Land Use Change and Ecosystem Valuation in North Georgia

A model of land allocation at the aggregate watershed level was developed assuming profit/net benefit maximization under risk neutrality. The econometric land use model was analyzed as an equation by equation SURE model as all the independent variables were the same for both equations. In analyzing effect of land use change on water quality, we took year 2005 as our baseline and postulated three land use scenarios. We applied Benefit Transfer techniques to value water quality changes resulting from land use change and estimated lower bounds for WTP to improve water quality to meet the FCB criterion for drinking water supply and fishing waters and BOD (DO) criteria for fishing waters. Water quality modeling revealed that land use change would result in increased runoff, and associated increase in FCB and BOD/DO violations. But the BOD/DO violations could be curtailed by managing urban growth as evidenced absence of BOD violations in the managed growth scenario. Our study finds there may be problems of FCB under all postulated future land use scenarios. The findings also support existing literature that there are problems with FCB violation in the study area at the moment. Finally, it seems that the people of UCRB would be willing to pay a lower bound value between USD 15,785,740 and USD 16,141,230 per year to create and maintain quality standards for fishing and drinking water supply.Ecosystem, Economic value, North Georgia, land use, land use change, fish, water quality, structural time series, willingness to pay, benefit transfer, forecasting, vector autoregression, Upper Chattahoochee River, Environmental Economics and Policy, Land Economics/Use,

Antimicrobial susceptibility profiles and prevalence of ESBLS among E.coli isolates recovered from people working in hospitality industry within Nairobi, Kenya

Objective: To determine the antimicrobial susceptibility profiles with key focus on ESBL-producing E.coli strains isolated from participants working in the hospitality industry in Nairobi, KenyaStudy design: A cross sectional descriptive study.Setting: Centre for Microbiology Research at Kenya Medical Research Institute, Nairobi.Subjects: A total of 323 food-handlers working within Nairobi County were recruited.Results: High resistances were recorded for Sulfamethoxazole/Trimethoprim (70%), Ampicillin (44.6%), Streptomycin (42%) and Tetracyclines (41%) while Imipenem and Cefepime were effective against 99% of the isolates. A third of all isolates were multidrug resistant. The prevalence of ESBLs was 3.4% while CMT, IRT and pAmpC-phenotypes accounted for <2%. About 1% of the ESBL-producers were also resistant to ciprofloxacin and gentamicin. The blaTEM accounted for 37%, blaSHV (25%), blaCTX-M (12%) and blaOXA-1 gene (7%). Majority of MDR strains were obtained from young individuals working in middle class hotels. Genetic relatedness of the MDR isolates was apparently influenced by the resistance profiles, hotel type and clinical characteristics.Conclusion: This study revealed that apparently healthy people working in the hospitality industry carry MDR E. coli that could potentially be transmitted to the general public. Infections by such strains could result in limited treatment options increasing the chances of patient mortality. Therefore, there is need to contain the spread of such strains through promotion of rational use of antimicrobials, properhygiene and certification of food handlers based on proper laboratory investigations

Carriage, antimicrobial susceptibility profiles and genetic diversity of Staphylococcus aureus and MRSA isolates recovered from students in a Kenyan university

Objective: To determine the carriage, antimicrobial susceptibility profiles and genetic diversity of Staphylococcus aureus and MRSA isolates recovered from students in a Kenyan University.Study design: A cross sectional descriptive study.Setting: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.Subjects: A total of 237 healthy students residing within the University residence halls were recruited.Results: A total of 231 S. aureus isolates were recovered. All isolates were susceptible to nitrofurantoin and linezolid and resistant in high numbers (194, 81.9%) to ampicillin. Resistances to amoxicillin-clavulanic acid, erythromycin, chloramphenicol, gentamicin, ciprofloxacin, norfloxacin and trimethoprimsulfamethoxazole were below 20%. The overall prevalence of MRSA among the study population was 11.3% (26/231). Based on carriage of the mec cassettes, the SCCmecV (61.5%) was more prevalent among the MRSA followed by SCCmecII (53.9%). Carriage of the lukFS-PV gene was 26.9% and 35.7% among the MRSA and MSSA strains respectively, and there was no statistical association between the two strains with regard to carriage of the gene (p=0.487). Analysis of genetic relations showed evidence of strain sharing among students.Conclusion: The study revealed the presence of MRSA strains, which are also multi-drug resistant, circulating among a healthy student population in a university setting within Central Kenya. Therefore, these results indicate the existence of potential risk factors, thus necessitating a comprehensive surveillance on MRSA and studies on control measures to help in curbing the spread of MRSA strains

Users’ perception on factors contributing to electronic medical records systems use: a focus group discussion study in healthcare facilities setting in Kenya

Background Electronic medical records systems (EMRs) adoption in healthcare to facilitate work processes have become common in many countries. Although EMRs are associated with quality patient care, patient safety, and cost reduction, their adoption rates are comparatively low. Understanding factors associated with the use of the implemented EMRs are critical for advancing successful implementations and scale-up sustainable initiatives. The aim of this study was to explore end users’ perceptions and experiences on factors facilitating and hindering EMRs use in healthcare facilities in Kenya, a low- and middle-income country. Methods Two focus group discussions were conducted with EMRs users (n = 20) each representing a healthcare facility determined by the performance of the EMRs implementation. Content analysis was performed on the transcribed data and relevant themes derived. Results Six thematic categories for both facilitators and barriers emerged, and these related to (1) system functionalities; (2) training; (3) technical support; (4) human factors; (5) infrastructure, and (6) EMRs operation mode. The identified facilitators included: easiness of use and learning of the system complemented by EMRs upgrades, efficiency of EMRs in patient data management, responsive information technology (IT) and collegial support, and user training. The identified barriers included: frequent power blackouts, inadequate computers, retrospective data entry EMRs operation mode, lack of continuous training on system upgrades, and delayed IT support. Conclusions Users generally believed that the EMRs improved the work process, with multiple factors identified as facilitators and barriers to their use. Most users perceived system functionalities and training as motivators to EMRs use, while infrastructural issues posed as the greatest barrier. No specific EMRs use facilitators and/or barriers could be attributed to facility performance levels. Continuous evaluations are necessary to assess improvements of the identified factors as well as determine emerging issues.publishedVersio

Patterns of risky sexual behavior and associated factors among undergraduates in the Coastal region of Kenya

Background: The majority of students in the institutions of higher learning are single, young adults who easily fall prey to exuberance coupled with adequate freedom in campus life that predisposes them to High Risky Sexual Behaviour. Effective response to the challenges of risky sexual behaviour and mitigation of its negative effects on youth relies mainly on accurate information from the extent of the problem among this age group. Introduction: The purpose of this study was to determine the pattern of Risky Sexual Behaviour and the associated factors among first year University students in the Coastal region, Kenya. Methodology: A cross-sectional study involving 473 first year undergraduate students was carried out in two public Universities in the coastal region in Kenya. Data was collected using self-administered questionnaire. Results: Majority of the students were within the age of 17-20 years and a mean age of 19.6 (SD+ 1.79 years). More than half of the respondents (59.4%), had once had sex before. Majority of the students, 195(41.2%) had their first sexual intercourse within the age of 15-19 years, while a total of 67(14%) had their sexual debut at the age of 7-14years. Only 32.5% had used condoms consistently in the last twelve months. The male gender was associated with the history of having had sex, early sexual debut, multiple sexual partners, inconsistent use of condoms and having sex under the influence of alcohol. Conclusion: The respondents were relatively young and had significant Risky sexual behavior exhibited by early sexual debut, multiple sexual partners and low prevalence of condom use. Those in authority need to have a fresh look into the issue of child sexual molestation  Key words: Risky Sexual Behaviour, University Students, Condom Use, Sexual Debu

Prevalence of HepatitisB virus infections among HIV infected individuals in Nairobi, Kenya

Objectives: To determine the prevalence and characteristics of HBV infections among HIV infected individuals in Nairobi, KenyaDesign: A cross-sectional study.Setting: Kenya Medical Research Institute HBV Laboratory, Nairobi, KenyaSubjects: A total of four hundred HIV infected patients randomised from a Nairobi HIV comprehensive care centre between June and October 2015.Results: Of the 400 subjects screened; (27.75%) had HBV immunisation, (3%) had acute disease, (4.75%) were on recovery, (2.5%) were in chronic stage, (1.75%) were asymptomatic and (2.25%) had occult HBV. Statistical analysis showed that age andgender were not significantly associated with the risk of HBV or occult HBV infections.Conclusion: HIV/HBV co-infections is still >5.5% but the rates could be higher than reported here. Utility of HBV sero-markers especially in infection staging is therefore very important in disease diagnosis and surveillance

Predominance of CCR5 tropism in non-b HIV-1 subtypes circulating in Kisii County, Kenya

Introduction: The chemokine receptors CCR5 and CXCR4 are considered as the main receptors during HIV infection, replication, transmission and subsequent AIDS progression. CCR5 antagonists are drugs designed to inhibit viral entry by binding to these chemokine receptors. However, characterisation of HIV-1 co-receptor usage before rolling out of CCR5/CXCR4 antagonists has not yet been done in the country.Objective: To determine the HIV-1 co receptor usage among HIV-1 infected individuals and predict possible use CCR5 antagonistic drugs.Design: A cross sectional study Setting: Comprehensive HIV care clinics of Kisii Teaching & Referral Hospital, Kenya.Methods: A total of seventy-two (72) blood samples were obtained from both drug naïve (32) and experienced (40) study participants. Viral DNA was extracted using QIAamp MinElute Virus kit and partial HIV-1 V3 region was amplified and directly sequenced. Coreceptor usage predicted using insilico Geno2pheno (coreceptor) with a false positive rate of 15%.Results: Sixty-one individuals (77.8%) were infected with HIV-1 subtype A1, twelve (18.1%) HIV-1 subtype D and four (4.1%) were HIV-1 subtype C. CCR5-using variants were found in 52 (72.2%) while 20(27.8%) participants were infected with CXCR4–using variants. There was no significant difference in co-receptor usage a cross gender, HIV subtypes, disease staging or impact of treatment or CD 4 counts that was observed.Conclusions and recommendation: The detected high level of circulating R5 strains suggests the likelihood of a successful implementation and use of CCR5 antagonists in Kenya where HIV-1 A1 is the most predominant

The canopy effects of Prosopis juliflora (DC) and Acacia tortilis (Hayne) trees on herbaceous plants species and soil physico-chemical properties in Njemps Flats, Kenya

The canopy effects of an exotic and indigenous tree species on soil properties and understorey herbaceous plant species were investigated on the Njemps Flats, Baringo district, Kenya. Samples of soil and herbaceous plant species were obtained within the canopies of systematically selected P. juliflora (exotic) and A. tortilis (indigenous) trees, and from adjacent open areas. Standing biomass, frequency and cover of understorey plant species were significantly (P<0.05) higher in the open area than under the canopies. Cover for herbaceous plant species was 63% under P. juliflora, 82% under A. tortilis and 90% in open areas. All forbs occurred under the canopies indicating that they are more adapted to the shaded micro environments than grasses. Soils under the tree canopies had significantly (P<0.05) higher organic carbon and total nitrogen than those in adjacent open areas. Soils under A. tortilis had significantly (P<0.05) higher organic carbon and total nitrogen than soils from under P. juliflora. The results suggested that A. tortilis trees are more beneficial to soil physical and chemical properties than P. juliflora. Accordingly, the common practice of clearing woody trees indiscriminately to improve grassland for livestock production or for crop cultivation should not be recommended

Burden, causes, and outcomes of people with epilepsy admitted to a rural hospital in Kenya

Objective: People with epilepsy (PWE) develop complications and comorbidities often requiring admission to hospital, which adds to the burden on the health system, particularly in low-income countries. We determined the incidence, disability-adjusted life years (DALYs), risk factors, and causes of admissions in PWE. We also examined the predictors of prolonged hospital stay and death using data from linked clinical and demographic surveillance system. Methods: We studied children and adults admitted to a Kenyan rural hospital, between January 2003 and December 2011, with a diagnosis of epilepsy. Poisson regression was used to compute incidence and rate ratios, logistic regression to determine associated factors, and the DALY package of the R-statistical software to calculate years lived with disability (YLD) and years of life lost (YLL). Results: The overall incidence of admissions was 45.6/100,000 person-years of observation (PYO) (95% confidence interval [95% CI] 43.0–48.7) and decreased with age (p \u3c 0.001). The overall DALYs were 3.1/1,000 (95% CI, 1.8–4.7) PYO and comprised 55% of YLD. Factors associated with hospitalization were use of antiepileptic drugs (AEDs) (odds ratio [OR] 5.36, 95% CI 2.64–10.90), previous admission (OR 11.65, 95% CI 2.65–51.17), acute encephalopathy (OR 2.12, 95% CI 1.07–4.22), and adverse perinatal events (OR 2.87, 95% CI 1.06–7.74). Important causes of admission were epilepsy-related complications: convulsive status epilepticus (CSE) (38%), and postictal coma (12%). Age was independently associated with prolonged hospital stay (OR 1.02, 95% CI 1.00–1.04) and mortality (OR, 1.07, 95% CI 1.04–1.10). Significance: Epilepsy is associated with significant number of admissions to hospital, considerable duration of admission, and mortality. Improved supply of AEDs in the community, early initiation of treatment, and adherence would reduce hospitalization of PWE and thus the burden of epilepsy on the health system

Progress and priorities for reproductive, maternal, newborn, and child health in Kenya: A countdown to 2015 country case study

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 to 2015, using data from nationally representative Demographic Health Surveys done between 1989 and 2014. For comparison, we used modelled mortality estimates from the UN Inter-Agency Groups for Child and Maternal Mortality Estimation. We estimated time trends for key RMNCH indicators, as defined by Countdown to 2015, at both the national and the subnational level, and used linear regression methods to understand the determinants of change in intervention coverage during the past decade. Finally, we used the Lives Saved Tool (LiST) to model the effect of intervention scaleup by 2030.Findings: After an increase in mortality between 1990 and 2003, there was a reversal in all mortality trends from 2003 onwards, although progress was not substantial enough for Kenya to achieve Millennium Development Goal targets 4 or 5. Between 1990 and 2015, maternal mortality declined at half the rate of under-5 mortality, and changes in neonatal mortality were even slower. National-level trends in intervention coverage have improved, although some geographical inequities remain, especially for counties comprising the northeastern, eastern, and northern Rift Valley regions. Disaggregation of intervention coverage by wealth quintile also revealed wide inequities for several healthsystems-based interventions, such as skilled birth assistance. Multivariable analyses of predictors of change in family planning, skilled birth assistance, and full vaccination suggested that maternal literacy and family size are important drivers of positive change in key interventions across the continuum of care. LiST analyses clearly showed the importance of quality of care around birth for maternal and newborn survival.Interpretation: Intensified and focused efforts are needed for Kenya to achieve the RMNCH targets for 2030. Kenya must build on its previous progress to further reduce mortality through the widespread implementation of key preventive and curative interventions, especially those pertaining to labour, delivery, and the first day of life. Deliberate targeting of the poor, least educated, and rural women, through the scale-up of community-level interventions, is needed to improve equity and accelerate progress