Factors influencing anti-retroviral drug adherence in HIV infected children attending Kericho District Hospital, Kenya

Objective: To identify factors influencing anti-retroviral (ARV) drug adherence by HIV infected children aged 3 to 14 years attending Kericho District Hospital (KDH), Kenya.Design: A cross-sectional studySetting: Kericho District Hospital, KenyaSubjects: Two hundred and thirty ( 230) HIV infected children aged 3 to 14 years under caregivers who had been on ARV treatment for at least three months before study as verified by clinicians.Results: A total of 230 children aged between 3 and 14 years (mean age was 8.5 years ±3.2SD) were enrolled. Caregivers were aged between 16 and 90 years (mean age 34.6 years ± 10.4 SD). Majority, 178 (77.4%), of the caregivers were female and 137 (59.6%) were biological parents. ARV drug adherence levels, based on various methods of assessment, were sub-optimum, varied from 56.1% based on time of taking drugs, 49.1% based on pharmacy drug refills, 45.7% based on clinic appointments to 27.0% by pill counts.The key factors associated with adherence based on time of taking drugs were: caregiver being away from home (p=0.0010), caregiver forgetting to give drugs to the child (p=0.020), lack of disclosure of the child’s HIV infection status (p=0.0080) and side effects experienced by the child (p=0.0120), lack of knowledge on treatment (p=0.0030) and stigma (p=0.0470). Based on clinic appointments, the factors included caregiver being away from home (p=0.004), lack of disclosure of the child’s HIV infection (p=0.0000), side effects experienced by the child (p= 0.0030), stigma (p=0.0070) and transport cost (p=0.0240).Conclusion: The most important adherence factors among children were: caregiver being away from home, caregiver forgetting, lack of disclosure, child experiencing side effects, lack of knowledge and skills in managing the disease, stigma and transport costs to hospital

Adherence to antiretroviral drug therapy by adult patients attending HIV/AIDS clinic at a Kenyan tertiary helath institution

Objective: To determine antiretroviral drug adherence levels of HIV/AIDS in adult patients.Design: A cross sectional study.Setting: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya.Subjects: Three hundred and eighty four HIV/AIDS adult patients who attended HIV/AIDS clinic in MTRH for antiretroviral treatment and had been on treatment for at least three months as confirmed by clinicians.Results: Three hundred and eighty four respondents participated in this research; two third of whom were females (68%) and a third were males (32%). Fifty two per cent of these had attained secondary or post secondary education. The mean age was 36.1±8.5, years and ranged 18-63 years. While 93.5% of the participants adhered to clinic appointments, only 43.2% adhered to taking the drugs as per time schedule.Conclusion: Adherence to time of taking medications was low and could result in reduced efficacy

Evaluation of Genotype x Environment Interaction and Stability of Grain Yield and Related Yield Components in Pearl Millet (Pennisetum glaucum (L.) R.Br.)

Thirty six pearl millet genotypes were evaluated in randomized complete block design with two replications during 2011/2012 at two locations to study the magnitude of genotype by environment interaction for yield and yield related traits and identify the most stable high yielding genotypes. ANOVA of data at individual locations revealed significant differences among genotypes at Marigat and Koibatek for all yield components. Combined mean analysis of variance showed that the Genotype and location main effects and the genotype by environment interaction were highly significant (P≤0.01) for grain yield and other traits, indicating differential response of genotypes across testing locations and the need for stability analysis. Marigat was the most suitable environment and gave highest mean grain yield of 3620 kg/ha. The lowest yield 870 Kg/ha was recorded at Koibatek. Genotypes EUP 32, EUP 35, EUP 19 and EUP 10 produced high mean yield of 3530, 3080, 2690 and 2590 kg/ha respectively. The lowest grain 1290 kg/ha was obtained from genotype EUP 4.Based on the parameters of stability, three stable (widely adapted) and high yielding genotypes (EUP 34, EUP 18, and EUP 9) were identified. They also out-yield the standard open pollinated variety (OPV) check, Kat PM2. Genotypes EUP 32 was the highest yielding across all sites followed by EUP 35 and could be recommended for further multi-location evaluation in warmer environment and possible release for commercial production. The findings of this study showed that pearl millet hybrids have high potential for commercial production in Kenya than the OPVs. The ANOVA results showed that the effects of environments, genotypes and genotype x environment interaction (GE) were important in trait expression and performance of genotypes. In addition, it was observed that amount of rainfall received at both vegetative and post-anthesis phases and temperature had an effect on grain yield. The GGE biplot analysis characterised the environments in terms of stability and productivity, where Marigat was the best for grain yield; implying that environment-specific selection should be adopted. Genotypes EUP 34, EUP 18, and EUP 9 were the best performing since they out yielded the standard OPV check. These stable high yielding genotypes can be evaluated further in varied agro-ecologies and recommended for release as commercial hybrid varieties in ASALs of Kenya

Hypertension in Sub-Saharan Africa: Cross-Sectional Surveys in Four Rural and Urban Communities

Background: Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. Methods and Findings: We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009-2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3-21.3) in rural Nigeria, 21.4% (19.8-23.0) in rural Kenya, 23.7% (21.3-26.2) in urban Tanzania, and 38.0% (35.9-40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥160/100 mmHg) or grade 3 hypertension (≥180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). Conclusion: Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed

IL-17 and neutrophils: unexpected players in the type 2 immune response

The study of immunity to helminth infection has been central to understanding the function of type 2 cytokines and their targets. Although type 2 cytokines are considered anti-inflammatory and promote tissue repair, they also contribute to allergy and fibrosis. Here, we utilise data from helminth infection models, to illustrate that IL-17 and neutrophils, typically associated with pro-inflammatory responses, are intimately linked with type 2 immunity. Neutrophils work with IL-4Rα-activated macrophages to control incoming larvae but this comes at a cost of enhanced tissue damage. Chitinase like proteins (CLPs) bridge these diverse outcomes, inducing both protective IL-17 and reparative Th2 responses. Dysregulation of CLPs, IL-17 and neutrophils likely contribute to disease severity and pathology associated with type 2 immunity

Hyperreactio luteinalis could be a risk factor for development of HELLP syndrome: case report

OBJECTIVE: To report a unique case of hyperreactio luteinalis in pregnancy associated with ovarian torsion and subsequent development of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. DESIGN: Case report. ----- SETTING: University medical center. ----- PATIENT(S): A 34-year-old primigravida woman with ovarian torsion in 13 weeks of pregnancy and subsequent intrauterine growth restriction (IUGR) and HELLP syndrome. ----- INTERVENTION(S): Laparoscopic salpingo-oophorectomy due to the ovarian torsion and cesarean section (CS) due to the development of HELLP syndrome. ----- MAIN OUTCOME MEASURE(S): HELLP syndrome. ----- RESULT(S): In the first trimester the patient had symptoms of acute abdomen due to the ovarian torsion. Both ovaries were enlarged and multicystic. Hormonal studies confirmed an abnormally elevated level of hCG (192.000 IU/L), mild hyperthireosis, and hyperandrogenemia. Laparoscopic salpingo-oophorectomy was performed. At 30 weeks of pregnancy, IUGR was confirmed sonographically and clinically, and at 33 weeks severe preeclampsia developed. One week later, HELLP syndrome occurred. Emergency CS was preformed, and she delivered a female newborn weighing 1,640 g. Seven days after delivery, blood pressure and hormonal status returned to normal. ----- CONCLUSION(S): Hyperreactio luteinalis due to the abnormally high level of hCG in the first trimester could be a consequence of inappropriate trophoblast invasion and an early sign of subsequently developing preeclampsia, eclampsia, and HELLP syndrome

When Anthelminitics Don't Work

Over the years, helminthologists world wide have made commendable advance in the control of helminthes of economic importance in livestock industry. This has included novel control options which have encompassed grazing management systems in integrated control strategies. Admittedly, anthelmintics have remained the single most important component in all these approaches. However, in the last decade or two a lot of concern has been expressed with the regard to the loss of efficacy of these chemotherapeutics in containing the helminth menace in livestock production systems. This unfortunate situation has taken place at different levels ranging from individual farm level to specific global regions. The reasons for this loss of efficacy are varied and may be different at each of theses levels. This paper attempts to highlight possible causes leading to this ineffectiveness of anthelmintics. The Kenya Veterinarian Vol. 21 2001: pp. 29-3

The epidemiology and control of gastrointestinal nematodes of small ruminants in a semi-arid area of Kenya with emphasis on hypobiosis of Haemonchus contortus

A study on the epidemiological dynamics of gastrointestinal nematodes of small ruminants was conducted in a semi-arid area of Kenya over a period of two years. Three major trichostrongylid species were identified; Haemonchus, Trichostrongylus and Oesophagostomum. Trichuris and Strongyloides species were occasionally encountered. Of the major trichostrongylids, Haemonchus spp. was the most prevalent (90%) and accounted for about 80% of the total worm burden. This species was found to undergo hypobiosis at levels that varied with seasons: nil levels of hypobiosis were recorded during the wet months and as much as 80% was recorded during the dry months. Hypobiosis was not investigated in the other nematode species. Evaluation of the relationship between the faecal egg count and the worm burden showed that the two parameters were more highly correlated during the wet months than during the dry months. This was a desirable situation because it is during the wet season that livestock owners in this area need to closely monitor the worm burdens in their animals. Treatment with ivermectin before the onset of the rains not only delayed the onset of egg shedding but also controlled clinical helminthiasis. In addition, a temporal change in the pattern of the appearance of infective larvae on pasture was observed; the appearance was delayed for about a month after the onset of the rains. The effect of treatment administered during the rains was a temporary and a short-lived relief of infection as evidenced by a brief decline in egg output: it had no detectable impact on pasture infectivity. These results suggested that removal of hypobiotic larvae before they resumed development had the combined benefit of reducing both the severity of clinical helminthiasis and the level of pasture contamination. This impact was expressed in improved flock performance and particularly in the improvement of birth weights that subsequently enhanced kid and lamb survival rates. Probably due t

Pastoralism: Development Interventions, Survival Adaptations and Food Security - A Review

For the last 40 years or so, international development agencies have spent large sums of money to improve what they thought was development on pastoralist in many parts of the world including Kenya. In spite of such efforts, the pastoralist is getting poorer and the productivity arising from exploitation of his resources is ever dwindling. Honestly, something must be grossly wrong somewhere. Consequently, most development agencies are coming to grips with reality by recognizing that the pastoralist is the expert of his own niche from whom they should learn. The current trend is therefore, to develop pastoralist rather than “to develop the pastoralist”. It is rapidly being recognized that over the centuries indigenous pastorals communities have evolved sophisticated adaptations to specifically cope with the situations of scanty resources available in their environment which is largely harsh and unyielding. Pastroralism is gaining acclaim as an efficient system of utilizing and semi-arid land to enhance food security. The Kenya Veterinarian Vol. 25 2002: pp. 28-3