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.

Abstract
OBJECTIVE:
To determine HIV high risk groups among adults visiting Kenyatta National Hospital Voluntary Counselling and Testing Centre by use of Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS).
DESIGN:
A cross-sectional study of adults.
SETTING:
Kenyatta National Hospital Voluntary and Counselling Centre.
RESULTS:
Of the 6,415 adults screened for antibodies to HIV at Kenyatta National Hospital VCT Centre between July 2002 and February 2003, 728 tested positive in the two HIV screening tests used at the center, indicating a prevalence of 11%. Of these seropositive cases, 355 consented to participate in the study. Using STARHS, 34 (9.6%) of the plasma samples were classified as being from individuals with recent infection (within 170 days), giving an annual estimated HIV-1 incidence in this population of 1.3 infections per 100 person-years with a 95% CI of 0.872-1.728%. Young adults had a higher rate of new infection than older adults. Young females were infected much earlier in life, with a peak age of new infections of 26 years, versus 31 years for young males.
CONCLUSION:
This study confirms our hypothesis that STARHS or Detuned assay can be used to determine HIV incidence in this population. The HIV high risk groups as identified by this study are young women between ages 16 to 26 years old and men between ages 45 to 55 years of age.

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.

Objective: Rheumatoid arthritis is a
debilitating disease with accrual of joint damage during each flare of the disease that progresses to considerable functional disability. Early treatment is
thus aimed to achieve remission status so as to reduce the progression of joint
damage. Currently the disease activity parameter DAS28 (amongst others)
is used to define a remission status and thus demonstrate the efficacy
of a treatment regimen, however musculoskeletal ultrasound (MSUS) is
proving to be superior at determining the amount of inflammation within joints by grading synovial hypertrophy and neo-vascularization of the
inflamed synovium. This article is thus intended to shed light on the usefulness of musculoskeletal ultrasound
both greyscale and Doppler in the determination of treatment response
in rheumatoid arthritis patients. Design: This article will elaborate
the importance and effectiveness of musculoskeletal ultrasound. Thus it will involve a discussion on the need for an effective tool to detect inflammatory activity, the ability of ultrasound to detect and grade the disease activity i.e.
being sensitive to change, the various scoring systems currently used, and
lastly a comparison of musculoskeletal ultrasound to other modalities and
clinical and serological evaluation. Data source and extraction:
Published studies, reviews and guidelines regarding the use of
musculoskeletal ultrasound of the wrist/hand in assessing treatment
response in rheumatoid arthritis patients were sourced through the
internet and library searches and the relevant data extracted. Conclusion:
status of the patient or a high initial ESR with significant serological and clinical
improvement, which will again not be portrayed in the DAS28 results. There may also be variability when assessing joints that are swollen or tender in between different examiners4. Moreover, there is a subset of
patients who still have disease progression despite achieving clinical remission status5.
  Magnetic Resonance Imaging (MRI) and radiographic evaluation have also been used as adjuncts to clinical exam but both have their drawb

   

.

.

Oral infection with Herpes Simplex Virus (HSV) is a frequent and well documented complication in immunosuppressed individuals including patients on immunosuppressive medication. We report the development of severe oral infection with HSV type 1 in a 34 year old woman with type 1 diabetes mellitus and end stage renal disease (ESRD) following cadaveric renal transplantation at the Western General Hospital, Edinburgh. The role of acyclovir in therapy and chemoprophylaxis is discussed.

 

 

New-born mice were subjected to a regime of under-nutrition during lactation by doubling the size of the scope by lactating mother. The undernourished mice and controls were sacrificed at 2 and 3 weeks after birth. The brain was fixed in glutaraldehyde. Small blocks of paravermale region were fixed in osmium tetroxide, dehydrated and embedded in Epone. Thin sections of 0.04 microns were cut and stained with uranyl acetate and lead citrate and viewed with an electron microscope to detect ultrastructural changes in Purkinje cells undernourished. Purkinje cells of mice controls were well differentiated at 2 and 3 weeks after birth, they had a euchromatic central core surrounded by rich Nissl substance cytoplasm and mitochondria. Purkinje cells were delayed in their differentiation as evidenced by the irregular and rough segmentation of the endoplasmic reticulum and free ribosomes group. These changes with the small number of mitochondria show reduced protein synthesis machinery. Granule cells showed immature glomeruli with less synaptic contacts and few mitochondria compared to control. These changes confirm the delay in differentiation and maturation of Purkinje neurons as a result of postnatal undernutrition. (Age & Nutrition, Volume 6, No. 2, 1995)

Risk perceptions play a key role in production and investment behavior of farmers. However, insufficient attention has been given to understand its nature and distribution in cash crop farming such as coffee. This study, therefore, attempts to explore patterns of coffee farmers’ perceived sources of risk and the factors associated with them. Data were drawn from a representative sample of 195 farmers residing in southwest Ethiopia. Farmers’ perceptions of risk are uneven and include price or market risks, crop diseases and pests, human illness, financial and natural elements. Farmers’ perceptions of the sources of risk can partly be explained by a combination of family and farm characteristics, location attributes, human capital, access to information and other infrastructure. In all, the results imply that farm advisors and policy makers can use these characteristics in targeting households and farmers’ groups for communicating relevant information about risk in coffee farming.

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

1. Singh C. B.  .  August . .

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

n/a

Malaria is one of the most serious public health problems in Kenya. Pregnant women are among the groups with the highest risk of malaria. Use of insecticide treated bed nets (ITNs) is a cost-effective method of controlling malaria. Despite this, there is low utilisation of ITNs among pregnant women in Kilifi district which is an endemic malaria zone. To determine knowledge, attitude and practice on the use of ITNs in the prevention of malaria among pregnant women in Kilifi district. A descriptive cross-sectional study. The district hospital and the five health centres in Kilifi district Two hundred and twenty pregnant women attending antenatal clinics (ANC) between October and December 2007. Knowledge on malaria illness and ITNs was high with majority of pregnant women having adequate level of knowledge (86.9%). There was significant association between level of education and adequate knowledge (P-value = 0.010). Good attitude on ITNs use was low. There was no association between good attitude and any of the socio-demographic variables. The majority of pregnant women attending ANC owned ITNs (75.4%). ITNs usage was high (70.5%). There was significant association between religion and good practice (p-value = 0.050). Although adequate level of knowledge on malaria and protective role of ITNs was high, there was no association between knowledge with practice and attitude. Before any malaria preventive intervention is implemented in an area, different socio-cultural factors must be considered when behavioural interventions for malaria control are designed and implemented. Targeted health education should be disseminated to the community to remove stigma and misconceptions associated with ITNs. Community concerns and fears should be addressed.

Appendicitis is the most common surgical emergency, but its diagnosis in children can be a challenge to the treating surgeon. PMID: 19829951

To assess correlates of long-acting reversible contraceptive (LARC) use, and explore patterns of LARC use among female sex workers (FSWs) in Kenya.

n/a

We report a case of a 44 year old man who presented with right gluteal pain following trivial trauma, associated with unusual bones, with all the characteristics of clavicles articulating with the pelvic girdle. The pain on that side was completely relieved by excision of the bone.

n/a

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.

n/a

Keywords: land cover, remote sensing, Landsat

INTRODUCTION

In developing nations where resources are scarce and increased population pressures create stress on available resources. methods are needed to examine effects of human migration and resultant changes in land cover. Widespread availability and low cost of remotely sensed imagery and Geographic Information Systems (GIS) are making such methods a reality to develop quantitative resource mapping and land cover change detection in developing nations (Sheng et al.. l997). However, difficulties arise in tropical regions When trying to analyse traditional vegetation bands (Bands 3 and 4). or indices such as NDVI because saturated pixels limit spectral distinction.

Optimal pediatric HIV disclosure impacts illness and developmental experiences while improving access to timely treatment. However, disclosure rates in high HIV prevalence countries remain low and there are limited data on best practices. We conducted a qualitative study of disclosure practices and interviewed healthcare providers from five pediatric HIV clinics in Kenya. We identified themes central to disclosure practices, rationale for approaches, barriers to implementing disclosure, and creative strategies to overcome challenges. We used these insights to develop a practice-based framework for disclosure that is sensitive to practical challenges. Overall, providers had limited training but extensive experience in disclosure, endorsed individualized disclosure practices, invested substantial time on disclosure despite clinical burden, and noted adverse outcomes associated with unplanned or abrupt disclosure. Providers advocated for an approach to disclosure that is child-centered but respects caregiver fears and values. Caregiver support was provided to enable caregivers to be the person who ultimately disclosed HIV status to children. Unplanned or abrupt disclosure to children was reported to have severe and persistent adverse impact and was a stimulus to accelerate disclosure in scenarios when providers believed children may be suspecting their diagnosis. Based on these expert insights, the framework we developed incorporates concurrent evaluation of child and caregiver readiness, identifies cues to prompt disclosure discussions, includes caregiver education and support, and utilizes a gradual approach of unveiling HIV diagnosis to the child.

n/a

In most animals there is bilateral access of odorants to the olfactory sensory epithelium. Air enters the nose through two external nares and passes back through the nasal cavity, which is divided down the midline by a cartilaginous nasal septum. The olfactory mucosa, a sheet of ciliated bipolar receptor cells, is found in the caudal two thirds of the nasal cavity. Axons from the sensory cells project to an ipsilateral extension of the telencephalon known as the olfactory bulb. If a single external naris of a rat pup is surgically closed (usually via brief cauterization) on the day after the day of birth (P1) and the subject is examined on P30, the size of the ipsilateral olfactory bulb is reduced by approximately 25%. The large reduction in size, coupled with the clear lamination and other features of the olfactory system, indicates that the manipulation is an ideal preparation for examining the regulation of early growth. We know that both olfactory bulbs are of equal size at the time of occlusion, but that 30 days later there is a large discrepancy. What series of events produces the changes? The present paper outlines what is known about the anatomical, biochemical and physiological changes introduced by naris occlusion in order to lay a framework for further work.

Induction of labor is being increasingly used to prevent adverse outcomes in the mother and the newborn.This study assessed the prevalence of induction of labor and determinants of its use in Africa. Methods We performed secondary analysis of the WHO Global Survey of Maternal and Newborn Health of 2004 and 2005. The African database was analyzed to determine the use of induction of labor at the country level and indications for induction of labor. The un-met needs for specific obstetric indications and at country level were assessed. Determinants of use of induction of labor were explored with multivariate regression analysis. Results A total of 83,437 deliveries were recorded in the 7 participating countries. Average rate of induction was 4.4% with a range of 1.4 – 6.8%. Pre-labor rupture of membranes was the commonest indication for induction of labor. Two groups of women were identified: 2,776 women with indications had induction of labor while 7,996 women although had indications but labor was not induced. Induction of labor was associated with reduction of stillbirths and perinatal deaths [OR – 0.34; 95% CI (0.27 – 0.43)]. Unmet need for induction of labor ranged between 66.0% and 80.2% across countries. Determinants of having an induction of labor were place of residence, duration of schooling, type of health facility and level of antenatal care. Conclusion Utilization of induction of labor in health facilities in Africa is very low. Improvements in social and health infrastructure are required to reverse the high unmet need for induction of labor.

n/a

n/a

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.

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.

This study seeks to document recent trends in early childhood mortality in the country and to offer some plausible explanations for the upsurge in the trends. Data and information from various sources are used in this paper to achieve this purpose. The results obtained show that infant, child and under-five mortality rates had declined in the 1960s and 1970s but were taking un upward trend since early 1990s. This situation is attributable to a combination of factors, including increased poverty, adverse effects of economic hardships and cost recovery programs associated with structural adjustment programs, increased childhood malnutrition, decreased use of certain maternity care services, decline in the coverage of child immunisations, inability of the public health system to provide services, and the HIV/ AIDS epidemic and the recent ethnic clashes that rocked some parts of the Rift Valley, Coast, Nyanza and Western province. In order to reverse the upward trend in mortality, there is an urgent need to intensify efforts to reduce poverty, to enable most people to have adequate food supply, improve the public health sector so that it can deliver health care to all people; to make greater efforts to raise the living standards of rural populations and improve the quality of housing, sanitary and sewerage conditions in urban slums. In addition, concerted efforts must continue to be made to contain the spread of HIV/AIDS, to assist AIDs orphans and to eliminate completely and to avoid recurrence of ethnic clashes and cattle rustling.

n/a

Students intellectual, social and human development is enhanced if lecturers are equipped with appropriate pedagogical and people-skills. Insights gained from lecturers capacity-building in-service training programs in a public university in Kenya are presented in this paper. Twenty thematic areas were covered aimed at improving competences of lecturers in facilitating students' learning. In-service lecturers' responses were analyzed qualitatively. In-service lecturers have training expectations and challenges in teaching university students when preparing them to become responsible citizens. They are generally satisfied with focused professional development seminars they attend, and are likely to provide effective lecturing and improved classroom practices in their faculties.

n/a

n/a

n/a

n/a

n/a

OBJECTIVE: To determine the prevalence of Xerophthalmia among Kenyan children aged four to seven years in high risk using Conjuctival Impression Cytology and transfer. DESIGN: A cross sectional community based study. SETTING: Mathare slum in Nairobi and Tiva/Ithiani area of Kitui. SUBJECTS: Children aged four to seven years residing in the above areas were assessed for both clinical and cytological features of vitamin A deficiency. RESULTS: Of the 342 children included in this study, 316 (92.0%) were normal, five (1.5%) had XN, 19 (5.9% had XIA and two (0.6%) had XIB. No signs of corneal Xerophthalmia were seen in this study. Conjuctival impression cytology and transfer (CICT) was used to asses for squamous metaplastic changes associated with Vitamin A deficiency (VAD). Seventy five (23.1%) of the children were normal by CICT while 249 (76.9%) were abnormal. In comparing the two areas of study, only 13.2% of the children in Mathare had normal CICT compared to 50% in Kitui. For each of the age groups studied there was significant difference between the two areas with children from Mathare being more deficient than those from Kitui. CONCLUSION: VAD is a significant health problem in the high risk areas assessed by CICT in this study.

Online learning has increasingly been adopted by most institutions of higher learning to facilitate teaching and learning as a continuum to the traditional face-to-face approach. Most of these institutions utilize Learning Management Systems which contain features that are intended to make students active participants not only by delivering learning resources to learners but also providing the environment for effective interaction in the learning process. Our examination of the literature reveals that there is limited empirical evidence that addresses how these features are being utilized by students in promoting Self-Regulated learning. To realize the usefulness of the features of Learning Management Systems in promoting Self-Regulated Learning, a structured survey was carried out among University students in Kenya. The findings reveal that the features of Learning Management Systems are underutilized by students. The qualitative results of the study illustrate that students face several challenges that obstruct them from being actively involved in online learning. There is lack of individualized feedback on students' learning habits, lack of instructor guidance, lack of interaction with course instructors, lack of peer interaction and lack of automation tools. This study provides insights for educators and researchers on the areas of focus that can be prioritized towards offering support to students in improving their Self-Regulated learning in online learning environments.

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.

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.

A simple gas chromatographic assay utilising alkali flame ionisation detection is described for the estimation of cyclophosphamide as its trifluoroacetate derivative from plasma. Examination of five patients following intravenous cyclophosphamide gave values of 8.9 h (SD 2.7) for the half-life and 0.061 liters/h/kg (SD 0.011) for whole-body clearance of the drug.

The mountain bongo antelope Tragelaphus eurycerus isaaci has rapidly declined in recent decades, due to a combination of hunting, habitat degradation and disease. Endemic to Kenya, mountain bongo populations have shrunk to approximately 100 individuals now mainly confined to the Aberdares mountain ranges. Indirect observation of bongo signs (e.g. tracks, dung) can be misleading, thus methods to ensure reliable species identification, such as DNA-based techniques, are necessary to effectively study and monitor this species. We assessed bongo presence in four mountain habitats in Kenya (Mount Kenya National Park, Aberdare National Park, Eburu and Mau forests) and carried out a preliminary analysis of genetic variation by examining 466 bp of the first domain of the mtDNA control region using DNA extracted from faecal samples. Of the 201 dung samples collected in the field, 102 samples were molecularly identified as bongo, 97 as waterbuck, one as African buffalo and one as Aders’ duiker. Overall species-identification accuracy by experienced trackers was 64%, with very high error of commission when identifying bongo sign (37%), and high error of omission for waterbuck sign (82%), suggesting that the two species’ signs are easily confused. Despite high variation in the mtDNA control region in most antelope species, our results suggest low genetic variation in mountain bongo as only two haplotypes were detected in 102 samples analyzed. In contrast, the analysis of 63 waterbuck samples from the same sites revealed 21 haplotypes. Nevertheless, further examination using nuclear DNA markers (e.g. microsatellites) in a multi-locus approach is still required, especially because the use of mitochondrial DNA can result in population overestimation as distinct dung samples can potentially be originated from the same individual.

This article considers the extent to which farming activities undertaken by low-income dwellers in Nairobi, Kenya, play a role in the food security and nutritional status of the households involved. It compares three low-income groups - two in Korogocho, viz. those who practise urban agriculture and those who do not, and one in the Kitui-Kanuku-Kinyago area, viz. households involved in the Undugu Society Urban Agriculture Project (USUAP). The questionnaire results indicate that those who farmed produced mainly for home consumption. The major problem urban farmers faced was theft. The food situation of the USUAP farming group was generally better than that of the two Korogocho groups. In all three groups, purchased food formed by far the most important food source. On average, all three groups had inadequate energy intake. However, the energy and protein intakes in the USUAP group were higher than in the other two groups. The USUAP group purchased more food, a fact related to their higher level of welfare as a result of benefits derived from income-generating activities and a shelter improvement project that came along with the urban agriculture project. Measures of nutritional health for young children showed a similar pattern in favor of the farming groups, albeit to a lesser extent. The long-term beneficial effect on nutritional status, however, was negligible. Bibliogr., notes, ref., sum. in English and French

OBJECTIVE: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya. SUBJECTS: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic. RESULTS: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H.pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. CONCLUSION: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

OBJECTIVE: To determine the prevalence of H. pylori and the associated upper gastrointestinal endoscopic lesions in diabetic outpatients with dyspepsia.
DESIGN: Cross-sectional study.
SETTING: Kenyatta National Hospital (KNH), Nairobi, Kenya.
SUBJECTS: Adult diabetic outpatients with dyspepsia attending the KNH diabetic clinic. RESULTS: Of the 257 randomly selected diabetic outpatients screened, 137 (53.3%) had dyspepsia. Seventy one of these patients underwent an upper gastrointestinal endoscopy. Fifty five (77.5%) of the 71 patients had H.pylori infection identified by rapid urease test and histology. The prevalence of H. pylori increased with HbA1c level but there was no statistically significant association with poor glycaemic control (HbA1c >7.0%). Forty eight (67.6%) of the 71 had gastritis, 17 (25.7%) had duodenitis, eight (11.3%) had oesophageal candidiasis, seven (9.9%) had bile reflux, six (8.5%) had reflux oesophagitis, six (8.5%) had ulcers (five duodenal, one gastric) and one (1.4%) had gastric cancer. Fourteen (19%) had endoscopically normal mucosa. The prevalence of H. pylori was 82.3% (32/38) in patients with antral gastritis. All ulcers and the cancer lesion (adenocarcinoma) were associated with H. pylori. Histological gastritis was found in 57 (81.8%) and was significantly associated with H. pylori. CONCLUSION: Although dyspepsia is common in diabetic outpatients at KNH, endoscopic findings and H. pylori status are not significantly different from those of non-diabetic population.

No abstract available.

The human body louse, Pediculus humanus, showed eighteen midgut proteins ranging between 12 and 117 kDa, when analysed by SDS-PAGE electrophoresis. Seven of them (12 kDa, 17 kDa, 29 kDa, 35 kDa, 40 kDa, 55 kDa and 97 kDa) were major bands based on their intensity of staining. The immunization of rabbits with a midgut extract elicited the production of protective polyclonal antibodies. These antibodies reacted strongly with all major midgut proteins as well as with 63 kDa and 117 kDa proteins when tested by the Western blot technique. The analysis of the proteins revealed that the 12 kDa, 25 kDa, 29 kDa, 35 kDa, 45 kDa, 87 kDa and 97 kDa proteins are glycosylated and none of them contained a lipid moiety. By electroelution, the proteins of 35 kDa and 63 kDa were purified. On trypsinization, the proteins of 35 kDa and 63 kDa produced four major fragments (F1, F2, F3, and F4) when resolved on a 18% SDS-PAGE. The F1 fragment of the 35 kDa protein reacted with the polyclonal antibodies by the immunoblot technique.

n/a

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.

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.

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.

The results of soil surveys at the ICIPE research site at Ungoye, South Nyanza, and the Ngori Ngori toposequence in Narok, Kenya, are discussed to provide insight into the applicability of soil survey information to soil and water management. It is concluded that soil survey information in soil and water management programmes can be used through understanding and appreciation of the criteria used in categorizing soils and their management implications. From the examples given it is noted that chemical aspects of the soil should be viewed not just as a means to assess its fertility, but also as a base to predict the behaviour of the soils when subjected to different types of management.

The results of soil surveys at the ICIPE research site at Ungoye, South Nyanza, and the Ngori Ngori toposequence in Narok, Kenya, are discussed to provide insight into the applicability of soil survey information to soil and water management. It is concluded that soil survey information in soil and water management programmes can be used through understanding and appreciation of the criteria used in categorizing soils and their management implications. From the examples given it is noted that chemical aspects of the soil should be viewed not just as a means to assess its fertility, but also as a base to predict the behaviour of the soils when subjected to different types of management.

A total of 133 observations on mean daily mass gains from 19 calves reared on either whole milk (control) or preserved colostrum (treatment) were estimated. The control group had a total of 104 observations computed, while the treatment group had a total of 29 observations. There was no significant difference in the overall mean daily mass gains between the treatment and control groups which were 0.2257 and 0.3607 kg, respectively (P < 0.1). Partial budgeting analysis estimated that with an annual calf crop of 80 calves, the use of preserved colostrum would result in a direct saving of an estimated US$1,800 per year for the farm.

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.

PURPOSE:
To assess whether unilateral axial elongation in chronic traumatic cataract is associated with the time interval from trauma to surgery.

SETTING:
PCEA Kikuyu Hospital Eye Unit, Nairobi, Kenya.

METHODS:
This retrospective cohort study analyzed patients with traumatic cataract operated on between 1998 and 2007. Study patients (n = 13) had a delay from trauma to surgery of more than 1 year and an interocular axial length (AL) difference greater than 1.0 mm. Randomly selected age-matched control patients (n = 14) had less than 1 year delay between trauma and surgery. The correlation between interocular AL difference and surgical delay was calculated in each group.

RESULTS:
The median interval from trauma to surgical treatment in study patients was 8 years (range 1 to 27 years). Study patients had a significantly higher median interocular AL difference (3.09 mm; interquartile range [IQR] 2.45 to 4.13 mm) than control patients (0.24 mm; IQR 0.15 to 0.30 mm) (P = .000). The length of delay from trauma to surgical treatment did not correlate strongly with the interocular AL difference in study or control patients (R(2) = 0.0143 and R(2) = 0.1697, respectively).

CONCLUSIONS:
Unilateral AL elongation may occur in young adults with chronic traumatic cataract. Delay of more than 1 year from trauma to surgery was associated with axial elongation, although the degree of elongation did not correlate with duration of delay. Surgeons are advised to implant lower-power intraocular lenses in such patients based on biometry readings to avoid postoperative refractive surprises.

n/a

n/a

n/a

n/a

Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners.

Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners.

As the Lord Jesus faced imminent death upon the Cross, He dedicated all His beloved disciples to a love relationship with His Mother saying, “Behold your mother!” St. John was present at the foot of the Cross, representing all mankind. And from that hour, he took her into his home. This commissioning of the Blessed Virgin Mary as Mother of all mankind illustrates the great love with which the LORD Jesus offered His life for all peoples - by giving us the gift of His mother. All are to comprehend that Mary has an active role to play in our faith and in our spiritual life. We acknowledge that this is how the LORD Jesus wished to bring His Sacrifice to completion by entrusting His mother to His beloved disciple, and in the beloved disciple to all mankind. It is a concrete maternal love relationship between Mary and all who trustingly commend themselves to her care. Under the watchful eye of Mary is a spiritual journey where we learn from the Blessed Mother of God what living a worthy discipleship in the LORD is, and we meditatively pray with the Blessed Mary as the first Christian Community did before Pentecost.

JASPA Working Paper, ILO, Addis Ababa

JASPA Working Paper, ILO, Addis Ababa

The need for improving practice in low-income settings has been demonstrated in recent research assessing the quality of hospital care. Consequently, the Ministry of Health developed clinical practice guidelines and an evidenced-based programme for their dissemination. This thesis explored what factors influence the uptake of the best-practice recommendations in a university teaching hospital. This thesis used a mixed methods research approach that utilized a before and after design and participatory action research. This approach recognizes that health recommendations are compiled for universal use, but that their successful implementation requires particular attention to the individual and complex socio-political contexts of each setting, both at the micro and -macro level, which in this case was the Kenyatta National Hospital (KNH). This thesis is supported by eighteen months of participant observation, based on ethnographic research methodology and action research. Patients' care was largely inconsistent with best-practice recommendations, with nine of the 17 key indicators having performance of below 10% in the pre-intervention period. The intervention had an absolute effect size of over 20% in eight of the 17 key indicators; three of which had an effect size of over 50%. The indicators that required collective efficacy achieved performance of less than 10% in the post-intervention period. The activities during the action research component failed to predict the trend in practitioners' performance, illustrating the difficulty of gaining a holistic understanding of the quantitative results using component parts of the qualitative results as the lens. The notion of professionalism provided an overarching understanding of the implementation process. There were clear gaps between the stated values espoused in the ideal of professionalism and the observed actions of professionals in KNH. Gaps spanned knowledge management, expertise and skills, teamwork, conscientiousness and patient centeredness. I attributed the gaps in professionalism to complexity of professional development.

Abstract
BACKGROUND: The anatomy of the radial artery draws great interests among anatomists for its frequent involvement in variations. Equally, these variations have gained significant attention from clinicians because of the preference to use the radial artery for catheterization. The commonest of radial artery variations involve its site of origin. In published literature, data on this variations exist, but the prevalence of such variations in a Kenyan population has hitherto been unknown.
METHODS: Sixty-two upper limbs from 50 formalin-fixed cadavers were studied during dissection in the Department of Human Anatomy, University of Nairobi.
RESULTS: Fifty-four (87.1%) radial arteries arose within the cubital fossa, while eight (12.9%) had a high origin. Out of the eight high arteries, two (3.2%) branched off from the axillary artery, another two (3.2%) were branches of the proximal third of the brachial artery and four (6.5%) arose from the middle third of the brachial artery. The high origin radial arteries were more common on the right upper limbs (5 out of the 8 cases). Both axillary and brachial origins were seen bilaterally.
CONCLUSION: The present study details important variations in the anatomy of the radial artery in a Kenyan population. With the radial artery being utilized during clinical, surgical and radiological interventions so frequently, an increased understanding and anticipation of such topographic variances is paramount.

The effect of acqueous extract of the tuber of Adenia globosa on the isolated preparation of the rat uterus was determined. The crude drug caused a dose-dependent contraction of the tissue preparation. This action was enhanced by a small dose of oxytocin. The results are discussed in relation to the traditional uses of this plant.

n/a