Upper gastrointestinal endoscopy findings in patients referred with upper gastrointestinal symptoms in Eldoret, Kenya: a retrospective review

Background: Dyspepsia is one of the major indications for upper gastrointestinal endoscopy. Other indications include dysphagia, odynophagia and gastrointestinal bleeding. Endoscopy is an expensive procedure that is out of reach of many patients in resource constrained region such as western Kenya. We reviewed endoscopy records from both public and private health institutions spanning ten years.Objective: To determine the pattern of referral and endoscopy diagnoses in patients referred for upper gastrointestinal endoscopy in Eldoret, Kenya.Design: Retrospective chart review.Setting: Moi Teaching and Referral Hospital, private hospitals and private clinics inEldoret, KenyaSubjects: One thousand six hundred and ninety (1690) Patients who underwent upper GI endoscopy from 1993 to 2003 were reviewed after obtaining clearances from the respective institutions. Information on age, sex, symptoms, and endoscopy diagnosis were extracted and subjected to statistical analysis.Results: The most common symptom was dyspepsia in 1059 (62.7%) followed by dysphagia in 224 (13.3%). Others were referred with diagnosis of cancer of the stomach or oesophagus. Common endoscopy diagnoses were cancer of the oesophagus in 199 (11.8%) and duodenal ulcer in 186 (11.0%). The majority of the patients (30.4%) had normal endoscopy findings. Of the 1059 patients with dyspepsia, only 154 (14.5%) had duodenal ulcer and 34 (3.2%) had gastric ulcers, the majority, 37.2% had normal endoscopy findings.Conclusion: Dyspepsia was main reason for referral, but the majority of such patients had normal findings. Cancer of the oesophagus was the main diagnosis in patients with dysphagia. In view of the cost of endoscopy, only those with dyspepsia and alarm symptoms be referred for the procedure

Variability in Proximate Analysis of Twelve Selected Elite Pigeonpea Genotypes Across Varied Agro-Ecological Zones in Kenya

Pigeonpea [Cajanus cajan (L.) Millsp.] is a legume crop majorly grown in semi-arid tropics as a warm-season perennial that is depended on by more than a billion people mainly in Asia and Africa as their main source of protein. The study was carried out to assess variation in nutritional quality and determine influence of environmental factors on nutritional composition among 12 elite pigeonpea genotypes through proximate analysis based on AOAC official methods. The field experiment was conducted in four varied agro-ecological zones (Kabete, Kerio Valley, UoE and Kiboko) in randomized complete block design (RCBD).The genotypes and environment varied significantly (P≤ 0.05) for all the parameters measured except for lipids. The mean proximate composition results of the 12 pigeonpea genotype seed samples across the four environments were; moisture (9.597), lipids (1.948), ash (3.89), protein (21.049) and Carbohydrates (63.51) g/100g. Kabete and Kerio Valley scored the highest level of proteins (22.02 & 21.99 g/100 g) respectively while university of Eldoret recorded the least (19.4 g/100 g). The identified potential genotypes with high protein and ash content can be utilized in breeding for better nutritional quality to enhance nutritional and food security. Keywords: Pigeonpea, malnutrition, food security, proximate analysis, agro-ecological zone

Assessment of phenotypic and genetic variation against pod borer among a subset of elite pigeonpea (Cajanus cajan) genotypes in Kenya

Molecular marker information supported by quality morphological data facilitates the choice of suitable parents for applied breeding. The main aim of this study was to assess genetic diversity among 55 cultivated yield elite pigeonpea lines using 21 simple sequence repeat (SSR) markers that are well distributed across the genome. Among the 55 pigeonpea genotypes, 16 medium duration were selected and evaluated in the field for response to pod borer resistance in varied agro-ecological zones of Kenya during long rains of April-October cropping season Twenty one primer pairs detected 80 alleles with a mean of 3.9 alleles per locus and polymorphism information content (PIC) ranging from 0.09 to 0.75 averaging to 0.39 suggesting a low genetic diversity. However, marker CcM1820 revealed the highest number of alleles (9) with a PIC value of 0.75. The genotype response to pod borer attack was significant (P≤0.05) with three genotypes (ICEAPs 01541, 01154-2 and 00902) revealing tolerance to pod borer. The markers based on Neighbor Joining, grouped the 55 genotypes into three main clusters based on parentage selection. Most genotypes developed from ICEAP 00068 as the maternal parent were grouped in Cluster I while cluster II comprised of improved genotypes and cluster III comprised genotypes developed from ICPL 87091 as maternal parent. The resistant genotypes identified in the field experiment were grouped in cluster I except ICEAP 00902 which grouped in cluster II. Future studies should focus on broadening genetic base by including more landraces and wild relatives to maximize selection and improve breeding work

Combining Drought and Aluminum Toxicity Tolerance To Improve Sorghum Productivity

Moisture stress and aluminium toxicity in sorghum production can be overcome by breeding for tolerance. This study was set up to determine the response of sorghum (Sorghum bicolor L.) genotypes to post- anthesis drought and aluminium toxicity. Sorghum inbred P1 with stay green drought tolerance was crossed with P2, a standard aluminium tolerant cultivar. The parents, the first filial plants (F1) and KM-4 were tested for drought and aluminium toxicity tolerance in the field and solution culture with 0 and \u3bcMol 148 Al3+ respectively. The drought experiment was laid in RCBD with three replicates and split -plot arrangement. Randomly selected plots were denied irrigation from six weeks after emergence. There were significant (P < 0.05) differences between treatments and accessions. Panicle weight of F1 was outstanding and significantly different from the rest both with and without water. F1 out performed P1, P2 and KM-4 by 95.61, 146.37 and 328.81% without water; and by 155.44, 124. 27 and 82.02% with water, respectively. There were significant (P < 0.05) differences in the sorghum accessions with P2, KM-4 and F1 being tolerant. These results indicate that multiple stress tolerance can increase sorghum productivity.Le stress hydrique et la toxicit\ue9 aluminique dans la production de sorgho peuvent \ueatre surmont\ue9s par am\ue9lioration de la tol\ue9rance. Cette \ue9tude \ue9tait faite dans le but de d\ue9terminer la r\ue9ponse des g\ue9notypes du sorgho (Sorghum bicolor L.) \ue0 la s\ue9cheresse post-anth\ue9sis et la toxicit\ue9 aluminique. Le sorgho de lign\ue9e pure P1 dot\ue9 d'une persistence chlorophyllienne caract\ue9risant sa tol\ue9rance \ue0 la s\ue9cheresse, \ue9tait crois\ue9 avec P2, un cultivar de tol\ue9rance standard \ue0 l'aluminium. Les parents, les premi\ue8res plantes filiales (F1) et KM-4 \ue9taient test\ue9s au champs et avec une solution de culture 0 et 148 Al3+ \u3bcMol respectivement pour tol\ue9rance \ue0 la s\ue9cheresse et \ue0 la toxicit\ue9 aluminique. Le dispositif experimental de l'essai sur la s\ue9cheresse \ue9tait en blocs al\ue9atoires compl\ue9tement randomis\ue9s avec trois r\ue9p\ue9titions et un arrangement en split-plot. Les parcelles al\ue9atoirement s\ue9lectionn\ue9es n'\ue9taitent pas arros\ue9es depuis six semaines apr\ue8s \ue9mergence. Des diff\ue9rences significatives (P < 0.05) \ue9taient observ\ue9es entre traitements et accessions. Le poids des panicules de F1 \ue9tait exceptionnellement diff\ue9rent de celui avec ou sans eau. F1 avait \ue9t\ue9 plus performant que P1, P2 et KM-4 avec 95.61, 146.37 et 328.81 % sans eau; et avec 155.44, 124. 27 et 82.02 % avec eau, respectivement. De diff\ue9rences significatives (P < 0.05) \ue9taient aussi r\ue9v\ue9l\ue9es entre les accessions de sorgho, le parent P2, les accessions KM-4 et les plants F1 \ue9tant tol\ue9rants. Ces r\ue9sultats indiquent que la tol\ue9rance multiple au stress peut augmenter la productivit\ue9 du sorgho

Morbidity and mortality in HIV - infected children admitted at Moi Teaching and Referral Hospital in Western Kenya

Background: HIV-infected children are at higher risk of opportunistic infections that could result in hospitalisation. The outcomes of hospitalisation are variable and depend on the admission diagnosis, the patients’ immune status and whether or not the patient is on anti-retroviral drugs.Objective: To describe the characteristics and causes of hospitalisation and mortality for HIV infected children admitted to Moi Teaching and Referral hospital in western Kenya.Design: a retrospective study of prospectively collected data.Setting: The paediatric wards of Moi Teaching and Referral Hospital (MTRH). A Kenyan National Referral Hospital.Subjects: HIV-infected children admitted the paediatric wards.Interventions: Treatment with combination anti-retroviral therapy (cART), treatment of common opportunistic infections.Main outcome measures: Demographic and clinical data, including diagnosis, immune status, and treatment with combination anti-retroviral therapy (cART), were extracted from hospital admission records of HIV-infected children registered with the USAIDAcademic Model Providing Access to Healthcare (AMPATH) partnership. We conducted descriptive statistical analyses and used chi-square and fisher’s exact tests to assess for associations between categorical variables and each of the independent variables.Results: Between December 2006 and May 2009, 396 HIV-infected children were admitted to MTRH. Median age at admission was 2.0 years (range 0-15); 236 (59%) were male; 36 (15%) of available 236 orphan status entries were orphaned; 198 (73%) were in CDC categories B and C and 61 (16%) of available 386 had been on ART. Among 108 patients with documented immunologic status, the mean CD4 cell percentage was 16% (SD 10.8). Among the 396 children, 104 (15%) were diagnosed with pneumonia, 92 (14%) with gastroenteritis, 36 (9%) with tuberculosis and 37 (9%) with malaria. Deaths occurred in 28(7%) of the patients. The median duration of hospitalisation was seven days (range 1- 516) for discharged patients and six days (range 0-72) for those who died. A significantly higher percentage of the children who were not previously enrolled in AMPATH died, signifying 14 (15%) mortality among this population of admitted patients, p = 0.0017. Of those who died, (17%) were diagnosed with pneumonia and 22 (79%) of them were not on cART.Conclusion: The common diagnoses at hospitalisation included pneumonia, gastroenteritis, malaria and tuberculosis. Higher mortality occurred among those diagnosed with pneumonia and those not previously enrolled in the HIV care programme. Aggressive treatment and prevention of the most prevalent diseases and early enrollment into HIV care are recommended for HIV-infected children. A follow-up study to investigate the pathological causes of death in this population is recommended

Chemical Assessment and Antimicrobial Activity of Solvent Extracts from Kalanchoe densiflora

ABSTRACT Kalanchoe densiflora leaves were sequentially extracted using hexane, ethyl acetate, chloroform, acetone and methanol. The solvents were evaporated through rotor evaporation under vacuum to yield five extracts. The extracts were then subjected to chemical and photochemical analyses to identify the components present and their functional groups. In addition the extracts were tested for antimicrobial activities against eight micro-organisms; Bacillus subtilis, Candida albicans, Escherichia coli, Klebsiella pneumoniae, Salmonella typhi, Staphylococcus aureus, Proteus mirabilis and Pseudomonas aeruginosa. The extracts were found to posses' tannins, saponins, terpenoids, flavonoids and cardiac glycosides. It was also found that unsaturated bonds, carboxyl groups and aldehydes were present in the extracts. In addition, the extracts showed antimicrobial activity against Bacillus spp, E. coli and P. aeruginosa as indicated by presence of zones of inhibition. Acetonic and methanolic extracts were sensitive to P. aeruginosa, Bacillus spp. and S. aureus while hexane extract was highly sensitive to E.coli. K. densiflora extracts was found to have broad antimicrobial effect since it was active against gram positive and gram negative bacteria. Crude extracts from K. densiflora can be used in control of diseases such as; acute enteritis, pneumonias and opportunistic diseases amongst other diseases caused by these microorganisms

Implementation of World Health Organization Integrated Management of Childhood Illnesses (IMCI) Guidelines for the Assessment of Pneumonia in the Under 5s in Rural Malawi

The Cooking and Pneumonia Study (CAPS) is a pragmatic cluster-level randomized controlled trial of the effect of an advanced cookstove intervention on pneumonia in children under the age of 5 years (under 5s) in Malawi (www.capstudy.org). The primary outcome of the trial is the incidence of pneumonia during a two-year follow-up period, as diagnosed by healthcare providers who are using the World Health Organization (WHO) integrated management of childhood illnesses (IMCI) pneumonia assessment protocol and who are blinded to the trial arms. We evaluated the quality of pneumonia assessment in under 5s in this setting via a cross-sectional study of provider-patient encounters at nine outpatient clinics located within the catchment area of 150 village-level clusters enrolled in the trial across the two study locations of Chikhwawa and Karonga, Malawi, between May and June 2015 using the IMCI guidelines as a benchmark. Data were collected using a key equipment checklist, an IMCI pneumonia knowledge test, and a clinical evaluation checklist. The median number of key equipment items available was 6 (range 4 to 7) out of a possible 7. The median score on the IMCI pneumonia knowledge test among 23 clinicians was 75% (range 60% to 89%). Among a total of 176 consultations performed by 15 clinicians, a median of 9 (range 3 to 13) out of 13 clinical evaluation tasks were performed. Overall, the clinicians were adequately equipped for the assessment of sick children, had good knowledge of the IMCI guidelines, and conducted largely thorough clinical evaluations. We recommend the simple pragmatic approach to quality assurance described herein for similar studies conducted in challenging research settings

Evaluation of Selected Pigeonpea (Cajanus cajan (L.) Millsp.) Genotypes for Resistance to Insect Pest Complex in Dry Areas of North Rift Valley, Kenya

Pigeonpea is an important pulse crop that has gained importance in semi-arid tropics, although its yield potential has not been fully realized due to biotic and abiotic stresses that limit its production. Insect pest complex of pod borer (Helicoverpa armigera), sucking bug (Clavigralla tomentosicollis) and pod fly (Melanagromyza cholcosoma) are the major limiting factors to its production causing up to 100% yield loss. The objective of this study was to evaluate resistant genotypes to insect pest complex in dry parts of North Rift Valley Kenya. The study was carried out in three sites (Kenya Agricultural Livestock Research Organization- Marigat, Agricultural Training Centre-Koibatek and Fluorspar-Chepsirei) for one season during long rain of April-November 2014 growing season. Sixteen ICRISAT elite genotypes were evaluated in randomized complete block design (RCBD) with 75cm inter and 25 cm intra spacing. Significant (P≤0.05) differences in grain yield performance, incidence and severity of the insect pests were revealed in all sites. The damage was more severe in Marigat (Pod borer-37.2%, Sucking bug-39.3% and pod fly-5.9%) than ATC- Koibatek (Pod borer-1.9%, Sucking bug-8.4% and pod fly-5.9%) and Fluorspar (Pod borer-3.6%, Sucking bug-6.8% and pod fly-2.9%). Genotypes ICEAPs 00850R, 00902, 01541 and 1154-2 showed potential levels of resistance to the insect pest complex and high yields. Grain yield associated negatively (P≤0.05) with pod borer and sucking bug damage correlated non-significantly with pod fly damage. The potential genotypes identified in this study need to be further evaluated in two seasons and in other multi-locations to validate these findings to be used in breeding

Factors Influencing the Implementation of Integrated Management of Childhood Illness (IMCI) by Healthcare Workers at Public Health centers & Dispensaries in Mwanza, Tanzania.

\ud Integrated Management of Childhood Illness (IMCI) was developed by the World Health Organization (WHO) and the United Nations International Children's Fund (UNICEF) and aims at reducing childhood morbidity and mortality in resource-limited settings including Tanzania. It was introduced in 1996 and has been scaled up in all districts in the country. The purpose of this study was to identify factors influencing the implementation of IMCI in the health facilities in Mwanza, Tanzania since reports indicates that the guidelines are not full adhered to by the healthcare workers. A cross-sectional study design was used and a sample size of 95 healthcare workers drawn from health centers and dispensaries within Mwanza city were interviewed using self-administered questionnaires. Structured interview was also used to get views from the city IMCI focal person and the 2 facilitators. Data were analyzed using SPSS and presented using figures and tables. Only 51% of healthcare workers interviewed had been trained. 69% of trained Healthcare workers expressed understanding of the IMCI approach. Most of the respondents (77%) had a positive attitude that IMCI approach was a better approach in managing common childhood illnesses especially with the reality of resource constraint in the health facilities. The main challenges identified in the implementation of IMCI are low initial training coverage among health care workers, lack of essential drugs and supplies, lack of onsite mentoring and lack of refresher courses and regular supportive supervision. Supporting the healthcare workers through training, onsite mentoring, supportive supervision and strengthening the healthcare system through increasing access to essential medicines, vaccines, strengthening supply chain management, increasing healthcare financing, improving leadership & management were the major interventions that could assist in IMCI implementation. The healthcare workers can implement better IMCI through the collaboration of supervisors, IMCI focal person, Council Health Management Teams (CHMT) and other stakeholders interested in child health. However, significant barriers impede a sustainable IMCI implementation. Recommendations have been made related to supportive supervision and HealthCare system strengthening among others.\u

IMCI and ETAT Integration at a Primary Healthcare Facility in Malawi:A Human Factors Approach

Abstract Background Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality. They were set out in the Millennium Development Goals. Each guideline was established separately so the purpose of this study was to understand how these systems have been integrated in a primary care setting and identify barriers and facilitators to this integration using a systems approach. Method Interviews were carried out with members of staff of different levels within a primary healthcare clinic in Malawi. Along with observations from the clinic this provided a well-rounded view of the running of the clinic. This data was then analysed using the SEIPS 2.0 work systems framework. The work system elements specified in this model were used to identify and categorise themes that influenced the clinic’s efficiency. Results A process map of the flow of patients through the clinic was created, showing the tasks undertaken and the interactions between staff and patients. In their interviews, staff identified several organisational elements that served as barriers to the implementation of care. They included workload, available resources, ineffective time management, delegation of roles and adaptation of care. In terms of the external environment there was a lack of clarity over the two sets of guidelines and how they were to be integrated which was a key barrier to the process. Under the heading of tools and technology a lack of guideline copies was identified as a barrier. However, the health passport system and other forms of recording were highlighted as being important facilitators. Other issues highlighted were the lack of transport provided, challenges regarding teamwork and attitudes of members of staff, patient factors such as their beliefs and regard for the care and education provided by the clinic. Conclusions This study provides the first information on the challenges and issues involved in combining IMCI and ETAT and identified a number of barriers. These barriers included a lack of resources, staff training and heavy workload. This provided areas to work on in order to improve implementation