Caeserean myomectomy in a primigravida at term

Caesarean myomectomy is a controversial topic in our set up. This is a case report of a 29-year-old primigravida who was scheduled to undergo caesarean section due to a large lower uterine segment fibroid at term. Intra-operatively, the uterine fibroid interfered with closure of the uterus after extraction of the infant. A caesarean myomectomy was successfully carried out and hysterectomy avoided. The decision to carry out caesarean myomectomy should be individualized to the patient, presentation, surgeon’s experience and available resources

Uterine Rupture in a Primigravida with Mullerian Anomaly at 27 Weeks Gestation

Mullerian anomalies are rare and are often associated with infertility, chronic pelvic pain and pregnancy  wastage. This is a case report of a primigravida at 27 weeks gestation, who presented in shock. Intra- operatively, a mullerian anomaly with a ruptured left horn was found and excised. She made remarkable  recovery and was discharged home. Uterine anomalies should be ruled out in the evaluation of pregnancy  wastage. When present, management should be individualized based on the clinical history, presentation, anatomical aberration and the patient’s future fertility desire

Identifying user needs for weather and climate services to enhance resilience to climate shocks in sub-Saharan Africa

The vulnerability of social-ecological systems in sub-Saharan Africa (SSA) to climate variability and change means that there is an urgent need to better integrate weather and climate information into societal decision-making processes. Long-term climate adaptation in these regions has received increasing attention, with recent initiatives aiming to increase resilience to climate change at timescales of years to decades. Less focus has been given to weather and short-term climate information. However, users are principally interested in shorter timescales (hours to seasons) where actions can immediately reduce the impacts of severe weather events. Focusing on the priority sectors of agriculture and food security, water and disaster management, this paper uses a systematic literature review approach to analyse 61 empirical case studies drawn from academic literature and projects across SSA. We identify the main users of climate services and outline current practices and reported benefits. Barriers that impede the delivery and uptake of climate services are identified and potential strategies for overcoming them outlined based on the reporting of successful practices. Our findings show that greater capacity building of personnel working for National Meteorological and Hydrological Services and Agricultural Extension staff and reinforcing and sustaining collaboration between different stakeholders (climate scientists, hydrologists, extension workers, farmers and other user groups), are essential factors for improving the uptake and utility of weather and climate services to enhance resilience to climate shocks in SSA

Elasticity in ecosystem services: Exploring the variable relationship between ecosystems and human well-being

Although ecosystem services are increasingly recognized as benefits people obtain from nature, we still have a poor understanding of how they actually enhance multidimensional human well-being, and how well-being is affected by ecosystem change. We develop a concept of “ecosystem service elasticity” (ES elasticity) that describes the sensitivity of human well-being to changes in ecosystems. ES Elasticity is a result of complex social and ecological dynamics and is context dependent, individually variable, and likely to demonstrate nonlinear dynamics such as thresholds and hysteresis. We present a conceptual framework that unpacks the chain of causality from ecosystem stocks through flows, goods, value, and shares to contribute to the well-being of different people. This framework builds on previous conceptualizations, but places multidimensional well-being of different people as the final element. This ultimately disaggregated approach emphasizes how different people access benefits and how benefits match their needs or aspirations. Applying this framework to case studies of individual coastal ecosystem services in East Africa illustrates a wide range of social and ecological factors that can affect ES elasticity. For example, food web and habitat dynamics affect the sensitivity of different fisheries ecosystem services to ecological change. Meanwhile high cultural significance, or lack of alternatives enhance ES elasticity, while social mechanisms that prevent access can reduce elasticity. Mapping out how chains are interlinked illustrates how different types of value and the well-being of different people are linked to each other and to common ecological stocks. We suggest that examining chains for individual ecosystem services can suggest potential interventions aimed at poverty alleviation and sustainable ecosystems while mapping out of interlinkages between chains can help to identify possible ecosystem service trade-offs and winners and losers. We discuss conceptual and practical challenges of applying such a framework and conclude on its utility as a heuristic for structuring interdisciplinary analysis of ecosystem services and human wellbeing.This paper results from the project Sustainable Poverty Alleviation from Coastal Ecosystem Services (SPACES) project number NE-K010484-1, funded by the Ecosystem Services for Poverty Alleviation (ESPA) programme. The ESPA programme is funded by the Department for International Development (DFID), the Economic and Social Research Council (ESRC), and the Natural Environment Research Council (NERC).

Prevalence, incidence, and distribution of human papillomavirus types in female sex workers in Kenya

Female sex workers (FSWs) have a notably high risk of acquiring human papillomavirus (HPV) infections. Relatively few studies address the type-specific prevalence and incidence of HPV among FSWs in sub-Saharan Africa. FSWs (n = 348) attending the Korogocho clinic in Nairobi, Kenya participated from August 2009 to March 2011. HPV DNA was detected using the SPF10-LiPA25 PCR assay. Baseline prevalence of HPV infection and cervical dysplasia were calculated, stratified by HIV-serostatus. Incidence rate (IR) of infection was calculated as number of new infections from baseline over person-months among 160 HPV-negative participants with complete 12-month follow-up. Baseline HPV prevalence was 23.6% for any HPV and 20.4% for high-risk HPV (hrHPV) types. Most prevalent types were HPV52 (10.1%), HPV35 (2.3%), and HPV51 (2.3%). A quarter (24%) of participants were HIV-positive. HPV prevalence was higher in HIV-positive (32.1%) than HIV-negative (20.8%) participants. hrHPV prevalence was higher in HIV-positive (27.4%) than HIV-negative (18.2%) women. During follow-up, HPV IR was 31.4 (95% CI: 23.8–41.5) for any HPV and 24.2 (95% CI: 17.9–32.8) for hrHPV types. HPV52 had the highest IR (6.0; 95% CI: 6.5–10.3). Overall HPV and hrHPV prevalence were lower than expected, but both prevalence and incidence were higher in HIV-positive than in HIV-negative women

Individual and partner risk factors associated with abnormal cervical cytology among women in HIV-discordant relationships

Individual and sexual partner characteristics may increase risk of abnormal cervical cytology among women in HIV-discordant relationships. Papanicolaou smears were obtained in a prospective cohort of Kenyan HIV-discordant couples. Of 441 women, 283 (64%) were HIV-infected and 158 (36%) were HIV-uninfected with HIV-infected partners. Overall, 79 (18%) had low-grade and 25 (6%) high-grade cervical abnormalities. Lack of male circumcision, male HSV-2 seropositivity and lower couple socioeconomic status were associated with cervical abnormalities (p350 cells/µL) had the lowest prevalence of high-grade cervical lesions. HIV-infected women (CD4>350 cells/µL) and HIV-uninfected women with HIV-infected partners (CD4≤350 cells/µL) were at similar intermediate risk (P>0.05), and HIV-infected women (CD4≤350 cells/µL) had significantly higher risk of high-grade cervical abnormalities (p=0.05). Women in HIV-discordant relationships have high rates of cervical lesions and this may be influenced by couple-level factors, including HIV status and CD4 count of the infected partner

Investigation of the governance structure of Nairobi dairy value chain and its influence on food safety

The dairy value chain of Nairobi is comprised, in its majority, of small-scale independent enterprises that operate within a complex interlinked system. In this complexity, the coordination and power structures of the system may have major influences on the management of dairy food safety. Therefore, the aim of this study was to investigate the governance and challenges issues faced by stakeholders throughout the Nairobi dairy value chain and assess their potential implications on food safety. Qualitative data was collected through focus group discussions and key informant interviews based on a dairy value chain mapping framework previously developed. Thematic analysis enabled identification of governance themes, key challenges and their implication on food safety. Themes were organized depending on their association with farmers (informal settlement or peri-urban), dairy cooperatives, dairy traders, processing companies, retailers or government officers. The identified governance themes included: i) weak linkage between government and farmers, ii) inadequate compliance with government regulations by traders and retailers, iii) emphasis on business licenses and permits for revenue rather than for food safety, iv) multiple licensing resulting in high business cost and lack of compliance, v) fragmented regulation, vi) unfair competition and vii) sanctions that do not always result in compliance. The key challenges identified included, amongst others: i) inadequate farmer support, ii) harassment of traders and retailers and iii) high business costs by traders, retailers, dairy cooperatives and large processors. The implication of governance and challenges of food safety were, amongst others: i) inadequate extension services, ii) insufficient cold chain, iii) delivery of adulterated and low milk quality to bulking centres, iv) inadequate food safety training and v) lack of policies for management of waste milk. The range of issues highlighted are based on stakeholders’ perceptions and reflects the complexity of the relationships between them. Many of the governance themes demonstrate the linkages that are both beneficial or confrontational between the formal and informal sectors, and between industry and regulatory authorities, with possible direct food safety consequences. Findings obtained provide indications to decision-makers of potential governance areas that could help improve efficiency and food safety along the dairy value chain

HIV-Neutralizing Activity of Cationic Polypeptides in Cervicovaginal Secretions of Women in HIV-Serodiscordant Relationships

HIV exposed seronegative (HESN) women represent the population most in need of a prophylactic antiviral strategy. Mucosal cationic polypeptides can potentially be regulated for this purpose and we here aimed to determine their endogenous expression and HIV neutralizing activity in genital secretions of women at risk of HIV infection.Cervicovaginal secretions (CVS) of Kenyan women in HIV-serodiscordant relationships (HESN, n = 164; HIV seropositive, n = 60) and low-risk controls (n = 72) were assessed for the cationic polypeptides HNP1–3, LL-37 and SLPI by ELISA and for HIV neutralizing activity by a PBMC-based assay using an HIV primary isolate. Median levels of HNP1–3 and LL-37 in CVS were similar across study groups. Neither HSV-2 serostatus, nor presence of bacterial vaginosis, correlated with levels of HNP1–3 or LL-37 in the HESN women. However, an association with their partner's viral load was observed. High viral load (>10,000 HIV RNA copies/ml plasma) correlated with higher levels of HNP1–3 and LL-37 (p = 0.04 and 0.03, respectively). SLPI was most abundant in the low-risk group and did not correlate with male partner's viral load in the HESN women. HIV neutralizing activity was found in CVS of all study groups. In experimental studies, selective depletion of cationic polypeptides from CVS rendered the remaining CVS fraction non-neutralizing, whereas the cationic polypeptide fraction retained the activity. Furthermore, recombinant HNP1–3 and LL-37 could induce neutralizing activity when added to CVS lacking intrinsic activity.These findings show that CVS from HESN, low-risk, and HIV seropositive women contain HIV neutralizing activity. Although several innate immune proteins, including HNP1–3 and LL-37, contribute to this activity these molecules can also have inflammatory properties. This balance is influenced by hormonal and environmental factors and in the present HIV serodiscordant couple cohort study we show that a partner's viral load is associated with levels of such molecules