Search

Although typhoid fever has largely been eliminated in high-income countries, it remains a major global public health concern especially among low- and middle-income countries. The causative agent, Salmonella enterica serovar Typhi (S. Typhi), is a human restricted pathogen with a limited capacity to replicate outside the human host. Human carriers, 90% of whom have gallstones in their gallbladder, continue to shed the pathogen for an ill-defined period of time after treatment. The genetic mechanisms involved in establishing the carrier state are poorly understood, but S. Typhi is thought to undergo specific genetic changes within the gallbladder as an adaptive mechanism. In the current study, we aimed to identify the genetic differences in longitudinal clinical S. Typhi isolates from asymptomatic carriers with gallstones in a typhoid endemic setting in Nairobi, Kenya. Whole-genome sequences were analyzed from 22 S. Typhi isolates, 20 from stool samples, and 2 from blood samples, all genotype 4.3.1 (H58). Out of this, 19 strains were from four patients also diagnosed with gallstones, of whom three had typhoid symptoms and continued to shed S. Typhi after treatment. All isolates had point mutations in the quinolone resistance-determining region (QRDR), and only sub-lineage 4.3.1.2.EA3 encoded multidrug resistance genes. There was no variation in antimicrobial resistance patterns among strains from the same patient/household. Non-multidrug resistant (MDR) isolates formed significantly stronger biofilms in vitro than the MDR isolates, p

Maize productivity has remained low and has worsened in the wake of a changing climate, resulting in new invasive pests, with pests that were earlier designated as minor becoming major and with pathogens being transported by pests and/or entering their feeding sites. A study was conducted in 2021 in the Kisumu and Makueni counties, Kenya, to determine how different maize cropping systems affect insect diversity, insect damage to maize, and insects’ ability to spread mycotoxigenic fungi in pre-harvest maize. The field experiments used a randomized complete block design, with the four treatments being maize monocrop, maize intercropped with beans, maize–bean intercrop with the addition of Trichoderma harzianum at planting, and push–pull technology. The FAW, Spodoptera frugiperda (J.E Smith) (Lepidoptera: Noctuidae), was the most damaging pest in the two regions. The push–pull and the maize–bean intercropping technologies significantly reduced the maize foliage and ear damage caused by the FAW. Beetles passively spread mycotoxigenic Aspergillus spp. and Fusarium verticillioides on pre-harvest maize. Maize weevils, namely, Sitophilus zeamais Motschulsky, 1855 (Coleoptera: Curculionidae), and Carpophilus dimidiatus Fabricius, 1792 (Coleoptera: Nitidulidae), earwigs, namely, Forficula spp. L. (Dermaptera: Forficulidae), and carpenter ants, namely, Camponotus spp. L. (Hymenoptera: Formicidae) carried the highest number of spores on their exoskeletons. This study stresses the role of insects in the spread of fungi on pre-harvest maize and their possible control by intercropping and other cropping technologies.

The present study examined the impact of professional development training on Canadian and Kenyan teachers’ confidence, comfort, and perceptions of their abilities to teach early literacy skills in the primary or elementary grades. Data were collected prior to and following training on how to integrate early literacy software as part of ongoing in-class instruction. Domain and technology constructs consistent with Mishra and Koehler’s (2006) technology integration model were assessed, as were perceptions related to delivery pacing. Overall, outcomes reflected more similarities than differences across the two groups of teachers. Limitations in foundational knowledge regarding concepts specific to early literacy were evident in both groups, despite higher levels of perceived confidence in Kenyan teachers compared to Canadian teachers in some content areas. Perceived comfort using technology and teaching with technology were highly correlated, with no differences observed across teacher groups. Pacing was perceived to be faster for Kenyan teachers compared to Canadian teachers. Implications for professional development in this domain are discussed.

Copyright of Estudios de Asia y África is the property of El Colegio de Mexico AC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This cross-sectional study sought to establish the level of knowledge of diabetes among community members in rural and urban areas of Kenya and determine how this impacts on attitudes and practices towards diabetes. A face-to-face interview was performed for selected respondents using a structured questionnaire for data collection. Of 1982 respondents, 1151 (58%) were female and 831 (42%) male and age ranged from 13 to 65 years. There were 539 (27%) with a good knowledge of diabetes; of these 52% had tertiary education; 25% had secondary education, and 14% and 9% had primary and no education, respectively. Only 971(49%) of the respondents had a positive attitude towards diabetes, while 813 (41%) demonstrated good practices towards diabetes. This study indicated that the level of knowledge of diabetes was poor. It also indicated poor attitudes and practices of the community towards diabetes. A comprehensive nationwide diabetes education programme is necessary to improve this situation. [ABSTRACT FROM AUTHOR]

Export earnings from livestock products are important to Kenya's economic development but recent fluctuations in exports warrant investigation of the responsible factors. Cointegration and error-correction representation following the Engle-Granger and Johansen procedures are used to test for long-run equilibrium relationships among exports of meat, milk and butter. Two cointegrating vectors involving milk and butter exports as endogenous variables are identified from the three-commodity system. Tests for exogeneity support the independence of meat exports of the other commodities. Estimates of restricted error-correction models corroborate these findings, leading to acceptance of the hypothesis that milk and butter exports are indeed determined endogenously. Conclusions are that meat exports are not related to milk and butter exports and that exports of milk and butter influence each other just as much as does the foreign exchange rate, the level of the national income and the price differential between export and domestic prices. [ABSTRACT FROM PUBLISHER]

The CYP2C19 gene presents polymorphism affecting the pharmacokinetics of several drugs of clinical importance. The purpose of this study was to investigate the correlation between CYP2C19 genotype and metabolic phenotype in a group of 38 Brazilian volunteers, evaluating the phenotype prediction capacity of the genotyping procedure. For CYP2C19 phenotyping, omeprazole was used as the probe drug, using the hydroxylation metabolic ratio as the phenotypic indicator. Venous blood samples were drawn before and three hours after an oral administration of 20 mg omeprazole. The plasma concentrations of omeprazole and hydroxy-omeprazole were determined by high performance liquid chromatography. The genotyping assay was carried out using a Real-Time-PCR-based assay, identifying the alleles *1 (completely functional), *2, *3 and *4 (null). The phenotyping procedure estimated the presence of 4 poor, 34 extensive and 1 ultra-extensive metabolizer. The genotyping identified 4 poor, 23 extensive and 11 intensive metabolizers. The groups of volunteers classified according to the number of active alleles of CYP2C19 had significant differences in the metabolic ratios of omeprazole hydroxylation. However, volunteers exhibiting the same number of active alleles presented different phenotypes. Therefore, the phenotyping of CYP2C19 is a more promising alternative to dose individualization of CYP2C19 substrate drugs.O gene CYP2C19 apresenta polimorfismo genético, com impacto importante na farmacocinética de diversos fármacos de importância clínica. O objetivo deste estudo foi avaliar a correlação entre genótipo e fenótipo de CYP2C19 em um grupo de 38 voluntários brasileiros, avaliando a capacidade de predição do fenótipo a partir de testes de genotipagem. Para a fenotipagem, utilizou-se omeprazol (OME) como fármaco-sonda para CYP2C19, empregando sua razão metabólica de hidroxilação como indicador fenotípico. Amostras de sangue foram coletadas antes e três horas após a administração oral de 20mg do fármaco. As concentrações plasmáticas de OME e seu metabólito foram determinadas por cromatografia líquida de alta eficiência. A genotipagem de CYP2C19 foi realizada através de ensaio baseado na reação em cadeia da polimerase em tempo real, identificando os alelos *1 (completamente funcional),*2 e *3 (nulos). Pela fenotipagem foi possível estimar a presença de 3 metabolizadores lentos, 34 rápidos e 1 ultra-rápido; enquanto pela genotipagem foi determinada a presença de 4 metabolizadores lentos, 23 rápidos e 11 intermediários. Os grupos de voluntários classificados de acordo com o número de alelos ativos apresentaram diferenças significativas entre as razões metabólicas de hidroxilação de omeprazol. Entretanto, indivíduos com o mesmo genótipo apresentaram fenótipos diferentes. Desta forma, a fenotipagem apresenta-se como alternativa mais promissora para a individualização das doses de fármacos substratos de CYP2C19.

Cuando Daniel Arap Moi, a la edad relativamente temprana de 54 años, llegó al poder como el segundo presidente de Kenia, en 1978, después de que el presidente fundador, Jomo Kenyatta, falleciera a los 84 años, prometió inmediatamente seguir los pasos de su antecesor. Este pronunciamiento fue significativo por diversos motivos. El nuevo mandatario buscaba inspirar al pueblo un respeto similar al que tenía Kenyatta, quien por su avanzada edad merecía el calificativo de mzee, título de reverencia para un anciano en swahili. Moi se apropiaba del discurso de la edad como un medio para justificar su posición autorita ria al asumir la metáfora del anciano paternal que constituía la máscara del poder político en Kenia. Como argumenta Ogola, esta imaginería paternal, utilizada en todo el país, siempre ha legitimado la gerontocracia.

Durante los años noventa, se produjo la emergencia de un género musical relativamente nuevo dentro de los límites de la cultura popular keniana. Las actuaciones públicas de los mūgithi marcaron el comienzo de nuevas direcciones para la música keniana en general, y específicamente para la música contemporánea gīkūyū en lo que respecta a temas y estilo. La presentación, básicamente un fenómeno urbano dominado por guitarristas gīkūyū en solitario, se discute en este artículo como el espacio principal donde las identidades son negociadas, incorporando puntos de contacto e interacciones entre tradición y modernidad en un escenario urbano.

Background: Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons., Methods: This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed as a multi-component intervention employing setting appropriate strategies for HIV care sensitization and integration, task shifting, resource reorganization, linkage advocacy, skills development and education to promote ED-HTS with a focus on higher-risk persons. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and persons never HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). HTS data were evaluated as facility-based HIV testing (completed in the ED) and distribution of HIV self-tests independently, and aggregated as ED-HTS. Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains., Results: All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS among all presenting patients increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR = 1.31, 95% CI: 1.21-1.43; p  < 0.001). Among 605 enrolled patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR = 11.2, 95%CI: 6.9-18.1; p  < 0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, facilities-based HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR = 13.8, 95%CI: 5.5-28.7, p  < 0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16 wk post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation., Conclusions: The HEATED program increased overall ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons already in contact with health systems.

Background: Interpersonal violence is a significant contributor to global morbidity, and affects young adults, particularly males. In Kenya, injuries, including those from interpersonal violence, are a leading cause of emergency department (ED) visits., Objective: This study aims to evaluate the frequency, demographics, and types of injuries caused by interpersonal and intimate partner violence among patients presenting to the Kenyatta National Hospital (KNH) ED in Nairobi, Kenya., Methods: This was a prospective cross-sectional study among injured adult patients presenting to the KNH ED., Results: Of 665 enrolled patients, 82% identified as male and the median age was 30 years. Among enrollees, 257 (39%) reported ever having experienced physical, sexual, and/or emotional violence. Seventy-one patients reported a history of intimate partner violence; more than half had experienced intimate partner violence within the past 12 months., Conclusions: Research on interpersonal injuries in ED settings is lacking, but data from a single Kenyan ED reveals a significant portion of injured patients with a history of interpersonal and intimate partner violence.

Background: Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons., Methods: This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed using setting specific data and utilizes resource reorganization, services integration and HIV sensitization to promote ED-HTS. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and those never previously HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains., Results: All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR=1.31, 95% CI:1.21-1.43; p<0.001) with a 62.9% relative increase in HIV self-test kit provision. Among 605 patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR=11.2, 95%CI:6.9-18.1; p<0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR=13.8, 95%CI:5.5-28.7, p<0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16-weeks post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation., Conclusions: The HEATED program increased ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons, already in contact with health systems.

Background: Epidemiological data show substantial variation in the risk of HIV infection between communities within African countries. We hypothesised that focusing appropriate interventions on geographies and key populations at high risk of HIV infection could improve the effect of investments in the HIV response., Methods: With use of Kenya as a case study, we developed a mathematical model that described the spatiotemporal evolution of the HIV epidemic and that incorporated the demographic, behavioural, and programmatic differences across subnational units. Modelled interventions (male circumcision, behaviour change communication, early antiretoviral therapy, and pre-exposure prophylaxis) could be provided to different population groups according to their risk behaviours or their location. For a given national budget, we compared the effect of a uniform intervention strategy, in which the same complement of interventions is provided across the country, with a focused strategy that tailors the set of interventions and amount of resources allocated to the local epidemiological conditions., Findings: A uniformly distributed combination of HIV prevention interventions could reduce the total number of new HIV infections by 40% during a 15-year period. With no additional spending, this effect could be increased by 14% during the 15 years-almost 100,000 extra infections, and result in 33% fewer new HIV infections occurring every year by the end of the period if the focused approach is used to tailor resource allocation to reflect patterns in local epidemiology. The cumulative difference in new infections during the 15-year projection period depends on total budget and costs of interventions, and could be as great as 150,000 (a cumulative difference as great as 22%) under different assumptions about the unit costs of intervention., Interpretation: The focused approach achieves greater effect than the uniform approach despite exactly the same investment. Through prioritisation of the people and locations at greatest risk of infection, and adaption of the interventions to reflect the local epidemiological context, the focused approach could substantially increase the efficiency and effectiveness of investments in HIV prevention., Funding: The Bill & Melinda Gates Foundation and UNAIDS., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: The high burden of HIV infections among female sex workers (FSW) in sub-Saharan Africa has been long recognised, but effective preventive interventions have largely not been taken to scale. We undertook a national geographical mapping exercise in 2011/2012 to assess the locations and population size of FSW in Kenya, to facilitate targeted HIV prevention services for this population., Methods and Findings: We used a geographical mapping approach, consisting of interviews with secondary key informants to identify "hot" spots frequented by FSW, their operational dynamics and the estimated numbers of FSW in those spots. This was followed by validation of the estimates through interviews with FSW at each spot identified. The mapping covered Nairobi, the capital city of Kenya, and 50 other major urban centres. In total, 11,609 secondary key informant interviews were conducted to identify FSW spots. Further, a total of 6,360 FSW were interviewed for spot validation purposes. A total of 10,670 spots where FSW congregate were identified. The estimated FSW population in all the towns mapped was 103,298 (range 77,878 to 128, 717). Size estimates in the towns mapped were extended to smaller towns that were not mapped, using a statistical model. The national urban FSW population estimate was 138,420 (range 107, 552 to 169, 288), covering all towns of over 5,000 population. We estimated that approximately 5% of the urban female population of reproductive age in Kenya could be sex workers, which is consistent with previous estimates from other sub-Saharan African countries., Conclusions: This study provides the first national level data on the size of the FSW population in Kenya. These data can be used to enhance HIV prevention programme planning and implementation for FSW, to form the basis for impact evaluations, and to improve programme coverage by directing efforts to locations with the greatest need.

Background: Road traffic injuries (RTIs) contribute to a significant proportion of the burden of disease in Kenya. They also have a significant impact on the social and economic well-being of individuals, their families, and society. However, though estimates quantifying the burden of RTIs in Kenya do exist, most of these studies date back to the early 2000s-more than one decade ago., Objective: This article aims to present the current status of road safety in Kenya. Using data from the police and vital registration systems in Kenya, we present the current epidemiology of RTIs in the nation. We also sought to assess the status of 3 well-known risk factors for RTIs-speeding and the use of helmets and reflective clothing., Methods: Data for this study were collected in 2 steps. The first step involved the collection of secondary data from the Kenya traffic police as well as the National Vital Registration System to assess the current trends of RTIs in Kenya. Following this, observational studies were conducted in the Thika and Naivasha districts in Kenya to assess the current status of speeding among all vehicles and the use of helmets and reflective clothing among motorcyclists., Results: The overall RTI rate in Kenya was 59.96 per 100,000 population in 2009, with vehicle passengers being the most affected. Notably, injuries to motorcyclists increased at an annual rate of approximately 29 percent (95% confidence interval [CI]: 27-32; P < .001). The mean age of death due to road traffic crashes was 35 years. Fatalities due to RTIs increased at an annual rate of 7 percent (95% CI: 6-8; P < .001) for the period 2004 to 2009. Observational studies revealed that 69.45 percent of vehicles in Thika and 34.32 percent of vehicles in Naivasha were speeding. Helmets were used by less than one third of motorcycle drivers in both study districts, with prevalence rates ranging between 3 and 4 percent among passengers., Conclusions: This study highlights the significant burden of RTIs in Kenya. A renewed focus on addressing this burden is necessary. Focusing on increasing helmet and reflective clothing use and enforcement of speed limits has the potential to prevent a large number of road traffic crashes, injuries, and fatalities. However, it is difficult to demonstrate the magnitude of the injury problem to policymakers with minimal or inaccurate data, and this study illustrates the need for national continuous, systematic, and sustainable data collection efforts, echoing similar calls for action throughout the injury literature.

This case report refers to a 26-year-old woman who attended a gynaecological clinic with a painful vulval swelling. She underwent surgical excision, was found to have a rare vulval low-flow arteriovenous malformation and was treated with embolisation therapy.

Contagious bovine pleuropneumonia (CBPP) is a disease that causes high morbidity and mortality losses to cattle. The financial implications of these losses are of great significance to cattle owners. Control of CBPP is therefore important as a way to salvage the losses and increase the incomes of cattle owners. This study estimated the economic cost of CBPP and the benefits of its control in twelve sub-Saharan African countries using a spreadsheet economic model developed in Microsoft Excel. The value of morbidity and mortality losses was estimated at 30 million euros (2.5 million per country) while the total economic cost (direct and indirect production losses plus disease control costs) was estimated at 44.8 million euros (3.7 million euros per country). An investment of 14.7 million euros to control CBPP would prevent a loss of 30 million euros. The financial return on investment in CBPP control is positive, with benefit-cost ratios that range from 1.61 (Ghana) to 2.56 (Kenya).

The first year of the Health Sciences Library Management Intern Program, funded by the National Library of Medicine and administered by the Council on Library Resources, has recently been completed. This paper discusses the origins of the internship, the selection of the successful applicants, and the motivation of the interns and host directors. The basic components of the intership year are described, and its effects on the host libraries and interns are considered. The immediate future of the internship is outlined, and other methods for training health sciences library administrators are briefly discussed.