Determination of dilution and quality control of total and anti-measles immunoglobulin G antibody assays

Objective: To determine the correct dilution and Quality control commercial ELISA of total and anti-measles antibodies for HIV infected pregnant women.Design: A laboratory based studySetting: The University of Nairobi, Department of Paediatrics laboratory.Subjects: HIV infected pregnant women enrolled and exposed to different ARVs depending on their degree of immunosuppression for prevention of mother-child transmission of HIV-1.Results: The dilution used in this study, was 1:400000. Tight error bars of +/-0.1 were produced hence testing was done in singles not in duplicates as recommended. Validation steps did not pass for measles ELISA.Conclusion: Despite the recommendations of the manufacture each laboratory should always optimize an assay before performing tests and reporting the result. Every laboratory should determine the best dilution to use for quantitative TIgG assays and should perform internal and external quality control before reporting the results. These results will give insight on good laboratory practice during trouble shooting while assays are failing

Agribusiness diversification into digitalisation: a marketing risk or a strategy for survival?

African agribusiness start-ups are developing business models that deliver multiple tech-driven solutions to address the varying needs of smallholder farmers. Whilst this can be key for the financial sustainability of new businesses, according to agri-en

Propagating uncertainty to estimates of above-ground biomass for Kenyan mangroves: a scaling procedure from tree to landscape level

Mangroves are globally important carbon stores and as such have potential for inclusion in future forest-based climate change mitigation strategies such as Reduced Emissions from Deforestation and Degradation (REDD+). Participation in REDD+ will require developing countries to produce robust estimates of forest above-ground biomass (AGB) accompanied by an appropriate measure of uncertainty. Final estimates of AGB should account for known sources of uncertainty (measurement and predictive) particularly when estimating AGB at large spatial scales. In this study, mixed-effects models were used to account for variability in the allometric relationship of Kenyan mangroves due to species and site effects. A generic biomass equation for Kenyan mangroves was produced in addition to a set of species-site specific equations. The generic equation has potential for broad application as it can be used to predict the AGB of new trees where there is no pre-existing knowledge of the specific species-site allometric relationship: the most commonly encountered scenario in practical biomass studies. Predictions of AGB using the mixed-effects model showed good correspondence with the original observed values of AGB although displayed a poorer fit at higher AGB values, suggesting caution in extrapolation. A strong relationship was found between the observed and predicted values of AGB using an independent validation dataset from the Zambezi Delta, Mozambique (R2 = 0.96, p = < 0.001). The simulation based approach to uncertainty propagation employed in the current study produced estimates of AGB at different spatial scales (tree – landscape level) accompanied by a realistic measure of the total uncertainty. Estimates of mangrove AGB in Kenya are presented at the plot, regional and landscape level accompanied by 95% prediction intervals. The 95% prediction intervals for landscape level estimates of total AGB stocks suggest that between 5.4 and 7.2 megatonnes of AGB is currently held in Kenyan mangrove forests

Diversifier pour favoriser le développement de l'agriculture numérique

Trois jeunes entrepreneurs travaillant dans le secteur de l'agriculture numérique ont appris à leurs dépens que l'offre de solutions technologiques aux petits exploitants agricoles d'Afrique peut se heurter à des obstacles particuliers. Dans cet article

Making morbidity multiple: History, legacies, and possibilities for global health

Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the single disease became integral not only to disease control but to the extension of biopolitical power. Multimorbidity, we observe, is hoped to challenge single disease approaches but is assembled from the same problematic, historically-loaded categories that it exposes as breaking down. Next, we highlight the consequences of such classificatory legacies in everyday lives and suggest why frameworks and interventions to integrate care have tended to have limited traction in practice. Finally, we argue that efforts to align priorities and disciplines around a standardised biomedical definition of multimorbidity risks retracing the same steps. We call for transdisciplinary work across the field of global health around a more holistic, reflexive understanding of multimorbidity that foregrounds the culture and history of translocated biomedicine, the intractability of single disease thinking, and its often-adverse consequences in local worlds. We outline key domains within the architecture of global health where transformation is needed, including care delivery, medical training, the organisation of knowledge and expertise, global governance, and financing

Human papillomavirus and abnormal cervical lesions among HIV-infected women in HIV-discordant couples from Kenya

Objective HIV infection increases the risk of high-grade cervical neoplasia and invasive cervical carcinoma. The study addresses the limited data describing human papillomavirus (HPV) infection and cervical neoplasia among HIV-infected women in HIV-discordant relationships in sub-Saharan Africa, which is needed to inform screening strategies. Methods A cross-sectional study of HIV-infected women with HIV-uninfected partners was conducted to determine the distribution of type-specific HPV infection and cervical cytology. This study was nested in a prospective cohort recruited between September 2007 and December 2009 in Nairobi, Kenya. Cervical cells for HPV DNA testing and conventional cervical cytology were collected. HPV types were detected and genotyped by Roche Linear Array PCR assay. Results Among 283 women, the overall HPV prevalence was 62%, and 132 (47%) had ≥1 high-risk (HR)-HPV genotype. Of 268 women with cervical cytology results, 18 (7%) had high-grade cervical lesions or more severe by cytology, of whom 16 (89%) were HR-HPV-positive compared with 82 (41%) of 199 women with normal cytology (p<0.001). The most common HR-HPV types in women with a high-grade lesion or more severe by cytology were HPV-52 (44%), HPV-31 (22%), HPV-35 (22%), HPV-51 (22%) and HPV-58 (22%). HR-HPV genotypes HPV-16 or HPV-18 were found in 17% of women with high-grade lesions or more severe. HR-HPV screening applied in this population would detect 89% of those with a high-grade lesion or more severe, while 44% of women with normal or low-grade cytology would screen positive. Conclusion HR-HPV prevalence was high in this population of HIV-infected women with an uninfected partner. Choice of screening for all HR genotypes versus a subset of HR genotypes in these HIV-infected women will strongly affect the performance of an HPV screening strategy relative to cytological screening. Regional and subpopulation differences in HR-HPV genotype distributions could affect screening test performance

Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya

BACKGROUND: Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation. METHODS: Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes. RESULTS: Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing. COM-B Model [Figure: see text] Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya CONCLUSION: ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms. DISCLOSURES: All Authors: No reported disclosures

Economic value and latent demand for agricultural drought forecast: Emerging market for weather and climate information in Central-Southern Nigeria

Provision of weather and climate services are expected to improve the capacity for rural households’ preparedness and response plans to weather shocks. With increase in public investments in developing and communicating weather information on local scale in Nigeria, uncertainty in timescales that meet farmers’ needs and economic value of the information is still poorly understood. It is now a policy concern on whether farmers’ preferences and demands might increase its uptake. This study analyzed the economic value, latent demand, and emerging market of weather and climate information in Central-Southern Nigeria. Farm-level cross-sectional data reveals that 76% of the respondents were willing to pay for improved weather information and early warnings in taking climate smart decisions. Within farmers who showed positive responses, 86% would pay for sub-seasonal to seasonal weather information while 38% would pay for medium and short range weather information respectively. The economic value of sub-seasonal to seasonal weather information was estimated at N1600 ($3.60) per year per capita with total aggregated value of N1.3 billion ($2.9 m) yearly for the derived savannah area. Predictive total market value of N17.43billion ($39 m) would be obtained from improved weather information in Nigeria. Simulated results of 5$193,360) for service providers. Large farm size, good farm-income, mobile phone dissemination channels, and location-specific information were drivers of farmers’ uptake decisions of weather information in the dry savannah area. The huge emerging market for improved weather information should be developed into a public–private market to efficiently facilitate uptake and use in Nigeria

Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya

<p>Abstract</p> <p>Background</p> <p>Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level.</p> <p>Methods</p> <p>A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions.</p> <p>Results</p> <p>Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; <it>P </it>< 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; <it>P </it>< 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR = 4.9, 95%CI = 3.7–6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR = 3.6, 95%CI = 2.1–6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending ≥ 4 peer-education sessions, compared with 34% (25/73) in those attending 1–3 sessions (P = 0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (<it>P </it>= 0.36).</p> <p>Conclusion</p> <p>Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk.</p