Kenya adaptation to climate change in the arid lands: anticipating, adapting to and coping with climate risks in Kenya - operational recommendations for KACCAL

Years of concerted activism to bring awareness of climate change and its consequences to the fore of global concerns are finally yielding dividends. Until recently, most climate change activity focused on medium- to long-term projections regarding the nature and trajectory of change processes. With the uncertainties inherent in long-term climate projections and the difficulty of building political and economic momentum from hypothetical future scenarios, progress was slow. The recent past has, however, resulted in a drastic increase in extreme climate events across the globe that has wreaked untold humanitarian and economic havoc. The costly present day manifestations of climate change have catapulted climate concerns to the forefront of the global arena. The recent high-level event convened by the Secretary General of the United Nations to address the leadership challenge of climate change and build momentum for climate change talks (Bali, Indonesia, December 2007) is a clear indication that the urgency of climate change has fostered the degree of serious commitment it requires from the global agenda. Whatever its impacts, it is widely acknowledged that poor communities, already vulnerable to a suite of existing risks and endowed with meagre resources, will be the most adversely affected as climate change is superimposed on their already tenuous situation. In recognition of the need to help vulnerable populations in developing countries adapt to the adverse impacts of climate change, the Global Environment Facility (GEF), in conjunction with its partners, funds programmes aimed at reducing the vulnerability of countries to the impacts of climate change and helps them build adaptive capacity. The Kenya Adaptation to Climate Change in the Arid Lands (KACCAL) project is one such initiative supported in conjunction with the World Bank and the United Nations Development Programme (UNDP). About 80% of Kenya is arid or semi-arid and the main livelihood activities in these areas are pastoral, agropastoral and subsistence agriculture. Currently, these populations are among the poorest in Kenya, suffer from a weak natural resource base, are negatively affected by socio-economic and demographic trends that see a growing population depending on diminishing rangelands, and are relatively marginalized from the growing economy. Add to this the impacts of climate change, of which the recent severe and extended droughts of 2001, 2004–06 and the widespread flooding in 2007 are an early signal, and the livelihood threats to the communities of Kenya’s arid and semi-arid lands (ASAL) are clear and present

Genetic diversity among tropical provitamin a maize inbred lines and implications for a biofortification program

Insights into the diversity and relationships among elite breeding materials are an important component in maize improvement programs. We genotyped 63 inbred lines bred for high levels of provitamin A using 137 single nucleotide polymorphism markers. A total of 272 alleles were detected with gene diversity of 0.36. Average genetic distance was 0.36 with 56% of the pairs of lines having between 0.30 and 0.40. Eighty-six percent of the pairs of lines showed relative kinship values <0.50, which indicated that the majority of these provitamin A inbred lines were unique. Relationship pattern and population structure analysis revealed presence of seven major groups with good agreement with Neighbour Joining clustering and somewhat correlated with pedigree and breeding origin. Utilization of this set of provitamin A lines in a new biofortification program will be aided by information from both molecular-based grouping and pedigree analysis. The results should guide breeders in selecting parents for hybrid formation and testing as a short-term objective, and parents with diverse alleles for new breeding starts as a long-term objective in a provitamin A breeding program

Knowledge and Perceptions on Malaria and Its Association with Aquatic Habitats

Background: Malaria remains the major cause of morbidity and mortality among children in Kenya. About 70 percent of the population is at risk of infection, and roughly 34,000 young children die of malaria-related causes annually.Objective: To investigate the knowledge and perceptions of the local people for malaria in relation to aquatic habitats along the Kenyan Lake Victoria basin.Design: Community-based cross-sectional study.Setting: The Kenyan Lake Victoria basin Region.Subjects: Two hundred and fourty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding malaria.Results: Mosquitoes were perceived to be the main cause of malaria. Most respondents were familiar with the main signs and symptoms of mild malaria. Majority of the respondents had poor knowledge of mosquito breeding habitats with 45% mentioning the lake and only 18.6 and 8.9% mentioning ponds and dams, respectively. Most female respondents did not know the difference between mosquitoes and lake flies, P=0.03, Fishers exact test. The majority (97.5%) of the respondents reported seeking conventional malaria treatment from health institutions.Conclusion: Mosquitoes are perceived to be the main cause of malaria by both males and females. A significant proportion of the respondents were familiar with the main signs and symptoms of malaria and sought conventional medicine for treatment of the disease. Most of the respondents, however, had poor knowledge on the breeding habitats of mosquitoes. Concerted effort is needed to scale-up health education and improve the knowledge of the community about mosquitoes and their breeding habitats, particularly malaria vectors which do not breed in deep lake waters. Effective anti-malarial drugs should also be available at the grassroots level where the problem of malaria is rampant

Comparison of alternative evidence summary and presentation formats in clinical guideline development: a mixed-method study.

BACKGROUND: Best formats for summarising and presenting evidence for use in clinical guideline development remain less well defined. We aimed to assess the effectiveness of different evidence summary formats to address this gap. METHODS: Healthcare professionals attending a one-week Kenyan, national guideline development workshop were randomly allocated to receive evidence packaged in three different formats: systematic reviews (SRs) alone, systematic reviews with summary-of-findings tables, and 'graded-entry' formats (a 'front-end' summary and a contextually framed narrative report plus the SR). The influence of format on the proportion of correct responses to key clinical questions, the primary outcome, was assessed using a written test. The secondary outcome was a composite endpoint, measured on a 5-point scale, of the clarity of presentation and ease of locating the quality of evidence for critical neonatal outcomes. Interviews conducted within two months following completion of trial data collection explored panel members' views on the evidence summary formats and experiences with appraisal and use of research information. RESULTS: 65 (93%) of 70 participants completed questions on the prespecified outcome measures. There were no differences between groups in the odds of correct responses to key clinical questions. 'Graded-entry' formats were associated with a higher mean composite score for clarity and accessibility of information about the quality of evidence for critical neonatal outcomes compared to systematic reviews alone (adjusted mean difference 0.52, 95% CI 0.06 to 0.99). There was no difference in the mean composite score between SR with SoF tables and SR alone. Findings from interviews with 16 panelists indicated that short narrative evidence reports were preferred for the improved clarity of information presentation and ease of use. CONCLUSIONS: Our findings suggest that 'graded-entry' evidence summary formats may improve clarity and accessibility of research evidence in clinical guideline development. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN05154264

Sexual vulnerability and HIV seroprevalence among the deaf and hearing impaired in Cameroon

<p>Abstract</p> <p>Background</p> <p>This quantitative cross-sectional study examines sexual behaviour of a target group of hearing-impaired persons in Yaounde, the capital city of the Republic of Cameroon. It measures their HIV prevalence to enable assessment of their sexual vulnerability and to help reduce the gap in existing HIV serology data among people with disabilities in general and the deaf in particular.</p> <p>Methods</p> <p>The snowball sampling procedure was adopted as an adequate approach to meet this hard-to-reach group. A total of 118 deaf participants were interviewed for the behavioural component, using sign language as a means of data collection, while 101 participants underwent HIV serology testing. Descriptive analyses were done for behavioural data with Epi info software, while sera were tested by health personnel, using rapid and confirmation test reagents.</p> <p>Results</p> <p>From the results, it was clear that the hearing impaired were highly involved in risky sexual practices, as observed through major sexual indicators, such as: age at first sexual intercourse; condom use; and knowledge of sexually transmitted infections and AIDS. Furthermore, it was noted that the HIV prevalence rate of the hearing impaired in the capital of Cameroon was 4%, close to the prevalence in the city's general population (4.7%).</p> <p>Conclusions</p> <p>Such results suggest that there is a need for in-depth behavioural research and serological studies in this domain to better understand the determinants of risky sexual behaviour among the hearing impaired, and to propose operational prevention approaches for this group.</p

A Rapid Assessment of the Quality of Neonatal Healthcare in Kilimanjaro Region, Northeast Tanzania.

While child mortality is declining in Africa there has been no evidence of a comparable reduction in neonatal mortality. The quality of inpatient neonatal care is likely a contributing factor but data from resource limited settings are few. The objective of this study was to assess the quality of neonatal care in the district hospitals of the Kilimanjaro region of Tanzania. Clinical records were reviewed for ill or premature neonates admitted to 13 inpatient health facilities in the Kilimanjaro region; staffing and equipment levels were also assessed. Among the 82 neonates reviewed, key health information was missing from a substantial proportion of records: on maternal antenatal cards, blood group was recorded for 52 (63.4%) mothers, Rhesus (Rh) factor for 39 (47.6%), VDRL for 59 (71.9%) and HIV status for 77 (93.1%). From neonatal clinical records, heart rate was recorded for3 (3.7%) neonates, respiratory rate in 14, (17.1%) and temperature in 33 (40.2%). None of 13 facilities had a functioning premature unit despite calculated gestational age <36 weeks in 45.6% of evaluated neonates. Intravenous fluids and oxygen were available in 9 out of 13 of facilities, while antibiotics and essential basic equipment were available in more than two thirds. Medication dosing errors were common; under-dosage for ampicillin, gentamicin and cloxacillin was found in 44.0%, 37.9% and 50% of cases, respectively, while over-dosage was found in 20.0%, 24.2% and 19.9%, respectively. Physician or assistant physician staffing levels by the WHO indicator levels (WISN) were generally low. Key aspects of neonatal care were found to be poorly documented or incorrectly implemented in this appraisal of neonatal care in Kilimanjaro. Efforts towards quality assurance and enhanced motivation of staff may improve outcomes for this vulnerable group

NUTRITIVE VALUE AND AVAILABILITY OF COMMONLY USED FEED INGREDIENTS FOR FARMED NILE TILAPIA (OREOCHROMIS NILOTICUS L.) AND AFRICAN CATFISH (CLARIAS GARIEPINUS, BURCHELL) IN KENYA, RWANDA AND TANZANIA

ABSTRACT Commonly utilized feed ingredients for culture of Nile tilapia (Oreochromis niloticus) and African catfish (Clarias gariepinus) from Kenya, Tanzania and Rwanda were collected over a period of six months (January -June 2010) and evaluated for their nutritive composition through proximate analysis. Most of the fish feed ingredients were found in all the three countries except a few that were unique to one or two countries as detailed in the results. Feed ingredients of animal origin exhibited significantly (P&lt;0.05) higher crude protein levels (407 -635 g/kg DM) compared to the feed ingredients of plant based origin. Freshwater shrimps (Caridina nilotica) contained the highest crude protein levels of 635 g/kg DM. Feed ingredients of animal origin had low ether extracts (EE) with an exception of Omena fish (Rastrineobola argentea). Crude fibre (CF) was generally higher on feed ingredients of plant origin and ranged between 55-368 g/kg DM while Nitrogen Free Extracts (NfE) and ash content were higher in the feedstuffs of plant origin with an exception of maize bran which had the lowest value. Omena fish and freshwater shrimp had higher ash content of 182 and 228g/kg DM compared to other feed ingredients of animal origin, which may indicate contamination with soil particles during drying process. Based on the feed ingredient availability, potential competition with other human uses, content of crude protein and crude fibre and the feasibility of removal of anti-nutritional factors, C. nilotica, blood meal, meat and bone meal, were identified as most promising sources of animal based protein. Cotton (Gossypium spp) and sunflower (Helianthus annuus) seed cakes provided the best option as source of processed plant based protein. Leaves of gallant soldier (Galisonga parviflora), sweet potato (Ipomoea batatus), cassava (Manihot esculenta) and papaya (Papaya carica) were identified as high potential feedstuffs of plant origin either processed or in raw form for small-scale fish farming. We recommend that in well fertilized semiintensive ponds, maize (Zea mays), wheat (Triticum aestivum) and rice (Oryza sativa) bran may be utilized where available to supplement natural pond food

A comparative evaluation of PDQ-Evidence

BACKGROUND: A strategy for minimising the time and obstacles to accessing systematic reviews of health system evidence is to collect them in a freely available database and make them easy to find through a simple ‘Google-style’ search interface. PDQ-Evidence was developed in this way. The objective of this study was to compare PDQ-Evidence to six other databases, namely Cochrane Library, EVIPNet VHL, Google Scholar, Health Systems Evidence, PubMed and Trip. METHODS: We recruited healthcare policy-makers, managers and health researchers in low-, middle- and highincome countries. Participants selected one of six pre-determined questions. They searched for a systematic review that addressed the chosen question and one question of their own in PDQ-Evidence and in two of the other six databases which they would normally have searched. We randomly allocated participants to search PDQ-Evidence first or to search the two other databases first. The primary outcomes were whether a systematic review was found and the time taken to find it. Secondary outcomes were perceived ease of use and perceived time spent searching. We asked open-ended questions about PDQ-Evidence, including likes, dislikes, challenges and suggestions for improvements. RESULTS: A total of 89 people from 21 countries completed the study; 83 were included in the primary analyses and 6 were excluded because of data errors that could not be corrected. Most participants chose PubMed and Cochrane Library as the other two databases. Participants were more likely to find a systematic review using PDQ-Evidence than using Cochrane Library or PubMed for the pre-defined questions. For their own questions, this difference was not found. Overall, it took slightly less time to find a systematic review using PDQ-Evidence. Participants perceived that it took less time, and most participants perceived PDQ-Evidence to be slightly easier to use than the two other databases. However, there were conflicting views about the design of PDQ-Evidence. CONCLUSIONS: PDQ-Evidence is at least as efficient as other databases for finding health system evidence. However, using PDQ-Evidence is not intuitive for some people

Evaluation of a simple polytetrafluoroethylene (PTFE)-based membrane for blood-feeding of malaria and dengue fever vectors in the laboratory

BACKGROUND: Controlled blood-feeding is essential for maintaining laboratory colonies of disease-transmitting mosquitoes and investigating pathogen transmission. We evaluated a low-cost artificial feeding (AF) method, as an alternative to direct human feeding (DHF), commonly used in mosquito laboratories. METHODS: We applied thinly-stretched pieces of polytetrafluoroethylene (PTFE) membranes cut from locally available seal tape (i.e. plumbers tape, commonly used for sealing pipe threads in gasworks or waterworks). Approximately 4 ml of bovine blood was placed on the bottom surfaces of inverted Styrofoam cups and then the PTFE membranes were thinly stretched over the surfaces. The cups were filled with boiled water to keep the blood warm (~37 degrees C), and held over netting cages containing 3-4 day-old inseminated adults of female Aedes aegypti, Anopheles gambiae (s.s.) or Anopheles arabiensis. Blood-feeding success, fecundity and survival of mosquitoes maintained by this system were compared against DHF. RESULTS: Aedes aegypti achieved 100% feeding success on both AF and DHF, and also similar fecundity rates (13.1 +/- 1.7 and 12.8 +/- 1.0 eggs/mosquito respectively; P > 0.05). An. arabiensis had slightly lower feeding success on AF (85.83 +/- 16.28%) than DHF (98.83 +/- 2.29%) though these were not statistically different (P > 0.05), and also comparable fecundity between AF (8.82 +/- 7.02) and DHF (8.02 +/- 5.81). Similarly, for An. gambiae (s.s.), we observed a marginal difference in feeding success between AF (86.00 +/- 10.86%) and DHF (98.92 +/- 2.65%), but similar fecundity by either method. Compared to DHF, mosquitoes fed using AF survived a similar number of days [Hazard Ratios (HR) for Ae. aegypti = 0.99 (0.75-1.34), P > 0.05; An. arabiensis = 0.96 (0.75-1.22), P > 0.05; and An. gambiae (s.s.) = 1.03 (0.79-1.35), P > 0.05]. CONCLUSIONS: Mosquitoes fed via this simple AF method had similar feeding success, fecundity and longevity. The method could potentially be used for laboratory colonization of mosquitoes, where DHF is unfeasible. If improved (e.g. minimizing temperature fluctuations), the approach could possibly also support studies where vectors are artificially infected with blood-borne pathogens