the end of the experiment. The supplemented groups showed good weight gains, body condition and retained nitrogen levels compared to the un-supplemented groups

Abstract: This study was conducted to determine the potential of incorporating Prosopis juliflora seed pods into typical dry land livestock production systems to minimize feed scarcity during the dry seasons and avoiding weight losses and poor performance. The study evaluated supplementation of weaner Galla goats with increasing amounts of Prosopis juliflora seedpods that is widely distributed in arid and semi arid areas of Kenya. This species is drought tolerant and with high productivity of seed pods whole year round. The overall aim of this study was therefore, to assess the feasibility of incorporating P. juliflora seedpods into a typical dry land livestock production system. The study further sought to find out the optimum supplementation level for improved performance. The experiment involved 20 weaner Galla goats of similar age (6 months) and weights (11-14 kg) which were randomly assigned to four treatments of 5 weaners each. The treatments were No P. juliflora (PJP0), 100 g/goat/day P. juliflora (PJP100), 200 g/goat/day P. juliflora (PJP200), 400 g/goat/day P. juliflora (PJP400). Supplementation involved providing the goats with their respective diets in the morning before mixed species range grass hay was offered as basal diet. The animals were weighed on weekly basis and weight gains calculated as difference in previous week’s weight and current week’s weight. The experiment lasted for 70 days. Overall, all the treatment groups exhibited higher average weekly weight gains than the control group throughout the experimental period. However, for the first 3 weeks, this was not statistically significant (p<0.05). From the 5th week up to the 10th week, there was significant difference (p<0.05) in the growth rates for the treatments except for the control group. Overall, treatment PJP200 exhibited highest total weight gain (3.960c) followed by PJP400 (2.700 kg). Group PJP0 had the lowest weight gain by the end of the experiment. The supplemented groups showed good weight gains, body condition and retained nitrogen levels compared to the un-supplemented groups

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