Utilization of Herbal Medicines among Diabetic Patients Attending Kenyatta National Hospital Outpatient Clinic

Background: World Health Organization has estimated that 70-90 % of Africa’s population still relies on herbal remedies in order to meet their healthcare needs. Although the role of herbal medicines in the management of diabetes is an emerging health issue, use of herb remedies is common among diabetics. Objectives: To evaluate knowledge, perception and describe the pattern of utilization of herbal medicines among diabetic outpatients at Kenyatta National Hospital. Methodology: The study was a tertiary hospital-based cross sectional study. Simple random sampling technique was used to select 251 adult diabetic outpatients who were interviewed. Data was captured into Microsoft Excel computer software and then exported to SPSS version 17.0 for analysis. Descriptive data was analyzed quantitatively and presented in form of charts and tables as appropriate. Statistical significance was determined using Pearson Chi Square at p<0.05. Where numbers of participants were too small, Fishers exact results were used. Results: The prevalence of use of herbal remedies for managing diabetes mellitus was 7.2%. However, the total prevalence of use of herbs among the diabetic outpatients was 39.5% implying that 32.3% of the study participants used herbs for other medical conditions. The commonest herbs used were ginger and Aloe vera used by 50% of the herbal users. Almost half of the herb users did not regard it important to inform the doctor about their use of herbs. The reasons given for use of herbal medicines were varied; the commonest being that herbs could easily be accessed 13 (13.1%) of the herbal users. There was no statistically significant relationship between socio-demographic characteristics and use of herbs (P>0.05). Conclusion: About 40% of diabetic outpatients are in some form of herbal remedy. In addition, 1 out of 5 of diabetic herbal users use them for managing diabetes; commonest herbs being Aloe vera and ginger. Therefore, healthcare workers and researchers should find ways of harmonizing the utilization of herbal and conventional medicines amongst diabetic patients

Optimization of FTA technology for large scale plant DNA isolation for use in marker assisted selection

Conventional methods for DNA acquisition and storage require expensive reagents and equipments. Experimental fields located in remote areas and large sample size presents greater challenge to developing country institutions constrained financially. FTATM technology uses a single format utilizing basic tools found in laboratory. In this study, FTATM cards were used to collect over 3000 samples from a field located 130 km and used to screen progeny plants using PCR-marker-assisted selection. PCR product yields and quality are sufficient for reliable scoring, distinguishing heterozygous fromhomozygous plants using ABI 3730 sequencer. Results indicate that this method is faster, easier and in-expensive

Marker assisted introgression of opaque2 gene into herbicide resistant elite maize inbred lines

Marker assisted selection in combination with conventional breeding can greatly accelerate the introgression of modified opaque2 genotype into herbicide resistant maize. By combining these two approaches, time and costs are greatly minimized. The application of opaque2 allele specific SSR markers was done on materials already undergoing selection in a breeding program for converting herbicide resistant maize lines into quality protein maize (QPM) which is the equivalent of modified opaque2 phenotype. The breeder had selected QPM lines using the light table in the previous cycle and we used leaf samples to extract DNA for analysis of the presence of the opaque2 gene using SSR markers. Two co-dominant SSR markers phi057 and umc1066 and a dominant marker phi112 were used. Umc1216, a modifier marker was also tested in combination with the opaque2 markers with theobjective of using the marker to select for modifiers for the opaque2 phenotype. The modified FTA paper technology protocol was applied in field sampling. The results showed 97% of the lines wereopaque2 while 3% were non-opaque2. Both methods of conventional breeding using light table and marker assisted selection (MAS) were comparable. However, the application of SSR markers and theFTA technology offers the breeder a fast, time saving, reliable and less labour intensive method of screening QPM maize during the early growing stages instead of having to wait to screen the kernels onthe light table after harvesting. Moreover, the routine biochemical analysis for high lysine and tryptophan levels need not be carried out at each backcross since the presence of the opaque2 gene is confirmed with markers

Combating Desertification through Enhancement of Woody Floral Diversity in the Drylands of Kenya: Analysis, Milestones, and Strategies

Desertification remains one of the most challenging phenomena in the drylands of Kenya, where it affects about 80% of the country. This is because of persistent degradation of these areas by climatic variations, human activities, and overgrazing by livestock and wildlife. In these areas, inhabitants suffer from widespread acute poverty and other adverse effects of drought. In order to effectively and efficiently combat desertification and reduce the impacts of further degradation, the Government of Kenya and partners are committed to developing and implementing methods, approaches, strategies, and mechanisms that would slow down or reverse this phenomenon. This chapter covers an in-depth review of advances made so far in the area of woody resources restoration and sustainable management in the drylands of Kenya through biodiversity assessments, conservation, rehabilitation, afforestation, and reafforestation initiatives and research. Achievements, challenges, and opportunities encountered are highlighted for sustainable development and wise utilization of dryland woody and allied resources

Impact of neurosurgical site infections on patient expenditure at a national referral hospital in Kenya: a cost of illness study

Background: Neurosurgical site infections result in prolonged hospitalisation and increased treatment costs. Cost of illness studies are important in computing the total costs of treatment of disease, as they quantify the burden of disease in terms of direct costs, productivity losses and intangible costs. Neurosurgical site infections do not occur at a high rate in most clinical settings. Their economic impact has been assumed to be minimal, and most studies have not exclusively studied their economic impact. Objective: To assess the economic burden of treatment of surgical site infections among trauma patients admitted at the neurosurgical ward of Kenyatta National Hospital. Methods: A prospective cost of illness study was conducted between April 2015 and June 2015 as part of a larger prospective cohort study. The patient perspective was adopted. The time horizon was the hospitalization period of the patients, which was a median of ten days. No discounting was done because the study was done within a year. A micro costing approach was used to compute direct costs on medication, laboratory and radiologic tests, cost of surgical procedures and nursing care, and direct non-medical costs incurred by patients for the average 10 day hospitalisation period. Productivity losses were also computed. Results: The total median cost of treating patients with neurosurgical site infections was higher, at USD 203.95 than that of patients without infection at USD 141.20. The median cost on antibiotics was USD 18.70 while that of non- antibiotic drugs was USD 33.03. The total median cost on laboratory and radiologic tests was USD 20 and USD 55 respectively. The key cost drivers were expenditures on meropenem, phenytoin, urea, electrolyte and creatinine tests and CT scans. With regards to costs of services, care-giver costs accounted for the highest median expenditure, followed by costs of surgery and nursing care. Conclusion: Neurosurgical site infections increase hospitalisation duration and costs. Prevention of these will reduce patient expenditure. Key words: cost of illness, neurosurgical site infection, productivity losse

Patterns of antimicrobial use in the neurosurgical ward of Kenyatta National Hospital

Background: Antibiotics in neurosurgery are used for prophylaxis and treatment of already established infection.  Guidelines state that prophylactic antibiotics should be given for up to 24 hours. For treatment of already established infections, empiric therapy with intravenous antibiotics for four to eight weeks is indicated. Studies have shown no distinction between antibiotic use for prophylaxis and treatment of established infection in neurosurgery. Objectives: To identify antibiotic use patterns and medication errors and their association with development of surgical site infections. Methods: A prospective cohort study involving adult neurosurgical patients was carried out at Kenyatta National Hospital, between April 2015 and July 2015. Patient demographic data as well as data on surgical procedures carried out, antibiotics used and medication errors was collected. Descriptive data analysis was done for all variables. To test for association between antibiotic use patterns and development of surgical site infections, the Fischer exact Chi square test was used. Results: Out of the 84 participants recruited in the study, 87.2% (n=68) used antibiotics. Ceftriaxone was the most commonly used (63.7%, n= 44), followed by metronidazole (40.4%, n=23).  Medication errors that were noted involved inappropriate choice and use of antibiotics. There was no distinction between use of antibiotics for prophylaxis and treatment of infection. There was no statistically significant association between patterns of antibiotic use and development of surgical site infection. Conclusion: Antibiotic use patterns do not affect the incidence of neurosurgical site infections. Prescribing errors of various types were prominent. An antibiotic use protocol should guide antimicrobial selection and use in neurosurgery. Key words: antibiotic, prophylaxis, medication error

Systematic Review, Meta-Analysis and Grading of Evidence on the Effectiveness of Antimicrobial Prophylaxis for Neurosurgical Site Infections

Background: Antimicrobial prophylaxis is crucial for neurosurgical procedures, even though they are clean procedures. Observational studies have shown the effectiveness of different antibiotics in preventing neurosurgical site infections, but there remains paucity of systematic reviews and meta-analyses which have assessed their effectiveness in East Africa. Objectives: To generate and appraise the quality of evidence that would inform antimicrobial prophylaxis in neurosurgery. Methodology: A systematic review and meta-analysis was conducted between October 2014 and December 2015. Studies that involved the administration of systemic antibiotics for prophylaxis, use of antibiotic impregnated shunt catheters among adult patients aged over 18 years were included and subjected to abstract, title and full text screening. A meta-analysis was carried out using RevMan (Review Manager) version 5 software. The quality of evidence was evaluated using the GRADE system. Results: One systematic review of randomized controlled trials (n=17) and 11 randomised controlled trials were included in the study. From the first meta-analysis, use of systemic antibiotics demonstrated an overall protective effect of 52% from development of surgical site infections [OR 0.48 (95% CI 0.30, 0.79)]. In the second meta-analysis, the use of antibiotic impregnated shunt catheters was associated with a higher risk of mortality compared to use of the standard shunt [(OR 1.47(95% CI 0.82, 2.62)]. Following evaluation of quality of evidence, in the antibiotics versus placebo arm, the quality of evidence was moderate, while that for antimicrobial impregnated shunts was very low. Conclusion: Antimicrobial prophylaxis using systemic antibiotics or antimicrobial impregnated shunts is effective in preventing neurosurgical site infections. Antimicrobial impregnated shunts are too expensive for our study population. Key words: systematic review, meta-analysis, antimicrobial prophylaxi

Quantitative trait loci (QTLs) for resistance to gray leaf spot and common rust diseases of maize

Gray leaf spot and common rust diseases can greatly reduce grain yield of maize in susceptible genotypes by between 10 and 70% on average. Control of these diseases through conventional measures has been quite ineffective and difficult to sustain. The most feasible way to control them is by breeding and deploying resistant maize genotypes. This study was carried out to evaluate germplasm for QTLs associated with resistance to GLS and common rust diseases by use of microsatellite markers and artificial inoculation with the two pathogens. A total of 41 genotypes comprising 23 recombinant inbred lines, 14 parental inbred lines and 4 hybrid checks were screened using 28 SSR markers and disease pressure by artificial inoculation (Tables 1 and 2). Out of the 14 parental inbred lines, only 4 were found to carry the QTL associating positively for the two diseases, and 10 out of the 23recombinant inbred lines with possible lineage from any of the 14 parents, were positively associated with the traits and seven of the markers used (Table 3). GLS QTLs were significant for two markers;bnlg1258 with a LOD score of 16.0 and umc2019 with a LOD score of 17.9 from regions 2.06 and 2.08 of chromosome 2, respectively. Significant QTLs for common rust resistance were identified in threeregions of chromosome 10, corresponding to markers phi054 with a LOD score of 14.0 at bin 10.00, umc1319 with a LOD score of 4.0 at bin 10.02 and bnlg1451 with a LOD score of 14.3 at bin 10.03. Theeffects of these QTLs were different from genotype to genotype. The disease severity scores (scale of 1-5) of artificial inoculation ranged from 1.5 to 2.5 for gray leaf spot with a mean of 1.88 and a range of1.5 to 3.0 with a mean of 1.74 for common rust. All the inbred lines scored better for the two diseases than the four hybrid checks which scored 3.5. The most resistant genotypes showed a score of 1.5 forgray leaf spot and common rust. All parents showed a score of less than 2.5 for GLS and common rust. Parental genotypes MAL40, MAL9, MAL13, MAL41, MAL11, MAL19, MAL23-2, MAL24, and MAL19-1,carried QTLs associated with resistance to grey leaf spot and common rust and thus were identified as sources of resistance conferred to the inbred lines. The selected lines are being used to make singlehybrids, double crosses, three way hybrids and synthetics resistant to diseases. The marker data was also used to analyze the diversity of the genotypes studied, with relevance to immune/resistant, tolerantor susceptible to the two diseases. Using the GLS genotypic data, 13 genotypes clustered into 11 groups, and using the common rust data, the 13 genotypes clustered into 12 clusters. This indicatesthat almost each of these genotypes was grouped in a cluster that contained lines that did not have positive association of marker and trait data. These results indicated that the putative QTLs for GLS areassociated with the 13 genotypes and two markers in chromosome 2 (bnlg1258 and umc2019), whereas those of common rust are associated with the 13 genotypes and three markers on chromosome 10 (phi054, umc1319, and bnlg1451)

Quantitative trait loci (QTLs) for resistance to gray leaf spot and common rust diseases of maize

Gray leaf spot and common rust diseases can greatly reduce grain yield of maize in susceptible genotypes by between 10 and 70% on average. Control of these diseases through conventional measures has been quite ineffective and difficult to sustain. The most feasible way to control them is by breeding and deploying resistant maize genotypes. This study was carried out to evaluate germplasm for QTLs associated with resistance to GLS and common rust diseases by use of microsatellite markers and artificial inoculation with the two pathogens. A total of 41 genotypes comprising 23 recombinant inbred lines, 14 parental inbred lines and 4 hybrid checks were screened using 28 SSR markers and disease pressure by artificial inoculatio