Factors associated with exclusive breastfeeding among mothers with children aged six months and below attending Baringo County Refferal Hospital, Kabarnet, Kenya

Background: Breast milk is the safest and most natural food for an infant and provides complete nutritional needs up to six months of age. It is important for growth and reduces infant morbidity and mortality. Exclusive breastfeeding reduces malnutrition and other health problems.Objective: To determine factors associated with exclusive breastfeeding among mothers with children aged six months and below.Design: A cross sectional study.Setting: Baringo County Referral Hospital, Kabarnet, Kenya.Subjects: Three hundred and thirty mothers with children aged six months and below attending Baringo County Referral Hospital, Kabarnet, Kenya.Results: The results showed that 95.8% of the mothers breastfed their babies with 2.2% being exclusively breastfed. Delay in onset of breastfeeding, early complementation, use of pre-lacteal feeds was still practiced. Logistic regression showed that mode of delivery and place of delivery are significant with P ≤ 0.05. Mothers who delivered in hospital were 0.018 more likely to breastfeed exclusively while mothers who delivered normally were four times more likely to breastfeed exclusively.Conclusion: This study could help mothers, Ministry of Health and other nongovernmental organisations working with child health programmes, in likely interventions and supporting the ongoing child survival programmes, by taking appropriate steps in enhancing exclusive breastfeeding. As mothers attend antenatal and post- natal clinics, they should be given bronchures that are simple, clear to understand and addressing concerns on cultural beliefs, negative attitudes and breastfeeding problems and possible solutions. All infants should be breastfed within an hour of birth, on demand and up to the first six months of age

Susceptibility of Cryptococcus neoformans and Cryptococcus gattii from clinical and environment sources in Nairobi, Kenya

Objective: To determine anti-fungal susceptibility of Cryptococcus neoformans andCryptococcus gattii from environmental and clinical sources in Nairobi, Kenya.Design: Prospective study.Setting: Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya.Subjects: A total of 123 isolates were tested for their susceptibility to fluconazole(FLC), amphotericin B(AMP) and fluorocytosine (5FC). Clinical isolates were 70(66Cryptococcus neoformans and 4 Cryptococcus gattii) while environmental isolates were53(41 C. neoformans and 12 C. gattii). The isolates were characterised using variousphenotypic tests including microscopic morphology, physiological and biochemicaltests (API 20 Caux), pigmentation on bird seed agar and reaction on canavanineglycine-bromthymolblue agar. European Committee on Anti-microbial SusceptibilityStandards (EUCAST) was used as the reference method for susceptibility testing.Results: Most C. neoformans isolates; clinical (61/66; 92.4%) and environmental (38/41;92.7%) were susceptible to FLC. The number of C. neoformans isolates inhibited atsusceptible dose dependent (SDD) range (16-32μg/ml) by FLC were clinical (4/66; 6.1%)and environmental (2/41; 4.9%). One C. neoformans isolate each; clinical (1/66; 1.5%)and environmental (1/41; 2.4%) was resistant to FLC. All C. gatti isolates from clinicaland environmental were fully susceptible to FLC. The percentage of C. neoformansisolates that were susceptible (S) (MIC ≤ 1.0 μg/ml) to AMP were; clinical(52/66; 90.2%)and environmental (37/41; 78.8%) while the rest were susceptible dose dependent(SDD) with MIC (2-8μg/ml). Reduced susceptibilities to 5FC was displayed in allclinical and environmental C. neoformans and C. gatii isolates; for instance resistanceto 5FC was reported in C. neoformans; clinical (8/66; 12.1%) and environmental (1/41;2.4 %). Among the C. gattii isolates there was also decreased susceptibility to 5FCwith Minimum Inhibition Concentration (MIC) range of between 0.5-32 μg/ml. Therewere no significant differences in susceptibility ranges among all the clinical andenvironmental isolates.Conclusion: This study demonstrated reduced susceptibilities among C. neoformansand C. gattii isolates to commonly used anti-fungal drugs

Supply-chain strategies for essential medicines in rural western Kenya during COVID-19

Problem: The coronavirus disease 2019 (COVID-19) pandemic has disrupted health systems worldwide and threatened the supply of essential medicines. Especially affected are vulnerable patients in low- and middle-income countries who can only afford access to public health systems. Approach: Soon after physical distancing and curfew orders began on 15 March 2020 in Kenya, we rapidly implemented three supply-chain strategies to ensure a continuous supply of essential medicines while minimizing patients' COVID-19 exposure risks. We redistributed central stocks of medicines to peripheral health facilities to ensure local availability for several months. We equipped smaller, remote health facilities with medicine tackle boxes. We also made deliveries of medicines to patients with difficulty reaching facilities. Local setting: Τo implement these strategies we leveraged our 30-year partnership with local health authorities in rural western Kenya and the existing revolving fund pharmacy scheme serving 85 peripheral health centres. Relevant changes: In April 2020, stocks of essential chronic and non-chronic disease medicines redistributed to peripheral health facilities increased to 835 140 units, as compared with 316 330 units in April 2019. We provided medicine tackle boxes to an additional 46 health facilities. Our team successfully delivered medications to 264 out of 311 patients (84.9%) with noncommunicable diseases whom we were able to reach. Lessons learnt: Our revolving fund pharmacy model has ensured that patients' access to essential medicines has not been interrupted during the pandemic. Success was built on a community approach to extend pharmaceutical services, adapting our current supply-chain infrastructure and working quickly in partnership with local health authorities

Isolation and characterisation of Cryptococcus neoformans and Cryptococcus gattii from environmental sources in Nairobi, Kenya

Objective: To establish the environmental reservoirs of Cryptococcus neoformans and Cryptococcus gattii in Nairobi, Kenya.Design: Prospective study.Setting: Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya.Subjects: A total of 400 environmental samples from different sites were analysed including; avian droppings, tree swabs, soil contaminated with avian droppings and swabs from garbage damping sites. Samples were subjected to various phenotypic tests including microscopic morphology, physiological and biochemical tests, pigmentation on bird seed agar and reaction on Canavanine-Glycine-Bromothymol Blue agar.Results: Cryptococcus neoformans was isolated from 23/200 (11.5%) dropping samples and Cryptococcus gattii in 5/200 (2.5%) of the same samples. Cryptococcus gattii was isolated from 7/60 (11.7%) tree swabs and Cryptococcus neoformans in 5/60 (8.5%) of the same samples. From other sites there was no Cryptococcus gattii recovered with (5/50: 10%), (6/60: 10%), (2/30: 6.7%) Cryptococcus neoformans recovered from chicken cage, garbage damping site and soil respectively.Conclusion: Findings clearly showed a high presence of Cryptococcus neoformans and Cryptococcus gattii from several environmental sites in Nairobi, Kenya .This could probably explain the high incidence of cryptococcal meningitis in HIV/AIDS patients in Kenya

Marketing System of Oil Crops in Kenya - Final Report

Appendices include

Is climate exacerbating the root causes of conflict in Mali? A climate security analysis through a structural equation modeling approach

This peer-reviewed article examines the link between climate variability and conflict in Mali. It advances the argument that climate is a threat multiplier, other words, climate indirectly affects conflict occurrence through numerous pathway