Objective To determine the safety and efficacy of UniPron as a reversible contraceptive. Methods Vaginal swabs were obtained before and after UniPron administration, cultured onto appropriate culture media and bacteria identification was done based on type of media used, Gram stain reactions, colony morphology and biochemical tests. Vaginal biopsy tissues were processed using paraffin wax method, stained with hematoxylin and eosin and examined under light microscopy to determine the effect of the product on vaginal tissues. The effect of UniPron on sperm was examined by mixing the product with electroejaculated spermatozoa in vitro at different concentrations. For efficacy studies, male baboons of proven fertility were mated with UniPron treated or untreated females of proven fertility during the fertile stages. Results All the five females (100%) that were treated with UniPron did not conceive and they regained total fertility when the treatment was stopped while all the controls conceived. At a concentration of 40%,UniPron completely immobilized spermatozoa in an in-vitro system. UniPron mechanism of action was by lowering the vaginal pH and on application in baboon, the pH was lowered for at least 3 h after which it went back to normal. Conclusions As we plan for a study to test UniPron as a microbicide to prevent STIs including HIV, our current study has established that this novel product is effective in contraception and harmless to vaginal tissues and vaginal microbial flora in a baboon model (Papio anubis).

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

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

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

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: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%.

Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised.

Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program.

Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%.

Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable.

Distinct pathogenic and epidemiological features underlie different strains resulting in different clinical manifestations of East Coast Fever and Corridor Disease in susceptible cattle. Unclear delineation of these strains limits the control of these diseases in endemic areas. Hence, an accurate characterization of strains can improve the treatment and prevention approaches as well as investigate their origin. Here, we describe a set of single nucleotide polymorphisms (SNPs) based on 13 near-complete mitogenomes of strains originating from East and Southern Africa, including the live vaccine stock strains. We identified 11 SNPs that are non-preferentially distributed within the coding and non-coding regions, all of which are synonymous except for two within the gene of buffalo-derived strains. Our analysis ascertains haplotype-specific mutations that segregate the different vaccine and the buffalo-derived strains except Muguga and Serengeti-transformed strains suggesting a shared lineage between the latter two vaccine strains. Phylogenetic analyses including the mitogenomes of other species: , , and , with the latter two sequenced in this study for the first time, were congruent with nuclear-encoded genes. Importantly, we describe seven haplotypes characterized by synonymous SNPs and parsimony-informative characters with the other three transforming species mitogenomes. We anticipate that tracking mitochondrial haplotypes from this study will provide insight into the parasite's epidemiological dynamics and underpin current control efforts.

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

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

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

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

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

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.

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

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.

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.

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.

The use of saliva in diagnosis of infectious diseases is an attractive alternative to procedures that involve blood drawing. It promises to reduce risks associated with accidental needle pricks and improve patient compliance particularly in malaria survey and drug efficacy studies. Quantification of parasitaemia is useful in establishing severity of disease and in assessing individual patient response to treatment. In current practice, microscopy is the recommended technique, despite its limitations. This study measured the levels of Plasmodium falciparum lactate dehydrogenase (PfLDH) in saliva of malaria patients and investigated the relationship with blood parasitaemia.

Nomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our study aimed at establishing the relative influence of social demographics, missed opportunities, and geographical mobility on severe under vaccination in children aged less than two years living in a nomadic pastoralist community of Kenya.

Nomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our study aimed at establishing the relative influence of social demographics, missed opportunities, and geographical mobility on severe under vaccination in children aged less than two years living in a nomadic pastoralist community of Kenya.

In the Tana River Basin in Kenya, six Regional Circulation Models (RCMs) simulating two Representative Concentration Pathways (RCPs) (i.e., 4.5 and 8.5) were used as input to the Soil and Water Assessment Tool (SWAT) model to determine the possible implications for the hydrology and water resources of the basin. Four hydrological characteristics – water yield, groundwater recharge, base flow and flow regulation – were determined and mapped throughout the basin for three 30-year time periods: 2020–2049, 2040–2069 and 2070–2099. Results were compared with a baseline period, 1983–2011. All four hydrological characteristics show steady increases under both RCPs for the entire basin but with considerable spatial heterogeneity and greater increases under RCP 8.5 than RCP 4.5. The results have important implications for the way water resources in the basin are managed. It is imperative that water managers and policy makers take into account the additional challenges imposed by climate change in operating built infrastructure.

Background: Postpartum haemorrhage (PPH) affects 6% of births and accounts for almost 30% of maternal deaths. The use of clinical protocols for preventing and treating PPH is recommended by WHO. Protocols should be evidence-based, regularly updated, widely available and routinely adhered to.
Broad Objective: To update the Kenyatta National Hospital (KNH) PPH prevention and management protocol based on latest recommendations, and ensure its dissemination and use by providers.
Materials and Methods: A literature search identified selected PPH-related guidelines which were assessed using the AGREE-II tool for guideline quality. A matrix was created to compare recommendations across guidelines. Recommendations included in the KNH protocol were based on agreement across guidelines, guideline quality, publication year, and contextual factors in our setting. To aid implementation, an updated KNH protocol document, a clinical algorithm and a PPH management checklist were developed. These were reviewed and accepted as best practice by KNH and University of Nairobi.
Results: Six PPH-related guidelines were used (WHO, FIGO, RCOG, ACOG, FOGSI, and the Kenya National Guidelines for Quality Obstetrics and Perinatal care). The KNH protocol covers PPH prevention, including: active management of third stage, oxytocin after vaginal or caesarean delivery, other drugs for prevention (when oxytocin is not available), controlled cord traction and delayed cord clamping. It also covers PPH management (supportive and definitive measures).
Conclusion: An updated PPH prevention and management protocol for KNH was developed. Implementation and adherence will help standardize PPH-related care and improve health outcomes for women.

Focus group discussion is frequently used as a qualitative approach to gain an in‐depth understanding of social issues. The method aims to obtain data from a purposely selected group of individuals rather than from a statistically representative sample of a broader population. Even though the application of this method in conservation research has been extensive, there are no critical assessment of the application of the technique. In addition, there are no readily available guidelines for conservation researchers.
Here, we reviewed the applications of focus group discussion within biodiversity and conservation research between 1996 and April 2017. We begin with a brief explanation of the technique for first‐time users. We then discuss in detail the empirical applications of this technique in conservation based on a structured literature review (using Scopus).
The screening process resulted in 170 articles, the majority of which (67%, n = 114,) were published between 2011 and 2017. Rarely was the method used as a stand‐alone technique. The number of participants per focus group (where reported) ranged from 3 to 21 participants with a median of 10 participants. There were seven (median) focus group meetings per study. Focus group discussion sessions lasted for 90 (median) minutes. Four main themes emerged from the review: understanding of people's perspectives regarding conservation (32%), followed by the assessment of conservation and livelihoods practices (21%), examination of challenges and impacts of resource management interventions (19%) and documenting the value of indigenous knowledge systems (16%). Most of the studies were in Africa (n = 76), followed by Asia (n = 44), and Europe (n = 30).
We noted serious gaps in the reporting of the methodological details in the reviewed papers. More than half of the studies (n = 101) did not report the sample size and group size (n = 93), whereas 54 studies did not mention the number of focus group discussion sessions while reporting results. Rarely have the studies provided any information on the rationale for choosing the technique. We have provided guidelines to improve the standard of reporting and future application of the technique for conservation.
1 INTRODUCTION
Conservation social science has come of age (Bennett et al., 2017). From being an outlier and on the sidelines of the discourse on conservation, the importance of understanding human perspectives is now centre stage in conservation decision making (Bennett et al., 2017; Khadka, Hujala, Wolfslehner, & Vacik, 2013; Paloniemi et al., 2012). Within the repertoire of tools that conservation biologists can use, focus group discussion is a commonly used method. Focus group discussion is a technique where a researcher assembles a group of individuals to discuss a specific topic, aiming to draw from the complex personal experiences, beliefs, perceptions and attitudes of the participants through a moderated interaction (Cornwall & Jewkes, 1995; Hayward, Simpson, & Wood, 2004; Israel, Schulz, Parker, & Becker, 1998; Kitzinger, 1994; Morgan, 1996).

Focus group discussion is widely used in conservation research unlike some of the other relatively lesser known techniques such as Nominal Group Technique (Hugé & Mukherjee, in prep) and Q methodology (Zabala & Mukherjee, 2017). The method's popularity is closely linked to the rise of participatory research, especially the “active experimentation with focus groups” in the academic social sciences during the 1980s (Morgan, 2002). The technique emerged as a qualitative data collection approach and a bridging strategy for scientific research and local knowledge (Cornwall & Jewkes, 1995). Focus group discussion is perceived to be a “cost‐effective” and “promising alternative” in participatory research (Morgan, 1996) offering a platform for differing paradigms or worldviews (Guba & Lincoln, 1994; Orr, 1992). Sociologists and psychologists have used the method since the 1940s (e.g. Merton & Kendall, 1946; Merton, Fiske & Kendall 1956). However, its popularity and application has grown across a wide range of disciplines including education (Flores & Alonso, 1995), communication and media studies (Lunt & Livingstone, 1996), sociology (Morgan, 1996), feminist research (Wilkinson, 1998, 1999), health research (Wilkinson, 1998) and marketing research (Morgan, Krueger, & King, 1998; Szybillo & Berger 1979).

Focus group discussion is sometimes seen as synonymous with interviews, especially the semi‐structured “one‐to‐one” and “group interviews” (Parker & Tritter, 2006). Similarities between these techniques relate to the tendency to uncover people's perceptions and values (e.g. Hargreaves, 1967; Lacey, 1970; Mac an Ghaill, 1994; Sewell, 1997; Skeggs, 1997). Consequently, there are cases where authors have confused and conflated these two distinctive methods (Parker & Tritter, 2006). However, existing evidence on the role of the researcher and the relationship with the participants points to a fundamental difference between the two techniques (Smithson, 2000). Interviews involve a one‐to‐one, qualitative and in‐depth discussion where the researcher adopts the role of an “investigator.” This implies the researcher asks questions, controls the dynamics of the discussion, or engages in dialogue with a specific individual at a time. In contrast, in a focus group discussion, researchers adopt the role of a “facilitator” or a “moderator.” In this setting, the researcher facilitates or moderates a group discussion between participants and not between the researcher and the participants. Unlike interviews, the researcher thereby takes a peripheral, rather than a centre‐stage role in a focus group discussion (Bloor, Frankland, Thomas, & Robson, 2001; Hohenthal, Owidi, Minoia, & Pellikka, 2015; Johnson, 1996; Kitzinger, 1994).

The link between people's perceptions and their socio‐cultural situation is critical to decision‐making on natural resources since most people derive their notions, mental constructions and interpretations from their immediate surrounding and develop these from experiential knowledge (Berkes, 2004). Given the rise of participatory research in conservation over the last few decades (Bennett et al., 2017), it is crucial to reflect on the scope and remit of focus group discussion as a methodological tool. Currently, there is relatively little or no critical discussion on the merits and demerits of focus group discussion in comparison to other similar qualitative techniques. It is therefore difficult to ascertain when and in which context, focus group discussion would be most appropriate. There are no guidelines for best practice for the application of the technique in conservation literature. In addition, there are no comprehensive reviews of the use of focus group discussion in conservation to the best of our knowledge.

Here we assess the strength and weaknesses of the focus group discussion technique based on a review of its application in conservation in the last two decades. We first briefly explain the procedure of the technique and then provide an overview of the different forms of focus group discussion. On the basis of a critical analysis of the relevant literature, we discuss the merits and potential pitfalls of the technique. Finally, we provide guidelines for reporting future applications of the technique and suggestions to address key psychological biases that can impact group interactions.

In this paper we document the use of dashboards in health care project management in an international health non-governmental organization. All projects at the organization monitor output performance on specific indicators against set targets and report these as project outputs performance report every month. In addition, projects prepare quality improvement report, compliance report and financial report. The four reports are then used to generate the monthly integrated performance monitoring and management dashboard which is shared with all staff and used by project managers and programme directors to review projects performance in the 4 parameters of measure and then used to provide appropriate technical support. We conducted a client satisfaction survey among staff to assess their levels of satisfaction with the dashboard and it came out that staff consider the dashboard as a “must have” monthly project management tool as it results in timely measurement of projects’ financial performance, programmatic performance, quality of service performance and compliance performance at a glance without the need to go through detailed reports. Programme directors and project managers use the dashboard to quickly identify hotspots, detect outliers in indicators of measure in a project and use this to deeply analyse possible causes of poor performance in projects for targeted technical assistance.

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.

This study conducted in western Kenya demonstrates how a gendered intersectionality lens can be used to explore how and the extent to which farming communities are coping with climate change. Results from a quantitative survey undertaken with 51 farmers and from 4 focused group discussions held with 33 farmers (19 males and 14 females) indicate that 85% of the respondents are willing to adopt climate-smart agriculture (CSA) interventions if constraining factors are resolved.This study reveals that farmers, regardless of whether they are male or female, are willing to adopt climate smart technologies and practices. However, factors such as ethnicity, education, age and marital status determine the levels of uptake of CSA technologies and practices. Looking at crops for instance, we find a high uptake (62.7%) of improved high yielding varieties (HYVs) amongst farmers with primary level education, meaning literacy levels influence adoption of practices. Analysis using age as a lens reveals that there is a high uptake among the youth and adults. Interestingly, the study site comprises of both the Luo and Kalenjin ethnic communities and even though they neighbor each other, we find a high rate of uptake among the Luo community due to existing social and cultural norms and practices related to farming. In conclusion, using a gendered intersectionality lens strengthens the argument for targeted interventions which focus on local needs and priorities while recognizing local contexts as informed by social, cultural and economic factors.

Keywords
Climate-smart agriculture Uptake Gender Intersectionality Kenya

This study conducted in western Kenya demonstrates how a gendered intersectionality lens can be used to explore how and the extent to which farming communities are coping with climate change. Results from a quantitative survey undertaken with 51 farmers and from 4 focused group discussions held with 33 farmers (19 males and 14 females) indicate that 85% of the respondents are willing to adopt climate-smart agriculture (CSA) interventions if constraining factors are resolved. This study reveals that farmers, regardless of whether they are male or female, are willing to adopt climate-smart technologies and practices. However, factors such as ethnicity, education, age, and marital status determine the levels of uptake of CSA technologies and practices. Looking at crops, for instance, we find a high uptake (62.7%) of improved high yielding varieties (HYVs) amongst farmers with primary level education, meaning literacy levels influence the adoption of practices. Analysis using age as a lens reveals that there is a high uptake among youth and adults. Interestingly, the study site comprises both the Luo and Kalenjin ethnic communities and even though they neighbor each other, we find a high rate of uptake among the Luo community due to existing social and cultural norms and practices related to farming. In conclusion, using a gendered intersectionality lens strengthens the argument for targeted interventions that focus on local needs and priorities while recognizing local contexts as informed by social, cultural, and economic factors.

Keywords
Climate-smart agriculture Uptake Gender Intersectionality Kenya

Intelligent agents have been used in collaborative learning. However, they are
rarely used to facilitate group interactions in collaborative m-learning environments. In view
of this, the paper discusses the use of intelligent agents in facilitating collaborative learning
in mobile learning environments. The paper demonstrates how to design intelligent agents
and integrate them in collaborative mobile learning environments to allow group learners to
improve their levels of group knowledge construction.

Intelligent agents have been used in collaborative learning. However, they are rarely used to
facilitate group interactions in collaborative m-learning environments. In view of this, the
paper discusses the use of intelligent agents in facilitating collaborative learning in mobile
learning environments. The paper demonstrates how to design intelligent agents and
integrate them in collaborative mobile learning environments to allow group learners to
improve their levels of group knowledge construction. The design was implemented in a
collaborative mobile learning system running on Modular Object-Oriented Dynamic
Learning Environment (Moodle) platform. The application was used in some experiments to
investigate the effects of those facilitated interactions on the level of group knowledge
construction.

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The creation of scientific weather forecasts is troubled by many technological challenges while their utilization is dismal. Consequently, the majority of small-scale farmers in Africa continue to consult weather lore to reach various cropping decisions. Weather lore is a body of informal folklore associated with the prediction of the weather based on indigenous knowledge and human observation of the environment. As such, it tends to be more holistic and more localized to the farmers’ context. However, weather lore has limitations such as inability to offer forecasts beyond a season. Different types of weather lore exist and utilize almost all available human senses (feel, smell, sight and hear). Out of all the types of weather lore in existence, it is the visual or observed weather lore that is mostly used by indigenous societies to come up with weather predictions. Further, meteorologists continue to treat weather lore knowledge as superstition partly because there is no means to scientifically evaluate and validate it. The visualization and characterization of visual sky objects (such as moon, clouds, stars, rainbow, etc) in forecasting weather is a significant subject of research. In order to realize the integration of visual weather lore knowledge in modern weather forecasting systems, there is a need to represent and scientifically substantiate weather lore. This article is aimed at coming up with a method of organizing the weather lore from the visual perspective of humans. To achieve this objective, we used fuzzy cognitive mapping to model and represent causal relationships between weather lore concepts and weather outcomes. The results demonstrated that FCMs are efficient for matrix representation of selected weather outcome scenarios caused visual weather lore concepts. Based on these results the recommendation of this study is to use this approach as a preliminary processing task towards verifying weather lore.

Maseru is the capital city of Lesotho and is a relatively small city with roughly 67 vehicles registered each day. Traffic lights are used with the intension of effectively managing vehicular traffic at junctions. These traffic lights follow a predetermined sequence usually based on historic data. As a result of this design, they inherently fail to efficaciously manage traffic flow when it is abnormal. Vehicles on one side have to wait even though there are no cars on other sides of the road. The consequences of this include increased congestion and atmospheric air pollution. Technological advancements have resulted in the now widely researched Internet of Things paradigm with one of its applications being vehicular traffic management. The focus of this paper is the design of a prototype reactive system based on Internet of Things whose functionality includes traffic lights that are capable of reacting to prevailing conditions. The system makes use of Radio Frequency IDentifier technology and mobile tools to ubiquitously collect traffic data and disseminate value added traffic information

Objective

To determine the difference in infection rate between 24 h versus five days of prophylactic antibiotic use in management of Gustilo II open tibia fractures.
Design

Unblinded randomized control trial.
Setting

Accident and Emergency, orthopedic wards and outpatient clinics at Kenyatta National Hospital (KNH).
Patients

The study involved patients aged 18–80 years admitted through accident and emergency department with Gustilo II traumatic open tibia fractures.
Intervention

Patients were randomized into either 24 hour or five day group and antibiotics started for 24 hours or five days after surgical debridement. The wounds were exposed and scored using ASEPSIS wound scoring system for infection after 48 h, 5 days and at 14 days.
Outcome measures

The main outcomes of interest were presence of infection at days 2, 5 and 14 and effect of duration to antibiotic administration on infection rate.
Results

There was no significant difference in infection rates between 24-hour and 5-day groups with infection rates of 23% (9/40) vs. 19% (7/37) respectively (p = 0.699). The infection rate was significantly associated with time lapsed before administration of antibiotics (p = 0.004).
Conclusion

In the use of prophylactic antibiotics for the management of Gustilo II traumatic open tibia fractures, there is no difference in infection rate between 24 hours and five days regimen but time to antibiotic administration correlates with infection rate. Antibiotic use for 24 hours only has proven adequate prophylaxis against infection. This is underlined in our study which we hope shall inform practice in our setting. A larger, more appropriately controlled study would be useful.

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.

Microalgae has had a number of applications. This study explores the formation of biodiesel from lipids and
formation of charred biomass fuel from the algae species found at Ruai Wastewater facility at Ruai, Nairobi. The
resulting biomass after solvent extraction was carbonized and the gross calorific value determined using a constant
volume bomb calorimeter. The bio-oil obtained from the algae was transesterified and the calorific value
determined. In one of the cases, carbon dioxide was bubbled through fresh algae from the waste water facility and
the biodiesel from this sample which was later sun-dried, crushed, then subjected to solvent extraction and
subsequent transesterification had the highest calorific value of 27,620 KJ/g compared to 22,758KJ/g in algae
sample which was not subjected to such a treatment. In the case of the charred biomass fuel, the gross calorific
value was found to be approx 23,132 KJ/g which makes it a medium calorific value fuel. GC-MS analysis was
performed on one of the transesterification samples and methyl esters of the isolated fatty acids were identified as
methyl esters of polyunsaturated fatty acid α-linolenic acid (18:3, n-3; ALA), Hexadecanoic acid and cis-9-hexadecenoic acid. In addition an alkane heptadecane was also isolated. This study shows that algae, which is
present in many water systems in Kenya can be used as a valuable source of fatty acids that are taken in diet by
animals and humans thus building a healthy nation.
Keywords: Microalgae, transesterification, biodiesel

Microalgae has had a number of applications. This study explores the formation of biodiesel from lipids and
formation of charred biomass fuel from the algae species found at Ruai Wastewater facility at Ruai, Nairobi. The resulting biomass after solvent extraction was carbonized and the gross calorific value determined using a constant volume bomb calorimeter. The bio-oil obtained from the algae was transesterified and the calorific value determined. In one of the cases, carbon dioxide was bubbled through fresh algae from the waste water facility and the biodiesel from this sample which was later sun-dried, crushed, then subjected to solvent extraction and subsequent transesterification had the highest calorific value of 27,620 KJ/g compared to 22,758KJ/g in algae sample which was not subjected to such a treatment. In the case of the charred biomass fuel, the gross calorific value was found to be approx 23,132 KJ/g which makes it a medium calorific value fuel. GC-MS analysis was performed on one of the transesterification samples and methyl esters of the isolated fatty acids were identified as methyl esters of polyunsaturated fatty acid α-linolenic acid (18:3, n-3; ALA), Hexadecanoic acid and cis-9-hexadecenoic acid. In addition an alkane heptadecane was also isolated. This study shows that algae, which is present in many water systems in Kenya can be used as a valuable source of fatty acids that are taken in diet by animals and humans thus building a healthy nation.

In recent years, the Kenyan government has worked to use Information and communication technologies (ICTs) to increase openness and transparency in their operations. These ICTs are seen as a cost-effective and convenient means to promote public participation in government in Kenya. While many of these efforts have had a government centered approach, the users perspective has been largely ignored. This research takes a user centered approach and looks at how user’s perspectives and attitudes affect adoption of e-government services. The iTax online service was selected as a case study for this research. The research framework is based on technology acceptance models focusing on the aspects of perceived usefulness and perceived ease of use by the users. This view is especially important in developing countries that are still grappling with issues of connectivity and basic infrastructure while developing e-governance initiatives. The data was collected using questionnaires (both paper and online), in depth interviews and a usability study focusing on the primary task of registering on the iTax government service. Findings indicate that the main pain point for both the government and the users is the speed of connectivity. While user/citizens generally think that provision of e-government services is a good idea, there is dissatisfaction with the complexity of the said egovernment service. Findings also show that issues of access in developing countries need to be viewed beyond infrastructure but also on service level. Service level access looks at the extent to which the service is usable to the targeted user. Service level access goes hand in hand with training since some users do have access to the infrastructure but lack the know how to effectively utilize the service. This research concludes that to increase the adoption of e-government services governments need to focus their strategies on the needs of users, their attitudes towards to the services and respond to these needs effectively.

Tsavorite, the vanadian variety of green grossular, is hosted exclusively in metasedimentary formations in the Neoproterozoic Metamorphic Mozambique Belt. In order to understand the origin of tsavorite in southeastern Kenya we integrated field investigations, geochemical studies, and dating. Two units are seen in outcrop: 1) a metasedimentary sequence, and 2) a quartz-feldspar migmatitic group. This second group of rocks shows classic "Pan-african geometry" with vertical and horizontal foliation planes. The metamorphism attains granulite facies. The metasedimentary sequence is different and recorded lower metamorphism (high-amphibolite facies, 680 °C), and if static recrystallization occurs, few traces of melting was observed. Landslide with sediment deformation structures of the sedimentary deposition are preserved. Systematic LA-ICPMS U/Pb dating was done on monazite and zircon. The migmatitic rocks recorded ages from 615 Ma to 585 Ma. The metasedimentary rocks recorded ages from 600 Ma to 595 Ma. Older ages of 850-720 Ma seems to be inherited ages from magmatic minerals. The formation of tsavorite is the result of a sedimentary sequence preserved from strain but heated by surrounding granulitic rocks between 600 to 595 Ma. The regional associated tectonic process is unclear but efficient for vertical displacement. We suggest that it is a peculiar event and process, and was unable to completely recrystallize the sedimentary rocks. These last are exceptionally preserved from strain and melt, a case that may be unique in the world.

A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV pre-exposure prophylaxis (PrEP) found stigma, sex work, mobility, and alcohol impacted adherence. We analyzed quantitative data from the same cohort to explore different definitions of intermittent adherence. Volunteers were randomized to daily emtricitabine/tenofovir or placebo, or intermittent (prescription: Mondays/Fridays/after sex, maximum 1 dose/day) emtricitabine/tenofovir or placebo (2:1:2:1), and followed for 4 months. By electronic monitoring, median adherence for daily dosing was 80 %. Median adherence for intermittent dosing was 71 % per a "relaxed" definition (accounting for off-prescription dosing) and 40 % per a "strict" definition (limited to the prescription). Factors associated with lower adherence included travel, transactional sex, and longer follow-up; higher adherence was associated with daily dosing and an income. The definition of intermittent dosing strongly affects interpretation of adherence. These findings suggest interventions should address challenges of mobility, sex work, and long-term PrEP.

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.

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

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

Recent Intergovernmental Panel on Climate Change (IPCC) reports [1] indicate that disasters associated with current climate extremes are impacting negatively on livelihoods and socio-economic systems. Extreme weather events such as floods and droughts are negatively impacting on agricultural production and other socio-economic sectors in the Greater Horn of Africa (GHA) region [2]. It is expected that climate change will increase the severity and frequency of these extreme weather events
with adverse effects particularly on vulnerable and poor communities.