Between Communities and Health Facilities in Health Service Delivery: Reality or Myth?

Summary Health service delivery remains a challenge for rural Kenya. Health sector reforms have come in at a time when different models are being tried to improve access and utilisation of health services being offered by various providers, such as NGOs, government and private for?profit practitioners. This article will examine a model that World Neighbours has been trying out. It explores questions raised by this model such as: can community voices influence quality and type of service? Can communities access and use services being offered from a facility where they do not decide on management, staffing or supplies? Can the more vulnerable members access these services where they have to pay? What institutional arrangements spur the energy of a community to influence health service delivery? The article analyses the above questions in light of trends of health service delivery from 1990s to date in terms of policy environment versus reality on the ground, using the example of Mukuyuni Health Centre where World Neighbours has been operating

Non-traumatic chest pain in patients presenting to an urban emergency Department in sub Saharan Africa: a prospective cohort study in Tanzania.

BACKGROUND:Non-traumatic chest pain (NTCP) is a common reason for emergency department (ED) attendance in high-income countries, with the primary concern focused on life threatening cardiovascular diseases. There is general lack of data on aetiologies, diagnosis and management of NTPC in Sub Sahara African (SSA) countries. We aimed to describe evaluation, diagnosis and outcomes of adult patients presenting with NTCP to an urban ED in Tanzania. METHOD:This was a prospective observational cohort study of consecutive adult (≥18 years) patients presenting with non-traumatic chest pain to the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH) in Dar es salaam from September 2017 to April 2018. Structured case report form was used to collected demographics, clinical presentation, investigations, diagnosis, and EMD disposition and in hospital mortality. We determined frequency of NTCP among our patients, aetiologies, 24-h and 7-day in-hospital mortality, and predictors for mortality. RESULTS:We screened 29,495 adults attending EMD-MNH during the study and 389 (1.3%) presented with NTCP of these, 349 (90%) were enrolled. The median age was 45 (IQR 29-60) years and 177 (50.7%) were female. Overall, 69.1% patients received electrocardiography (ECG) in the EMD and 34.1% had a troponin test. Heart failure and pulmonary tuberculosis (PTB) were the leading hospital diagnoses (12.6% each), followed by chronic kidney disease (10%) and acute coronary syndrome (ACS) (9.6%). Total of 167 (48%) patients were admitted, and the 24-h and 7-day in-hospital mortality were 5 (3%) and 16 (9.6%) respectively. Univariate risk factors for mortality were a Glasgow Coma Scale of < 15 [RR = 3.4 (95%CI 3.2-23)], Acute Coronary Syndrome [RR = 5.7 (95% CI 1.7-11.8) and Troponin > 0.04 ng/ml [RR 2.9 (95%CI 1.2-7.3)]. Features distinguishing cardiovascular from other causes were: bradycardia [RR = 2.6 (95%CI 2.1-3.2)], heart beat awareness [RR = 2.3 (95%CI 1.7-3.2)] and history of diabetic mellitus [RR = 2.2 (95% CI 1.6-3.0)]. CONCLUSION:In this ED of SSA country, heart failure and pulmonary tuberculosis were the leading causes of NCTP, and ACS was present in 9.6%. NTCP in this setting carries high mortality, and ACS was the leading risk factor for death. ED providers in SSA must increasingly consider cardiovascular causes of NTCP

Prevalence and Distribution of Cassava Bacterial Blight in the Kenyan Coast

Cassava (Manihot esculenta Crantz) is one of the staple food crops grown in Kenya. Diseases remain one of the major constraints for cassava production. Apart from other major viral diseaes Cassava mosaic and Cassava brown streak, Cassava bacterial blight (CBB) caused by Xanthomonas axonopodis pv manihotis and Xanthomonas axonopodis pv cassavae are a major constraint in cassava production in Kenya. This study was done to identify the prevalence, distribution, and farmers' knowledge of cassava bacterial blight in the coastal region of Kenya. A survey was conducted involving 250 farmers who were randomly selected from two regions of Kilifi and Taita Taveta counties. Among the 250 farmers interviewed, 61.6 % identified cassava bacterial blight symptoms in their farms. The main varieties found growing in the region were Tajirika, Karembo, Kibandameno, and Shibe which were all confirmed by farmers as susceptible to cassava bacterial blight. During the survey, plant samples were randomly collected in the field. Out of the 70 samples collected, 40 of them were confirmed positive with X.pv manihotis and X.pv cassavae which cause cassava bacterial blight. The study concluded that there is a widespread of cassava bacterial blight in Kilifi and Taita taveta counties. Kilifi County had the highest incidence of 22% with Taita Taveta having the lowest incidence of 13%. Kilifi County had a higher severity of 8% as compared to Taita Taveta which had 5% Severity. Therefore there is a need for a proper management program to be deployed in managing the disease to enhance cassava production in the region

Evaluation of growth characteristics of selected beauveria bassiana islolates under laboratory conditions in Kenya

Published online: July 2018An evaluation of the growth characteristics of nine B. bassiana isolates was conducted under laboratory conditions. Tests for spore concentration, viability, germination percentage, relative hyphal growth and speed of conidial germination were done. Isolate J59 showed the highest spore concentration of 120 and 114.2 spores per ml during the first and second assay respectively. Isolate J57 had the most viable number of spores in both assays. The highest germination percentage of over 80% was recorded for isolate J57. The relative hyphal growth was highest for the isolateRI under 6 days after inoculation followed closely by isolate J57 in both assays. In all the observed days, isolates BBC and BVT recorded the lowest relative hyphal growth but highest conidial germination at 2 to 10 hours after inoculation. Evaluation of growth is an important prerequisite for evaluation when considering the B. bassiana isolates for control of storage pests

INCIDENCE, SEVERITY AND DISTRIBUTION OF YELLOW LEAF CURL DISEASE OF TOMATO IN KENYA

Tomato ( Solanum lycopersicum L.) is an important fruiting vegetable grown in Kenya because of its commercial and high nutritional value. Viruses are a major constraint to tomato production in tropics and sub tropics, eliciting symptoms like stunting, leaf mosaic, distortion, chlorosis, mottling, and vein clearing similar to those caused by abiotic factors. Although begomoviruses are known to cause tomato yellow leaf curl disease (TYLCD) in Kenya, there is limited knowledge on the disease status in tomato fields. The objective of this study was to determine the incidence and distribution of TYLCD in Kenya using the double antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) technique. A survey was carried out in eight major tomato growing regions (259 fields) in Kenya during September to December, 2018. Presence of tomato yellow leaf curl virus was further confirmed using DAS\u2013ELISA. The disease was present across all the counties surveyed and its prevalence, incidences and severity varied across the counties and among the fields. The mean TYLCD prevalence ranged from 19.5% in Bungoma County, to 64% in Kwale County. There was significant difference (P<0.05) in disease incidences among the varieties sampled and the incidence was lower in plants grown from hybrids seed compared to conventional varieties. Mean disease severity was significant (P<0.05) and ranged from 0.18 to 2.20. Most farmers planted non-hybrid seeds. There is need for further determination of the diversity of begomoviruses infecting tomato using other techniques to provide more information towards breeding TYLCD-resistant tomato varieties.La tomate ( Solanum lycopersicum L.) est un important l\ue9gume-fruit cultiv\ue9 au Kenya en raison de sa valeur commercial et nutritionnelle \ue9lev\ue9e. Les virus sont une contrainte majeure \ue0 la production de tomates dans les r\ue9gions tropicales et subtropicales, provoquant des sympt\uf4mes tels que le rabougrissement, la mosa\uefque foliaire, la distorsion, la chlorose, la marbrure, le d\ue9gagement des veines similaires \ue0 ceux caus\ue9s par des facteurs abiotiques. Bien que les Begomovirus soient connus pour causer la maladie de l\u2019enroulement des feuilles jaunes de la tomate (TYLCD) au Kenya, les connaissances sur l\u2019\ue9tat de la maladie dans les champs de tomates sont limit\ue9es. L\u2019objectif de cette \ue9tude \ue9tait de d\ue9terminer l\u2019incidence et la distribution de TYLCD au Kenya en utilisant la technique de dosage immuno-enzymatique en sandwich \ue0 double anticorps (DAS-ELISA). Une enqu\ueate a \ue9t\ue9 men\ue9e dans huit grandes r\ue9gions productrices de tomates (259 champs) au Kenya de Septembre \ue0 D\ue9cembre 2018. La pr\ue9sence du virus de l\u2019enroulement des feuilles jaunes de la tomate a \ue9t\ue9 confirm\ue9e par DAS-ELISA. La maladie \ue9tait pr\ue9sente dans tous les comt\ue9s \ue9tudi\ue9s et sa pr\ue9valence, son incidence et sa gravit\ue9 variaient d\u2019un comt\ue9 \ue0 l\u2019autre et d\u2019une parcelle \ue0 l\u2019autre. La pr\ue9valence moyenne du TYLCD variait de 19,5 % dans le comt\ue9 de Bungoma \ue0 64 % dans le comt\ue9 de Kwale. Il y avait une diff\ue9rence significative (P<0,05) dans l\u2019incidence des maladies parmi les vari\ue9t\ue9s \ue9chantillonn\ue9es et l\u2019incidence \ue9tait plus faible chez les plantes cultiv\ue9es \ue0 partir de semences hybrides par rapport aux vari\ue9t\ue9s conventionnelles. La gravit\ue9 moyenne de la maladie \ue9tait statistiquement significative (P<0,05) et variait de 0,18 \ue0 2,20. La plupart des agriculteurs ont plant\ue9 des semences non hybrides. Il est n\ue9cessaire de d\ue9terminer davantage la diversit\ue9 des Begomovirus infectant la tomate en utilisant d\u2019autres techniques pour fournir plus d\u2019informations sur la s\ue9lection de vari\ue9t\ue9s de tomates r\ue9sistantes au TYLCD

PHYSICO-CHEMICAL PROPERTIES AND SENSORY QUALITY OF CASSAVA-COWPEA-MILLET COMPOSITE FLOURS

There is global increase in demand for good health and nutrition. The objective of this study was to formulate nutritious composite flours from cassava ( Manihot esculenta L.) roots, cowpea ( Vigna unguiculata ) leaves, and millet ( Pennisetum glaucum ), especially for children and expectant women. A Nutrisurvey software was used to formulate three flour products, namely 20:50:30, 10:50:40 and 15:60:25 of cassava roots, cowpea leaves, and millet, respectively to achieve more than 40% daily requirement of protein, iron and zinc for the expectant woman. The products were subjected to a sensory panel and evaluated against a standard commercial flour (Famila) sold in the Kenyan market. The flours were also subjected to accelerated shelf-life study based on physico-chemical properties and growth of yeast and molds. Results indicated that 20:50:30 and 10:50:40 had the highest colour scores on a 7-point hedonic scale, 5.2\ub11.35 and 5.2\ub11.48 (P<0.05). The score indicates a near equal acceptability of the flour based on colour for both the standard. The green porridge (15:60:25) was the least accepted flour and had the highest total aerobic count of 3.7 log cfu g-1 after four months of storage. The acid value of the flours ranged from as low as 1.84\ub10.01mg KOH g-1 for the 20:50:30 at day zero and as high as 12.9\ub11.73 mg KOH g-1 after six months of storage. The formulated 20:50:30 flours had protein (8.0%), fat (3.5%) carbohydrates (70%), zinc (0.6 mg100 g-1), iron (0.6 mg100g-1) and vitamin C (0.3 mg100 g-1).Il y a une augmentation mondiale de la demande d\u2019une bonne sant\ue9 et d\u2019une bonne nutrition. L\u2019objectif de cette \ue9tude \ue9tait de formuler des farines composites nutritives \ue0 partir de racines de manioc ( Manihot esculenta L.), de feuilles de ni\ue9b\ue9 ( Vigna unguiculata ) et de mil ( Pennisetum glaucum ), en particulier pour les enfants et les femmes enceintes. Un logiciel Nutrisurvey a \ue9t\ue9 utilis\ue9 pour formuler trois produits \ue0 base de farine, \ue0 savoir 20:50:30, 10:50:40 et 15:60:25 de racines de manioc, de feuilles de ni\ue9b\ue9 et de millet, respectivement, pour atteindre plus de 40% des besoins quotidiens en prot\ue9ines , fer et zinc pour la femme enceinte. Les produits ont \ue9t\ue9 soumis \ue0 un panel sensoriel et \ue9valu\ue9s par rapport \ue0 une farine commerciale standard (Famila) vendue sur le march\ue9 au Kenya. Les farines ont \ue9galement \ue9t\ue9 soumises \ue0 une \ue9tude de dur\ue9e de conservation acc\ue9l\ue9r\ue9e bas\ue9e sur les propri\ue9t\ue9s physicochimiques et la croissance des levures et des moisissures. Les r\ue9sultats ont indiqu\ue9 que 20:50:30 et 10:50:40 avaient le couleur les plus \ue9lev\ue9s sur une \ue9chelle h\ue9donique \ue0 7 points, 5,2 \ub1 1,35 et 5,2 \ub1 1,48 (P <0,05). L\u2018 \ue9chelle h\ue9donique indique une acceptabilit\ue9 presque \ue9gale de la farine sur la base de la couleur pour le standard. La bouillie verte (15:60:25) \ue9tait la farine la moins accept\ue9e et avait le compte a\ue9robie total le plus \ue9lev\ue9 de 3,7 log ufc g-1 apr\ue8s quatre mois de stockage. L\u2019indice d\u2019acide des farines variait entre 1,84 \ub1 0,01 mg KOH g-1 pour le 20:50:30 au jour z\ue9ro et jusqu\u2019\ue0 12,9 \ub1 1,73 mg KOH g-1 apr\ue8s six mois de stockage. Les farines formul\ue9es \ue0 20:50:30 contiennent des prot\ue9ines (8,0%), des lipides (3,5%), des glucides (70%), du zinc (0,6 mg100 g- 1), du fer (0,6 mg100g- 1) et de la vitamine C (0,3 mg100 g- 1)

Pathogenicity of Selected Kenyan Entomopathogenic Nematodes of Genus Steinernema against Banana Weevil (Cosmopolites Sordidus)

Banana weevil is a pest with a great impact on banana production in the world. The objective of this study was to evaluate the pathogenicity of the Kenyan entomopathogenic nematodes (EPNs) of genus Steinernema against the weevil Cosmopolites sordidus (Germar) under laboratory conditions. Adult weevils were trapped from banana fields in Maragua, Central Kenya and larvae extracted from the infested banana rhizomes. The adults were treated with three Kenyan EPNs Steinernema weiseri, Steinernema yirgalemense and the new Steinernema spp and with Steinernema carpocapsae ALL strain as a standard and plain distilled water as a control in five replicates. The treatments were 500ijs, 750ijs and 1000ijs per adult on petri dishes and 1000ijs, 3000ijs and 5000ijs per adult on pseudo-stems. The treatments for larvae in petri dishes were 300ijs, 400ijs and 500ijs. The adults were not susceptible to all the nematodes at all doses and preparations while larvae were highly susceptible to the four test EPNs at all concentrations. There was a significant difference at P<0.05 in the mortality of larvae between nematode Steinernema carpocapsae and Steinernema weiseri. A significant difference was observed between nematode Steinernema carpocapsae and Steinernema yirgalemense. There was also a significant difference between the new Steinernema spp and Steinernema weiseri and finally in the two nematodes the new Steinernema spp and Steinernema yirgalemense. All the test nematodes caused over 90 % larval mortality within 48 hours. The mean percent mortality of larva increased with nematode concentration for all the test nematodes. The results indicated that the four test EPNs significantly (P<0.05) caused high mortality within 24-48 hrs. The findings indicate that the banana weevil larvae are susceptible to the local entomopathogenic nematodes and potentially useful in the management of the banana weevil. It is however recommended that more research be conducted on the formulation and application technology to enhance their effectiveness in the field

Distribution and molecular diversity of whitefly species colonizing cassava in Kenya

Open Access Journal; Published online: 27 Sep 2021The whitefly, Bemisia tabaci (Gennadium, Hemiptera) has been reported to transmit viruses that cause cassava mosaic disease (CMD) and cassava brown streak disease (CBSD) in many parts of sub-Saharan Africa (SSA). Currently, there is limited information on the distribution, species and haplotype composition of the whitefly populations colonizing cassava in Kenya. A study was conducted in the major cassava growing regions of Kenya to address this gap. Analyses of mitochondrial DNA cytochrome oxidase 1 (mtCO1) sequences revealed the presence of four distinct whitefly species: Bemisia tabaci, Bemisia afer, Aleurodicus dispersus and Paraleyrodes bondari in Kenya. The B. tabaci haplotypes were further resolved into SSA1, SSA2 and Indian Ocean (IO) putative species. The SSA1 population had three haplogroups of SSA1-SG1, SSA-SG2 and SSA1-SG3. Application of KASP genotyping grouped the Bemisia tabaci into two haplogroups namely sub-Saharan Africa East and Southern Africa (SSA-ESA) and sub-Saharan Africa East and Central Africa (SSA-ECA). The study presents the first report of P. bondari (Bondar’s nesting whitefly) on cassava in Kenya. Bemisia tabaci was widely distributed in all the major cassava growing regions in Kenya. The increased detection of different whitefly species on cassava and genetically diverse B. tabaci mitotypes indicates a significant influence on the dynamics of cassava virus epidemics in the field. The study highlights the need for continuous monitoring of invasive whitefly species population on cassava for timely application of management practices to reduce the impact of cassava viral diseases and prevent potential yield losses

Susceptibility of common weeds and cultivated crops in major maize growing agroecological zones of Uganda to viruses causing maize lethal necrosis disease

Maize lethal necrosis (MLN) disease is caused when maize plants become co-infected with Maize chlorotic mottle virus (MCMV) and potyviruses notably Sugarcane Mosaic Virus (SCMV). Apart from maize, little is known about susceptibility of weed species and cultivated crop species usually growing in proximity with maize to MLN viruses in Uganda. The common weeds and crop plants were mechanically inoculated with combined sap from MCMV and SCMV infected maize plants. Samples were tested for MLN causing viruses by Double Antibody Sandwich Enzyme-Linked Immunosorbent Assay (DAS-ELISA) and Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). The weeds that were susceptible to MCMV were Digitaria abyssinica, Eleusine africana and Roetboellia cochinchinensis; while those susceptible to SCMV were Pennisetum purpureum, Panicum maximum and Roetboellia cochinchinensis. The cultivated crops were susceptible only to MCMV and included cassava (Manihot esculenta), groundnut (Arachis hypogaea) and bean (Phaseolus vulgaris). Common weeds and cultivated crops growing close to maize in Uganda have differential susceptibility to MLN causing viruses and can act as reservoirs of MLN causing viruses. It is critical to identify non-MLN hosts in cultivated crops for crop rotation and early weeding to reduce on MLN virus inoculum in cropping syste

Metagenomic analyses and genetic diversity of Tomato leaf curl Arusha virus affecting tomato plants in Kenya.

Funder: Bill and Melinda Gates Foundation; doi: http://dx.doi.org/10.13039/100000865BACKGROUND: Tomato production is threatened worldwide by the occurrence of begomoviruses which are associated with tomato leaf curl diseases. There is little information on the molecular properties of tomato begomoviruses in Kenya, hence we investigated the population and genetic diversity of begomoviruses associated with tomato leaf curl in Kenya. METHODS: Tomato leaf samples with virus-like symptoms were obtained from farmers' field across the country in 2018 and Illumina sequencing undertaken to determine the genetic diversity of associated begomoviruses. Additionally, the occurrence of selection pressure and recombinant isolates within the population were also evaluated. RESULTS: Twelve complete begomovirus genomes were obtained from our samples with an average coverage of 99.9%. The sequences showed 95.7-99.7% identity among each other and 95.9-98.9% similarities with a Tomato leaf curl virus Arusha virus (ToLCArV) isolate from Tanzania. Analysis of amino acid sequences showed the highest identities in the regions coding for the coat protein gene (98.5-100%) within the isolates, and 97.1-100% identity with the C4 gene of ToLCArV. Phylogenetic algorithms clustered all Kenyan isolates in the same clades with ToLCArV, thus confirming the isolates to be a variant of the virus. There was no evidence of recombination within our isolates. Estimation of selection pressure within the virus population revealed the occurrence of negative or purifying selection in five out of the six coding regions of the sequences. CONCLUSIONS: The begomovirus associated with tomato leaf curl diseases of tomato in Kenya is a variant of ToLCArV, possibly originating from Tanzania. There is low genetic diversity within the virus population and this information is useful in the development of appropriate management strategies for the disease in the country