Management of posterior urethral valves in rural Kenya

Background: Posterior Urethral Valves (PUV) are the most common cause of bladder outlet obstruction in children. Early detection is necessary to prevent potentially irreversible sequel. We conducted a study to determine the presentation, interventions and outcome of patients with PUV.Methods: A retrospective study was conducted over a six year period with an average of two years follow-up.Results: The commonest presenting symptoms were dysuria (55%), poor urinary stream(67%)and straining (39%). Malnutrition was present in 36%. Four patients developed chronic renal failure. There were four mortalities due to urosepsis, acute renal failure, and complications of Mainz-II ureterosigmoidostomy. 40% of patients developed valve bladder syndrome.Conclusion: The high incidence of valve bladder indicates delayed intervention even when addressed in the early postnatal period. This, coupled with malnutrition call for a multidisciplinary approach and long term follow up of these patients.Keywords: Posterior Urethral Valves, Valve Bladder Syndrome, LMIC

Inadvertent presence of genetically modified elements in maize food products in Kenyan markets

Kenya has a biosafety law and has tested genetically modified (GM) maize under confinement and containment, but has neither released nor commercialized any GM crop. This study assessed various maize food products from the Kenyan farms and markets for the inadvertent presence of GMOs. It assessed the possibility of ‘gene-flow’ to the maize farms near the Kenya Agricultural Research Institute (KARI), Kiboko where Bt maize was grown in confined field trials (CFT) during 2005 to 2006. The multistage sampling technique was used, while the polymerase chain reaction (PCR) and lateral-strip methods were used to analyze 120 food samples. Of these, 6.7% tested positive for cry1Ab, a globally commercialized gene, but were negative for cry1Ba, a non-commercialized gene. Neither cry1Ab nor cry1Ba genes were found in any of the maize certified seed samples. No ‘gene-flow’ was detected within the vicinity of the Kiboko CFT site. The maize imported into Kenya contained Bt genetic elements. Nevertheless, the confinement regulatory measures employed during the CFTs at Kiboko were effective. There is a need to enforce declaration of GM or non-GM and conduction of regulatory detection of food imports and for labelling of food products to enable consumers to make informed choices on what they buy and consume.Keywords: cry1Ab, cry1Ba, biosafety, GMOs, Bt maize.African Journal of Biotechnology Vol. 12(31), pp. 4881-489

Quantitative Analysis of Total Phenolic Content in Avocado (Persia Americana) Seeds in Eastern Province of Kenya

Phytochemical rich plants have played a significant role in diet based therapies to prevent and cure various ailments. The avocado (Persia Americana Mill,) fruits are much sought after for their high nutritional and sensory value. Avocado (Persia Americana) seeds were analysed for total phenolic content. This phenolic component is responsible for antioxidant activity. The amount of phenols was analysed using Folin-Ciocalteu method. The maximum phenolic content was found in the Fuerte seed extract (18.55 ± 2.8 mg/g) prepared at 50ºC. The phenolic content decreased by 10.3% at an extraction temperature of 50 °C to 70 °C and 32.1% at an extraction temperature of 50 °C to 100 °C for a duration of 30 minutes. Keywords: Avocado seeds, Persia Americana, Total phenolic

The Cow in the Room Livestock and Climate Engagement at the 2022 United Nations Climate Change Conference (COP27)

The UN Framework Convention on Climate Change Conference (UNFCCC COP27) was held November 6-18, 2022, in Sharm el Sheikh, Egypt, and ILRI was there actively telling the livestock sustainability story. Too often, climate discussions focus on the negative aspects of intensive livestock production. The livestock sector is often cited as the most intensive emitter of greenhouse gases within agricultural production systems, contributing to about 18% of anthropogenic greenhouse gas emissions, mainly from methane and nitrous oxide. However, science shows that sustainable livestock can bring adaptation, mitigation and economic growth benefits to both people and the planet. In addition, sustainable livestock production, especially in developing countries, can contribute to building climate resilience while boosting low-emission development and supporting food security and livelihoods. With food, for the first time, taking centre stage at COP27, the CGIAR Research Initiative on Livestock Climate and Systems Resilience, ILRI and the GLAD Project, along with partners, sought to ensure sustainable livestock is recognised as essential to climate change mitigation. As part of this process, we designed an integrated engagement, communications and media outreach plan. This included the innovative campaign dubbed ‘cow in the room’ #LetsTalkLivestock to drive our participation and narrative to COP27 and beyond

Endometrial Histopathology in Patients with Laparoscopic Proven Salpingitis and HIV-1 Infection

Study Objective. To identify sensitive and specific histological criteria for endometritis in women with laparoscopically-confirmed acute salpingitis. Methods. Women, age 18–40 years of age presenting with complaints of lower abdominal pain ≤2 weeks and no antibiotics use in past two weeks, were enrolled. They underwent clinical examination, screening for HIV; other sexually transmitted infections plus endometrial biopsy sampling for histopathology. Diagnostic laparoscopy confirmed the diagnosis of acute salpingitis. Controls were women undergoing tubal ligation and HIV-1 infected women asymptomatic for genital tract infection. Results. Of 125 women with laparoscopically-confirmed salpingitis, 38% were HIV-1 seropositive. Nineteen HIV-1 negative controls were recruited. For the diagnosis of endometritis, ≥1 plasma cells (PC) and ≥3 polymorphonuclear lymphocytes (PMN) per HPF in the endometrium had a sensitivity of 74% for HIV-1-seropositive, 63% for HIV-1-seronegative women with a specificity of 75% and positive predictive value of 85% regardless of HIV-1-infection for predicting moderate to severe salpingitis. For HIV-1-seronegative women with mild salpingitis, ≥1 PC and ≥3 PMN had a sensitivity of 16% and a PPV of 57%. Conclusion. Endometrial histology, did not perform well as a surrogate marker for moderate to severe salpingitis, and failed as a surrogate marker for mild salpingitis

Molecular characterization of rotavirus group A strains circulating prior to vaccine introduction in rural coastal Kenya, 2002-2013

Background Kenya introduced the monovalent Rotarix® rotavirus group A (RVA) vaccine nationally in mid-2014. Long-term surveillance data is important prior to wide-scale vaccine use to assess the impact on disease and to investigate the occurrence of heterotypic strains arising through immune selection. This report presents baseline data on RVA genotype circulation patterns and intra-genotype genetic diversity over a 7-year period in the pre-vaccine era in Kilifi, Kenya, from 2002 to 2004 and from 2010 to 2013. Methods A total of 745 RVA strains identified in children admitted with acute gastroenteritis to a referral hospital in Coastal Kenya, were sequenced using the di-deoxy sequencing method in the VP4 and VP7 genomic segments (encoding P and G proteins, respectively). Sequencing successfully generated 569 (76%) and 572 (77%) consensus sequences for the VP4 and VP7 genes respectively. G and P genotypes were determined by use of BLAST and the online RotaC v2 RVA classification tool. Results The most common GP combination was G1P[8] (51%), similar to the Rotarix® strain, followed by G9P[8] (15%) , G8P[4] (14%) and G2P[4] (5%). Unusual GP combinations—G1P[4], G2P[8], G3P[4,6], G8P[8,14], and G12P[4,6,8]—were observed at frequencies of <5%. Phylogenetic analysis showed that the infections were caused by both locally persistent strains as evidenced by divergence of local strains occurring over multiple seasons from the global ones, and newly introduced strains, which were closely related to global strains. The circulating RVA diversity showed temporal fluctuations both season by season and over the longer-term. None of the unusual strains increased in frequency over the observation period. Conclusions The circulating RVA diversity showed temporal fluctuations with several unusual strains recorded, which rarely caused major outbreaks. These data will be useful in interpreting genotype patterns observed in the region during the vaccine er

Understanding Adherence to Daily and Intermittent Regimens of Oral HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in Kenya

A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV preexposure 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, maximum1 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

HIV Protective Efficacy and Correlates of Tenofovir Blood Concentrations in a Clinical Trial of PrEP for HIV Prevention

Background: Antiretroviral pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy for which adherence is a known determinant of efficacy. Blood concentrations of PrEP medications are one objective marker of adherence. Methods: In a placebo-controlled PrEP efficacy trial of tenofovir disoproxil fumarate (TDF) and TDF with emtricitabine (FTC/TDF) among 4747 African women and men with an HIV-infected partner, we measured plasma tenofovir concentrations from participants in the active PrEP arms: 29 HIV seroconverters (cases) and 196 randomly selected controls who remained uninfected. Results: Among controls, 71% of visits had tenofovir concentrations >40 ng/mL, consistent with steady-state daily dosing, compared with 21% of cases at the visit HIV was first detected. Pill count data indicated that 96% of controls and 66% of cases had >80% adherence for these same visits. The estimated protective effect of PrEP against HIV, based on concentrations >40 ng/mL, was 88% (95% confidence interval: 60 to 96, P 40 ng/mL at month 1, 75% maintained this concentration at month 12. Only 5 of 29 seroconverters seemed to be consistently adherent to PrEP. Tenofovir concentrations >40 ng/mL were associated with older age and shorter time on study; concentrations ≤40 ng/mL occurred more commonly when participants reported no sex with their HIV-infected partner. Conclusions: Plasma concentrations of tenofovir consistent with daily dosing were highly predictive of protection from HIV acquisition. Most of those who took PrEP seemed to have high and consistent adherence