Validation and application of the Purdie assay in the analyses of the major polyunsaturated fatty acids

Scope and Method of Study:Cardiovascular diseases resulting from the accumulation of triglycerides in the heart blood vessels remain serious causes of human mortality around the world. This is in part due to lack of rapid and sensitive methods to quantify the different types of triglycerides associated with these diseases. To address this research gap, the objectives of this study were:1) To determine the sensitivity of a newly developed Purdie assay relative to GC-MS in the quantification of omega-3 and omega-6 polyunsaturated fatty acid (PUFAs) in human serum.2) To correlate the Purdie assay with the conventional methods.3) To quantify the levels of omega-3 and omega-6 PUFAs and their ratios in the Total Cholesterol (TC), High Density Lipoproteins Cholesterol (HDL-C) and Low Density Lipoprotein (LDL-C) fractions of human serum using the Purdie assay,4) To test and quantify the major PUFAs in different types of food.This work contributed in part to quantifying 6 PUFAs and their ratios in human serum and foods. Blood serum specimens, obtained from Hillcrest Medical Center (HMC), were analyzed on the same day using GC-MS vs. the Purdie assay. Results obtained from the two methods were compared using SAS t-test and resulted in good agreement between the total omega-3 and total omega-6 PUFA levels and for the omega-6:omega-3 ratios. In an attempt to refine the Purdie assay, 24 human serum samples were analyzed for TC, HDL-C and LDL-C using Purdie assay. The results were correlated with the results obtained by HMC clinical staff at alpha = 0.05. Results showed no significant difference for TC and HDL-C data.Findings and Conclusions:Our findings suggest that Purdie assay is an accurate and sensitive assay that can be used to quantify PUFAs in human serum as well as in food products. These properties along with its relatively low cost makes it a useful assay in identification of the risks posed by different types of foods as well as early detection of triglyceride-related cardiovascular diseases

Let them know they can just run around and nobody expects them to do homework: parents' expectations of early childhood education and care in Kenya

This paper reports findings from a study of Kenyan parents' perceptions of an ideal early childhood educational environment for their children. Honouring their voices and showcasing them as advocates for quality early childhood education and care, findings are presented as constructed conversations between parents. Twenty-three parents who are professionals, have young children and live in Nairobi were interviewed for this study. Data were then analysed using a constructivist grounded theory approach. Parents reported that quality programs included playfulness, freedom and purpose and that it took a partnership of teacher, child and parent to realise the ideal

Do Smallholder Farmers Perceive Rainfall Variability the Same and Correctly? Gendered and Spatial Analysis of Perception Versus Actual Trends of Rainfall in Three Livelihood Zones in Kenya

This study was part of a PhD thesis at Kenyatta University – Kenya Abstract In this paper we compared perceived rainfall variability with actual rainfall variability using a more nuanced and mixed approach in order to understand the influence of gender dynamics and spatial location on perceptions. To be able respond effectively to climate variability people must first perceive the changes correctly. Past studies have focused on general perceptions about climate changes but have failed to ascertain the correctness of these perceptions as well as to exhaustively focus on gender dynamics and livelihood expectations that shape these perceptions. To address these gaps we focused on a more nuanced comparison between actual climate variability and gendered perception across three livelihood zones.  We obtained historical Rainfall data from weather stations in the three livelihood zones which we analysed using Coefficient of Variance (CV) and Cumulative Departure Index (CDI). We then compared this with responses from inter-household survey data of 420 households that were stratified in stages depending on the zones and gender of the target respondents. Although it was not significantly different how women and men perceived the changes in rainfall (p-value above 0.05) men seemed to perceive the variations more correctly compared to women. All aspects of rainfall variability were significantly perceived differently in the three agricultural livelihood zones. Depending on specific livelihood expectations in each zone the variability of rainfall was either perceived correctly or wrongly. Keywords: Gendered perception, spatial perception, gender, rainfall variability, livelihood zones, Kenya

DETERMINANTS AND OUTCOMES OF URBAN LAND USE SUCCESSION - CASE STUDY OF UPPER HILL, NAIROBI

This paper is based on a PHD research carried out to explore Urban Land Use Succession (ULUS) that is driven by private actors financed by local or global capital, referred to as property-led urban redevelopment. ULUS is manifested in indicators like land values, height of buildings, and migration. Its motive is profit taking contrasting it from ULUS that is driven by public and public-private partnerships (PPPs). ULUS has helped reimage cities, but in some cases, it has resulted in negative consequences such as pressure on existing infrastructure and patchwork land use patterns. A case study of Upper Hill is used to identify the determinants of the phenomenon with a view to mirroring findings to the rest of Nairobi. Simple random sampling has been used to identify a sample of plots whose landowners have been interviewed using semi-structured interview schedules. Data collected was processed and analysed using Statistical Package for Social Scientists (SPSS). The findings show that ULUS is being determined by spatial policy (planning controls on property, land tenure, and public investment in infrastructure) which is largely controlled by the state. The county government’s laissez faire approach demonstrated in failure to prepare comprehensive policy and to adhere to policy standards has put pressure on existing infrastructure and resulted in unsustainable outcomes. In addition, the presence of both public and private land has implied ease of redevelopment on privately owned land as opposed to state land resulting in a dichotomy of contradictory states

Implementation of respondent driven sampling in Nairobi, Kenya, for tracking key family planning indicators among adolescents and youth: lessons learnt

Objective: Adolescents and youth constitute a significant proportion of the population in developing nations. Conventional survey methods risk missing adolescents/youth because their family planning/contraception (FP/C) behavior is hidden. Respondent-driven sampling (RDS), a modified chain-referral recruitment sampling approach, was used to reach unmarried adolescents/youth aged 15–24 in Nairobi, Kenya to measure key FP/C indicators. Seeds were selected and issued with three coupons which they used to invite their peers, male or female, to participate in the study. Referred participants were also given coupons to invite others till sample size was achieved. We report on key implementation parameters following standard RDS reporting recommendations. Results: A total of 1674 coupons were issued to generate a sample size of 1354. Coupon return rate was 82.7%. Study participants self-administered most survey questions and missing data was low. Differential enrolment by gender was seen with 56.0% of females recruiting females while 44.0% of males recruited males. In about two months, it was possible to reach the desired sample size using RDS methodology. Implementation challenges included presentation of expired coupons, recruitment of ineligible participants and difficulty recruiting seeds and recruits from affluent neighborhoods. Challenges were consistent with RDS implementation in other settings and populations. RDS can complement standard surveillance/survey approaches, particularly for mobile populations like adolescents/youth

Layered vulnerability and researchers’ responsibilities: learning from research involving Kenyan adolescents living with perinatal HIV infection

Background: Carefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/AIDS, without increasing burdens. Such studies, however, must navigate a ‘vulnerability paradox’, since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/AIDS (ALH) in Kenya, we develop an account of researchers’ responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency as ‘interacting layers’. Methods: Using a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders’ perspectives on vulner- ability and resilience of young people living with HIV/AIDS, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna’s layered account of vulnerability. Results: ALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences. Conclusions: The most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabili- ties, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interper- sonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers’ responsibilitie

Design and implementation of a community-based mother-to-mother peer support programme for the follow-up of low birthweight infants in rural western Kenya

Background: Globally, low birthweight (LBW) infants ( Methods: Key informant interviews were conducted with 10 mothers of neonates (infants days) from two rural communities in western Kenya. These data informed the identification of key characteristics required for mother-to-mother peer supporters (peer mothers) following up LBW infants post discharge. Forty potential peer mothers were invited to attend a 5-day training programme that focused on three main themes: supportive care using appropriate communication, identification of severe illness, and recommended care strategies for LBW infants. Sixteen peer mothers were mentored to conduct seven community follow-up visits to each mother-LBW infant pair with fifteen completing all the visits over a 6-month period. A mixed methods approach was used to evaluate the implementation of the programme. Quantitative data of peer mother socio-demographic characteristics, recruitment, and retention was collected. Two post-training focus group discussions were conducted with the peer mothers to explore their experiences of the programme. Descriptive statistics were generated from the quantitative data and the qualitative data was analysed using a thematic framework. Results: The median age of the peer mothers was 26 years (range 21–43). From March-August 2019, each peer mother conducted a median of 28 visits (range 7–77) with fourteen (88%) completing all their assigned follow-up visits. Post training, our interviews suggest that peer mothers felt empowered to promote appropriate infant feeding practices. They gave multiple examples of improved health seeking behaviours as a result of the peer mother training programme. Conclusion: Our peer mother training programme equipped peer mothers with the knowledge and skills for the post-discharge follow-up of LBW infants in this rural community in Kenya. Community-based interventions for LBW infants, delivered by appropriately trained peer mothers, have the potential to address the current gaps in post-discharge care for these infants

Hair Dye and Relaxer Use among Cisgender Women in Embu and Nakuru Counties, Kenya: Associations with Perceived Risk of Breast Cancer and Other Health Effects

Despite widespread use of hair products globally, little is known about the prevalence and patterns of use in populations outside the United States. As some hair products contain endocrine-disrupting chemicals (EDCs) and EDCs have been linked to breast cancer, which is increasing globally, in this study, we addressed key knowledge gaps about hair product use and practices, and perceptions of use among women in two counties in Kenya. Using community-engaged approaches in Embu and Nakuru, Kenya, we recruited women aged 15–50 years to complete a questionnaire that ascertained hair product use in the last 7–14 days, ever using hair dyes and chemical relaxers, and participants’ perceptions or harm around hair product use. In multivariable-adjusted regression models, we evaluated associations between participants’ sociodemographic characteristics and perceptions of hair product use in relation to if they have ever used hair dyes and relaxers. In our sample of 746 women (mean age, 30.4 ± 8.1 years), approximately one-third of participants reported ever using permanent and/or semi-permanent hair dyes, with approximately one-fifth reporting current use. Almost 60% reported ever using chemical relaxers, with a little over one-third reporting current use. Increasing age and having an occupation in the sales and service industry were statistically significant predictors of hair dye use (OR 1.04, 95% CI: 1.02–1.06 and OR 2.05, 95% CI: 1.38–3.03, respectively) and relaxer use (OR 1.03, 95% CI: 1.01–1.06 and OR 1.93, 95% CI: 1.30–2.87). On average, participants reported moderate-to-high levels of concern about exposures and general health effects from using hair products, and relatively high levels of perceived risk of breast cancer related to hair product use. However, in contrast to our hypotheses, we observed mixed evidence regarding whether higher levels of perceived risk were associated with lower odds of ever using hair dyes and relaxers. These findings add new knowledge to the extant literature on hair product use among women in Kenya, where breast cancer incidence rates are increasing. Improving the understanding of patterns of use of specific products and their chemical ingredients—which may be hormone disruptors or carcinogens—and exploring the role of environmental health literacy are critical for developing interventions to reduce potentially harmful exposures found in these products

Developing an intervention to improve the quality of childcare centers in resource-poor urban settings: a mixed methods study in Nairobi, Kenya

Background: Globally, 350 million under-5s do not have adequate childcare. This may damage their health and development and undermine societal and economic development. Rapid urbanization is changing patterns of work, social structures, and gender norms. Parents, mainly mothers, work long hours for insecure daily wages. To respond to increasing demand, childcare centers have sprung up in informal settlements. However, there is currently little or no support to ensure they provide safe, nurturing care accessible to low-income families. Here, we present the process of co-designing an intervention, delivered by local government community health teams to improve the quality of childcare centers and ultimately the health and development of under-5 children in informal settlements in Kenya.Methods: This mixed methods study started with a rapid mapping of the location and basic characteristics of all childcare centers in two informal settlements in Nairobi. Qualitative interviews were conducted with parents and grandparents (n = 44), childcare providers, and community health teams (n = 44). A series of 7 co-design workshops with representatives from government and non-governmental organizations (NGOs), community health teams, and childcare providers were held to design the intervention. Questionnaires to assess the knowledge, attitudes, and practices of community health volunteers (n = 22) and childcare center providers (n = 66) were conducted.Results: In total, 129 childcare centers were identified −55 in Korogocho and 77 in Viwandani. School-based providers dominated in Korogocho (73%) while home-based centers were prevalent in Viwandani (53%). All centers reported minimal support from any organization (19% supported) and this was particularly low among home-based (9%) and center-based (14%) providers. Home-based center providers were the least likely to be trained in early childhood development (20%), hence the co-designed intervention focused on supporting these centers. All co-design stakeholders agreed that with further training, community health volunteers were well placed to support these informal centers. Findings showed that given the context of informal settlements, support for strengthening management within the centers in addition to the core domains of WHO's Nurturing Care Framework was required as a key component of the intervention.Conclusion: Implementing a co-design process embedded within existing community health systems and drawing on the lived experiences of childcare providers and parents in informal settlements facilitated the development of an intervention with the potential for scalability and sustainability. Such interventions are urgently needed as the number of home-based and small center-based informal childcare centers is growing rapidly to meet the demand; yet, they receive little support to improve quality and are largely unregulated. Childcare providers, and government and community health teams were able to co-design an intervention delivered within current public community health structures to support centers in improving nurturing care. Further research on the effectiveness and sustainability of support to private and informal childcare centers in the context of low-income urban neighborhoods is needed

The Effect of Switching to Second-Line Antiretroviral Therapy on the Risk of Opportunistic Infections Among Patients Infected With Human Immunodeficiency Virus in Northern Tanzania

Background. Due to the unintended potential misclassifications of the World Health Organization (WHO) immunological failure criteria in predicting virological failure, limited availability of treatment options, poor laboratory infrastructure, and healthcare providers’ confidence in making switches, physicians delay switching patients to second-line antiretroviral therapy (ART). Evaluating whether timely switching and delayed switching are associated with the risk of opportunistic infections (OI) among patients with unrecognized treatment failure is critical to improve patient outcomes