Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/µL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, consideration of plasma viral load in ART initiation guidelines is warranted. Methods Using per-sex-act infectivity estimates and cross-sectional sexual behavior data from 2,484 HIV-1 infected persons with CD4 counts >350 enrolled in a study of African heterosexual HIV-1 serodiscordant couples, we calculated the number of transmissions expected and the number potentially averted under selected scenarios for ART initiation: i) CD4 count <500 cells/µL, ii) viral load ≥10,000 or ≥50,000 copies/mL and iii) universal treatment. For each scenario, we estimated the proportion of expected infections that could be averted, the proportion of infected persons initiating treatment, and the ratio of these proportions. Results Initiating treatment at viral load ≥50,000 copies/mL would require treating 19.8% of infected persons with CD4 counts >350 while averting 40.5% of expected transmissions (ratio 2.0); treating at viral load ≥10,0000 copies/mL had a ratio of 1.5. In contrast, initiation at CD4 count <500 would require treating 41.8%, while averting 48.4% (ratio 1.1). Conclusion Inclusion of viral load in ART initiation guidelines could permit targeting ART resources to HIV-1 infected persons who have a higher risk of transmitting HIV-1. Further work is needed to estimate costs and feasibility.

Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/µL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, consideration of plasma viral load in ART initiation guidelines is warranted.

Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/µL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, consideration of plasma viral load in ART initiation guidelines is warranted.

Annual seasonal droughts of 2-4 months occur in Kusa limiting access of households to safe drinking water. This compounds the health and socio-economic disasters through increased water borne diseases rated at 10% morbidity and 63% mortality and marginalizing economically the resource poor through drudgery and wastage of time in water fetching activities. The introduction of rooftop rainwater harvesting 5 m3 storage tanks has redressed the trend in 30% of the households owning these systems that harness the 900mm annual rainfall on 80-100 m2 individual roof catchments. A study carried in the area through structured questionnaires, group discussions and literature survey revealed that the tanks operated at reliability and satisfaction levels of 44-59% when the guttering system covered 25% of the available roof area and 80-100% for coverage of 100 % for daily demand levels of 100 liters. An assured supply of domestic water at homestead level resulted in a state of water security leading to increased use of water per capita thereby improving personal hygiene for the rural community. Morbidity and mortality rates from water borne diseases reduced from 10% to 9.8% and 63% to 31% respectively for households with rooftop-tank systems. The study showed that well sized roof-tank combinations and appropriate demand managed strategies are effective measures for ameliorating household water supply to mitigate against drought caused health and socio-economic disasters in the area.

Abstract

An important aspect of the UN Framework Convention on Climate Change (UNFCCC), which aims to limit the increase in global temperature to 1.5 °C by 2050, has been the development of monitoring and evaluation plans that integrate climate change perspectives into new policies and programs for the protection and functioning of ecological systems. These include measures that enhance adaptive capacity, strengthen resilience and reduce vulnerability to climate change. Ecosystem change and the interaction of the different drivers of change in ecosystems have been studied at different temporal and spatial scales across different disciplines. However, the use of long temporal records documenting environmental and climatic change in understanding the impacts of the interacting drivers of change and planning sustainable use of resources is relatively new. We present examples of the use of palaeoecological data from East Africa in planning for the long-term sustainable use of natural resources by providing long-term historical perspectives on human–environment–societal–wildlife interactions and engagement with the biocultural heritage and societal evaluations of these spaces to achieve an increasingly diverse set of conservation, social and economic objectives. We link the Earth system processes whose associated boundaries can be directly related to sustainable development goals in our attempt to prevent unacceptable environmental change. The realisation that humans are having a significant impact on climate and landscapes means we now need to showcase the societal relevance of palaeoecological research and utilise its output especially in our efforts to remain within a safe operating space for humanity and ecosystems.

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Normal 0 false false false MicrosoftInternetExplorer4 st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

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st1:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;}
Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = - 0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained.

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

Mwingi District lies within the Kenyan Arid and Semiarid lands (ASALs) in Eastern Province. Although some ethnobotanical surveys have been undertaken in some arid and semiarid areas of Kenya, limited studies have documented priority medicinal plants as well as local people's awareness of conservation needs of these plants. This study sought to establish the priority traditional medicinal plants used for human, livestock healthcare, and those used for protecting stored grains against pest infestation in Mwingi district. Further, the status of knowledge among the local people on the threat and conservation status of important medicinal species was documented. This study identified 18 species which were regarded as priority traditional medicinal plants for human health. In terms of priority, 8 were classified as moderate, 6 high, while 4 were ranked highest priority species. These four species are Albizia amara (Roxb.) Boiv. (Mimosacaeae), Aloe secundiflora (Engl. (Aloaceae), Acalypha fruticosa Forssk. (Euphorbiaceae) and Salvadora persica L. (Salvadoraceae). In regard to medicinal plants used for ethnoveterinary purposes, eleven species were identified while seven species were reported as being important for obtaining natural products or concoctions used for stored grain preservation especially against weevils. The data obtained revealed that there were new records of priority medicinal plants which had not been documented as priority species in the past. Results on conservation status of these plants showed that more than 80% of the respondents were unaware that wild medicinal plants were declining, and, consequently, few of them have any domesticated species. Some of the species that have been conserved on farm or deliberately allowed to persist when wild habitats are converted into agricultural lands include: Croton megalocarpus Hutch., Aloe secundiflora, Azadirachta indica A. Juss., Warburgia ugandensis Sprague, Ricinus communis L. and Terminalia brownie Fresen. A small proportion of the respondents however, were aware of the threats facing medicnal plants. Some of the plants reported as declining include, Solanum renschii Vatke (Solanaceae), Populus ilicifolia (Engl.) Rouleau (Salicaceae), Strychnos henningsii Gilg (Loganiaceae) and Rumex usambarensis (Dammer) Dammer (Polygonaceae). Considering the low level of understanding of conservation concerns for these species, there is need therefore, to build capacity among the local communities in this area particularly in regard to sustainable use of natural resources, conservation methods as well as domestication processes

The Nepal Demographic Health Survey (NDHS) in 2006 showed that more than half (56%) of the women with sexually transmitted infections (STIs), including HIV, in Nepal sought sexual health services. There is no such data for female sex workers (FSWs) and the limited studies on this group suggest they do not even use routine health services. This study explores FSWs use of sexual health services and the factors associated with their use and non-use of services. METHODS: This study aimed to explore the factors associated with utilisation of sexual health services by FSWs in the Kathmandu Valley of Nepal, and it used a mixed-method approach consisting of an interviewer administered questionnaire-based survey and in-depth interviews. RESULTS: The questionnaire survey, completed with 425 FSWs, showed that 90% FSWs self-reported sickness, and (30.8%) reported symptoms of STIs. A quarter (25%) of those reporting STIs had never visited any health facilities especially for sexual health services preferring to use non-governmental clinics (72%), private clinics (50%), hospital (27%) and health centres (13%). Multiple regression analysis showed that separated, married and street- based FSWs were more likely to seek health services from the clinics or hospitals. In- depth interviews with 15 FSWs revealed that FSWs perceived that personal, structural and socio-cultural barriers, such as inappropriate clinic opening hours, discrimination, the judgemental attitude of the service providers, lack of confidentiality, fear of public exposure, and higher fees for the services as barriers to their access and utilisation of sexual health services. CONCLUSION: FSWs have limited access to information and to health services, and operate under personal, structural and socio-cultural constraints. The 'education' to change individual behaviour, health worker and community perceptions, as well as the training of the health workers, is necessary.

Neuropathy is the most common neurologic complication of HIV but is widely under-diagnosed in resource-constrained settings. We aimed to identify tools that accurately distinguish individuals with moderate/severe peripheral neuropathy and can be administered by non-physician healthcare workers (HCW) in resource-constrained settings. Methods: We enrolled a convenience sample of 30 HIV-infected outpatients from a Kenyan HIV-care clinic. A HCW administered the Neuropathy Severity Score (NSS), Single Question Neuropathy Screen (Single-QNS), Subjective Peripheral Neuropathy Screen (Subjective-PNS), and Brief Peripheral Neuropathy Screen (Brief-PNS). Monofilament, graduated tuning fork, and two-point discrimination examinations were performed. Tools were validated against a neurologist's clinical assessment of moderate/severe neuropathy. Results: The sample was 57% male, mean age 38.6 years, and mean CD4 count 324 ceII s/ul, Neurologist's assessment identified 20% (6/30) with moderate/severe neuropathy. Diagnostic utilities for moderate/severe neuropathy were: Single¬QNS - 83% sensitivity, 71 % specificity; Subjective-PNS-total - 83% sensitivity, 83% specificity; Subjective-PNS-max and NSS - 67% sensitivity, 92% specificity; Brief-PNS - 0% sensitivity, 92% specificity; monofilament - 100% sensitivity, 88% specificity; graduated tuning fork - 83% sensitivity, 88% specificity; two-point discrimination - 75% sensitivity, 58% specificity. Conclusions: Pilot testing suggests Single-QNS, Subjective-PNS, and monofilament examination accurately identify HIV¬infected patients with moderate/severe neuropathy and may be useful diagnostic tools in resource-constrained settings.

Abstract Diabetes is a disease characterized by hyperglycaemia because of insufficient or nonproduction of insulin from the pancreas. Establishing prediabetic and diabetic condition often involves monitoring levels of glucose and some amino acids in blood using nonrapid and label-dependent methods. This work reports on a method with a potential of being used for quick label-free detection of diabetes mellitus type II based on Raman spectroscopy of blood applied onto a conductive silver-smeared glass slide. We show that Raman spectral profile from blood of streptozotocin-induced diabetic Sprague Dawley rats emanates from overlap of signals from valine, leucine, isoleucine, creatine, glucose, and fructose. The Raman spectral bands associated with these biomolecules have the potential of being used in prediabetic detection and diabetes prediction. Characteristic intense peaks in diabetic rat's blood spectra were centred at wave numbers 537 cm?1 associated with valine's CO2? rocking vibration, 829 cm?1 assigned to CH2 rocking vibration in leucine and 917?960 cm?1 ascribed to C?C and C?N stretching and CH3 rocking vibrations in various biomolecules. The average intensities of these bands were sensitive to antidiabetic drug administration on the rats as their values approached those of nondiabetic rats and so could be used as diabetes biomarker bands. Statistical analyses together with evaluation of average intensities of these biomarker bands showed that the herbal extract Rotheca myricoides Hochst had greater antidiabetic effect at low dose (50 mg/kg of body weight) than at high dose (100 mg/kg of body weight). A similar result was seen with area under curve values and could act as an additional parameter in diabetes detection and prediction.

Background: Congenital heart disease (CHD) is a significant cause of childhood morbidity and mortality worldwide. Bi-directional Glenn Shunts (BDGS) form part of the surgical strategy used to treat CHD; no data exists on BDGS usage in the study locality. Methods: A 7-year retrospective, descriptive study was carried out at the Kenyatta National Hospital in Nairobi, Kenya, between 1 January 2006 and 31 December 2012. Results: Eleven BDGS were performed on 11 patients; 63.6% had tricuspid atresia, 27.3% had double outlet right ventricle and 9.1% had pulmonary atresia with intact ventricular septum.

Conclusion: Further studies are warranted to identify factors contributing to the late performance of BDGS, poor post-operative follow-up and failure to perform FC.

Abstract
Background: In resource-limited settings, such as Kenya, access to CD4 testing is limited. Therefore, evaluation of
less expensive laboratory diagnostics is urgently needed to diagnose immuno-suppression in children.
Objectives: To evaluate utility of total lymphocyte count (TLC) as surrogate marker for CD4 count in HIV-infected
children.
Methods: This was a hospital based retrospective study conducted in three HIV clinics in Kisumu and Nairobi in
Kenya. TLC, CD4 count and CD4 percent data were abstracted from hospital records of 487 antiretroviral-naïve HIVinfected
children aged 1 month - 12 years.
Results: TLC and CD4 count were positively correlated (r = 0.66, p < 0.001) with highest correlation seen in
children with severe immuno-suppression (r = 0.72, p < 0.001) and children >59 months of age (r = 0.68, p <
0.001). Children were considered to have severe immuno-suppression if they met the following WHO set CD4
count thresholds: age below 12 months (CD4 counts < 1500 cells/mm3), age 12-35 months (CD4 count < 750
cells/mm3), age 36-59 months (CD4 count < 350 cells/mm3, and age above 59 months (CD4 count < 200 cells/
mm3). WHO recommended TLC threshold values for severe immuno-suppression of 4000, 3000, 2500 and 2000
cells/mm3 for age categories <12, 12-35, 36-59 and >59 months had low sensitivity of 25%, 23%, 33% and 62%
respectively in predicting severe immuno-suppression using CD4 count as gold standard. Raising TLC thresholds to
7000, 6000, 4500 and 3000 cells/mm3 for each of the stated age categories increased sensitivity to 71%, 64%, 56%
and 86%, with positive predictive values of 85%, 61%, 37%, 68% respectively but reduced specificity to 73%, 62%,
54% and 68% with negative predictive values of 54%, 65%, 71% and 87% respectively.
Conclusion: TLC is positively correlated with absolute CD4 count in children but current WHO age-specific
thresholds had low sensitivity to identify severely immunosuppressed Kenyan children. Sensitivity and therefore
utility of TLC to identify immuno-suppressed children may be improved by raising the TLC cut off levels across the
various age categories.

In resource-limited settings, such as Kenya, access to CD4 testing is limited. Therefore, evaluation of less expensive laboratory diagnostics is urgently needed to diagnose immuno-suppression in children. Objectives: To evaluate utility of total lymphocyte count (TLC) as surrogate marker for CD4 count in HIV-infected children. Methods: This was a hospital based retrospective study conducted in three HIV clinics in Kisumu and Nairobi in Kenya. TLC, CD4 count and CD4 percent data were abstracted from hospital records of 487 antiretroviral-naïve HIVinfected children aged 1 month - 12 years. Results: TLC and CD4 count were positively correlated (r = 0.66, p < 0.001) with highest correlation seen in children with severe immuno-suppression (r = 0.72, p < 0.001) and children >59 months of age (r = 0.68, p < 0.001). Children were considered to have severe immuno-suppression if they met the following WHO set CD4 count thresholds: age below 12 months (CD4 counts < 1500 cells/mm3), age 12-35 months (CD4 count < 750 cells/mm3), age 36-59 months (CD4 count < 350 cells/mm3, and age above 59 months (CD4 count < 200 cells/ mm3). WHO recommended TLC threshold values for severe immuno-suppression of 4000, 3000, 2500 and 2000 cells/mm3 for age categories <12, 12-35, 36-59 and >59 months had low sensitivity of 25%, 23%, 33% and 62% respectively in predicting severe immuno-suppression using CD4 count as gold standard. Raising TLC thresholds to 7000, 6000, 4500 and 3000 cells/mm3 for each of the stated age categories increased sensitivity to 71%, 64%, 56% and 86%, with positive predictive values of 85%, 61%, 37%, 68% respectively but reduced specificity to 73%, 62%, 54% and 68% with negative predictive values of 54%, 65%, 71% and 87% respectively. Conclusion: TLC is positively correlated with absolute CD4 count in children but current WHO age-specific thresholds had low sensitivity to identify severely immunosuppressed Kenyan children. Sensitivity and therefore utility of TLC to identify immuno-suppressed children may be improved by raising the TLC cut off levels across the various age categories.

In resource-limited settings, such as Kenya, access to CD4 testing is limited. Therefore, evaluation of less expensive laboratory diagnostics is urgently needed to diagnose immuno-suppression in children. Objectives: To evaluate utility of total lymphocyte count (TLC) as surrogate marker for CD4 count in HIV-infected children. Methods: This was a hospital based retrospective study conducted in three HIV clinics in Kisumu and Nairobi in Kenya. TLC, CD4 count and CD4 percent data were abstracted from hospital records of 487 antiretroviral-naïve HIVinfected children aged 1 month - 12 years. Results: TLC and CD4 count were positively correlated (r = 0.66, p < 0.001) with highest correlation seen in children with severe immuno-suppression (r = 0.72, p < 0.001) and children >59 months of age (r = 0.68, p < 0.001). Children were considered to have severe immuno-suppression if they met the following WHO set CD4 count thresholds: age below 12 months (CD4 counts < 1500 cells/mm3), age 12-35 months (CD4 count < 750 cells/mm3), age 36-59 months (CD4 count < 350 cells/mm3, and age above 59 months (CD4 count < 200 cells/ mm3). WHO recommended TLC threshold values for severe immuno-suppression of 4000, 3000, 2500 and 2000 cells/mm3 for age categories <12, 12-35, 36-59 and >59 months had low sensitivity of 25%, 23%, 33% and 62% respectively in predicting severe immuno-suppression using CD4 count as gold standard. Raising TLC thresholds to 7000, 6000, 4500 and 3000 cells/mm3 for each of the stated age categories increased sensitivity to 71%, 64%, 56% and 86%, with positive predictive values of 85%, 61%, 37%, 68% respectively but reduced specificity to 73%, 62%, 54% and 68% with negative predictive values of 54%, 65%, 71% and 87% respectively. Conclusion: TLC is positively correlated with absolute CD4 count in children but current WHO age-specific thresholds had low sensitivity to identify severely immunosuppressed Kenyan children. Sensitivity and therefore utility of TLC to identify immuno-suppressed children may be improved by raising the TLC cut off levels across the various age categories.

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Sorghum (Sorghum bicolorL.), wheat (Triticum aestivumL.), maize(Zea MaysL.), common bean (Phaseolus vulgaris L.) and garden pea (Pisum sativumL.) were tested as border crops for their ability to reduce the number of colonizing aphids and Potato Virus Y (PVY) incidence in seed potatoes (Solanum tuberosumL.). The experiment was done at Tigoni, Central Kenya for two seasons, from 03 May 2002 and from 17 October 2002. Apterae aphids were monitored weekly by picking 15 leaves from 5 randomly selected plants per plot while alate aphids were collected using yellow sticky traps mounted 0.5 m from the ground level at the edge of border crops. Three aphid species were recorded: Aphis gossypii (Glover), Macrosiphum euphorbiae (Thomas) and Myzus persicae (Sulzer). PVY incidence in the inner rows of potatoes surrounded by fallow and the border crops was statistically insignificant (P>0.05) but outer rows in crop-bordered plots had significantly less PVY than outer rows of fallow-bordered plots. The DAS- ELISA test used to confirm presence of PVY showed that the disease had the highest and lowest incidence in fallow and wheat bordered plots, respectively. This study shows that the effective border-crops can be used to manage aphids and PVY disease in potatoes. In addition, since most Kenyan potato growers are low income earners, adoption of border cropping technology can improve immensely the production success of the crop

Health systems face challenges of improving access to health services due to rising health care costs. Innovative services such as day surgery would improve service delivery. Day surgery is a concept where patients are admitted for surgical procedures and discharged the same day. Though used widely in developed countries due to its advantages, utilization in developing countries has been low. This study sought to establish how utilization of day surgery services was influenced by medical providers, patient awareness and cost among other factors.

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This study was done to determine the nature of utilization of dental auxiliaries and medical emergencies in private dental surgeries in Kenya. A self administering questionnaire with pre-paid postage was mailed to 138 dentists. 27.5% responded. 81.6% used dental auxiliaries and the main reason was to improve efficiency in managing patients. 93.5% of the auxiliaries were on job trained secondary school graduates. 63.2% of the respondents delegated duties which were mainly non-clinical. 26.3% did not delegate any duties. In a descending order, the reasons for non delegation were: that it would be risky to patients, not allowed by law, they did not find it necessary and that auxiliaries were not held responsible if something went wrong. The main duties delegated to the auxiliaries were cleaning of instruments and sterilization, mixing of restorative materials and preparing amalgam. Delegation was done primarily based on auxiliaries capability to perform the procedure and meet the set standards. 57.9% indicated that they rarely encountered medical emergencies. Syncope was the commonest emergency encountered. 72.7% indicated that auxiliaries could not handle medical emergencies because they were not trained. It is concluded that most dentists did not delegate clinical duties to dental auxiliaries and medical emergencies were rare.

This study was done to determine the nature of utilization of dental auxiliaries and medical emergencies in private dental surgeries in Kenya. A self administering questionnaire with pre-paid postage was mailed to 138 dentists. 27.5% responded. 81.6% used dental auxiliaries and the main reason was to improve efficiency in managing patients. 93.5% of the auxiliaries were on job trained secondary school graduates. 63.2% of the respondents delegated duties which were mainly non-clinical. 26.3% did not delegate any duties. In a descending order, the reasons for non delegation were: that it would be risky to patients, not allowed by law, they did not find it necessary and that auxiliaries were not held responsible if something went wrong. The main duties delegated to the auxiliaries were cleaning of instruments and sterilization, mixing of restorative materials and preparing amalgam. Delegation was done primarily based on auxiliaries capability to perform the procedure and meet the set standards. 57.9% indicated that they rarely encountered medical emergencies. Syncope was the commonest emergency encountered. 72.7% indicated that auxiliaries could not handle medical emergencies because they were not trained. It is concluded that most dentists did not delegate clinical duties to dental auxiliaries and medical emergencies were rare.

In the recent past, research on the utilization of deep learning algorithms for space applications has been widespread. One of the areas where such algorithms are gaining attention is in spacecraft pose estimation, which is a fundamental requirement in many spacecraft rendezvous and navigation operations. Nevertheless, the application of such algorithms in space operations faces unique challenges compared to application in terrestrial operations. In the latter, they are facilitated by powerful computers, servers, and shared resources, such as cloud services. However, these resources are limited in space environment and spacecrafts. Hence, to take advantage of these algorithms, an on-board inferencing that is power- and cost-effective is required. This paper investigates the use of a hybrid Field Programmable Gate Array (FPGA) and Systems-on-Chip (SoC) device for efficient onboard inferencing of the Convolutional Neural Network (CNN) part of such pose estimation methods. In this study, Xilinx’s Zynq UltraScale+ MPSoC device is used and proposed as an effective onboard-inferencing solution. The performance of the onboard and computer inferencing is compared, and the effectiveness of the hybrid FPGA-CPU architecture is verified. The FPGA-based inference has comparable accuracy to the PC-based inference with an average RMS error difference of less than 0.55. Two CNN models that are based on encoder-decoder architecture have been investigated in this study and three approaches demonstrated for landmarks localization.

Information and Communication Technologies (ICTs) mean different things to different people; there is little informed discussion on what ICTs actually are; how they are evolving and converging, where they might be going and what the implications are for their further use in poverty reduction. This paper explores the various definitions and conceptualizations of ICTs with a view to arriving at a working definition and conceptualization of ICTs in our attempt to suggest the requirements of a framework for the utilization of ICTs for poverty reduction. To work towards the framework, various definitions and dimensions of poverty are explored and poverty reduction efforts using the capability approach are considered. Lastly, a framework for the utilization of ICTs for poverty reduction is suggested.

This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified–aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research

Description
Environmental Protection Agency classifies slaughter house waste as one of the most toxic environmental pollutants due to high pathogen content. Composting and anaerobic digestion are among the most common methods used for its disposal. In this study, utilization of rumen fluid as bio–catalyst in microbial fuel cells is investigated. Different market wastes were converted to electricity by loading them in anodic anaerobic chamber and then adding rumen fluid from Dagoretti slaughterhouse. 0.584 V was obtained on day 19 from avocado fruit waste while the maximum voltage for tomato waste was 0.701 V on day 20. Water melon and fruits mixture produced the least voltage. The maximum power from the tested substrate was obtained from tomato wastes. The power and current density were in the range of 1.825 to 60.041 mW/m2 and 6.762 and 99.174 mA/m2 respectively for tomato wastes. A maximum voltage of 0.584 V was obtained from tomato wastes when 500ml rumen fluid was used while 0.248 Vwas obtained for avocado fruit waste with the same amount of rumen fluid. Electrode surface area of 0.006666 m2 gave the highest voltage and power amongst 0.00399 m2 and 0.01331 m2. When the influence of external resistors was investigated, power, voltage and current obtained across a 45kΩ were 0.385 V, 0.038 Ma and 0.01463 mW on day 7 respectively for tomato wastes.

Description
Environmental Protection Agency classifies slaughter house waste as one of the most toxic environmental pollutants due to high pathogen content. Composting and anaerobic digestion are among the most common methods used for its disposal. In this study, utilization of rumen fluid as bio–catalyst in microbial fuel cells is investigated. Different market wastes were converted to electricity by loading them in anodic anaerobic chamber and then adding rumen fluid from Dagoretti slaughterhouse. 0.584 V was obtained on day 19 from avocado fruit waste while the maximum voltage for tomato waste was 0.701 V on day 20. Water melon and fruits mixture produced the least voltage. The maximum power from the tested substrate was obtained from tomato wastes. The power and current density were in the range of 1.825 to 60.041 mW/m2 and 6.762 and 99.174 mA/m2 respectively for tomato wastes. A maximum voltage of 0.584 V was obtained from tomato wastes when 500ml rumen fluid was used while 0.248 Vwas obtained for avocado fruit waste with the same amount of rumen fluid. Electrode surface area of 0.006666 m2 gave the highest voltage and power amongst 0.00399 m2 and 0.01331 m2. When the influence of external resistors was investigated, power, voltage and current obtained across a 45kΩ were 0.385 V, 0.038 Ma and 0.01463 mW on day 7 respectively for tomato wastes.

Ultrasound 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.

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. 

Uwezeshaji Lugha ili Kuleta Maendeleo: Sera, Utendaji na Nafasi ya Kiswahili
Jayne Mutiga
Ikisiri
Nafasi ya lugha za waliokuwa wakoloni Afrika kama vile; Kiingereza, Kifaransa na Kireno, imezisukuma lugha za Kiafrika hadi ukingoni katika maendeleo ya kijamii na kiuchumi barani Afrika. Lugha za Kiafrika zimevurugwa na kutengwa katika msitari wa mbele wa uchumi wa nchi ambapo lugha hizi zinazungumzwa, jambo ambalo linaonekana kuwa mojawapo ya visababishi vya Afrika kutokuwa na maendeleo. Jambo hili limesasababishwa na nafasi ya lugha zilizokuwa zinatumiwa na wakoloni, kama vile Kiingereza, Kifaransa na Kireno na kuendelezwa na mtazamo wa waafrika wenyewe ambao huzidunisha lugha zao na kuamini kwamba wataweza kujiendeleza kupitia kumilisi vyema na kutumia lugha zilizotumiwa na serikali za kikoloni; jambo hili pamoja na wazo kuwa lugha ndiyo msingi au nguzo ya mchakato wa maendeleo ya namna yoyote ile. Swali la kujiuliza ni: Je, bara la Afrika linaweza kujipatia maendeleo yaliyo thabiti wakati wazungumzaji wanaendelea kutumia lugha ambazo zinaonekana kuzuia kuelimishwa pamoja na mawasiliano miongoni mwa watu wengi? Hivyo basi, lengo la makala haya ni kuangazia vile lugha inaweza kuwezeshwa ili kusaidia watumizi wake kushiriki katika shughuli za maendeleo ya nchi yao. Aidha inaendelea kuangazia njia ambazo zinaweza kutumiwa kuwezesha lugha ya Kiswahili nchini Kenya na katika eneo la Afrika Mashariki ili kuendeleza eneo hili wakati huu ambapo kuna katiba mpya na uundaji sera mpya nchini Kenya.