Comparison of Losartan And Enalapril Effects on Renal Function in Hypertensive Adults with Chronic Kidney Disease at a Kenyan Referral Hospital

Objective: The objective of this study was to compare renal function in diabetic hypertensive chronic kidney disease patients receiving enalapril or losartan.Design: This was a retrospective analytic cohort study.Setting: Kenyatta National Hospital, Nairobi, Kenya.Subjects: Two hundred adult patients with hypertension and diabetic nephropathy.Interventions: One hundred and sixteen participants received an enalapril regimen while 84 were on a losartan regimen.Main outcome measures: time to doubling of serum creatinine and  changes in the levels of proteinuria.Results: There was a higher risk of doubling of serum creatinine with losartan (Adjusted HR=1.572; [95% CI:1.015-2.434]; p=0.043) than enalapril. There was a significant difference in time to doubling between the two arms – losartan 18 months, enalapril 36 month (p=0.046). The changes in the levels of proteinuria between the two arms were not statistically significant for most of the follow up period except at the 15thmonth from treatment initiation (p=0.05).Conclusions: Enalapril was found to be more reno-protective compared to losartan. Where feasible, we suggest local use of enalapril as opposed to losartan for diabetic hypertensive chronic kidney disease patients

Coenzyme Q10 and endogenous antioxidants neuro-protect mice brain against deleterious effects of melarsoprol and Trypanasoma brucei rhodesiense

Melarsoprol (Mel B) is the only efficacious drug against late stage Human African Trypanosomiasis (HAT), but inadvertently is very toxic and induces Post Treatment Reactive Encephalopathy (PTRE) that is lethal in 5% of the patients. Investigations were conducted to establish the neuro-protective role of Coenzyme Q10 (CoQ10) and other cellular antioxidants ((Manganese Superoxide dismutase (MnSOD), Glutathione Reductase (GR), Copper-Zinc Superoxide dismutase (SOD-1) and glutathione (GSH)) against Mel B toxicity, PTRE and putative resultant brain degeneration in a mouse model. Female Swiss-white mice were infected with Trypanasoma brucei rhodesiense parasite and manipulated to simulate all phases of PTRE and HAT. Expression profiles of the antioxidants in brain tissues were assessed using immunoblots, while GSH was measured spectrophotometrically. Trypanosoma brucei rhodesiense infection resulted in elevation of expression of endogenous antioxidants in the early stage of infection (21dpi), with significant expression (two fold) observed at the terminal stage of the disease (57dpi). CoQ10 assisted in boosting Levels of GSH upon induction of severe late stage of HAT. Similarly CoQ10 administration significantly augmented levels of SOD-1, GR and GSH in infected than in uninfected mice that were treated with Melarsoprol. The time dependent dynamics of antioxidant suppression due to Melarsoprol, and potential ameliorating effects of CoQ10 on the same, indicate putative mechanism underlying and antidote to the toxicity of the drug with potential application in formulation of novel Melarsoprol-based drugs and development of novel markers for staging the disease. Key Words: Trypanasoma brucei rhodesiense, endogenous antioxidants, late stage HAT; Coenzyme Q10; Melarsoprol;   Abbreviations: GSH, glutathione; CoQ10, Coenzyme Q10; MnSOD, Manganese Superoxide dismutase; GR, Glutathione Reductase; SOD-1, Copper-Zinc Superoxide dismutase; Mel B, melarsoprol; PTRE, Post treatment reactive encephalopathy; HAT, Human African Trypanoomiasis; HEPES, N-2 hydroxyethylpiperazine-N`-2 ethane sulfonic acid; ICDH, isocitrate dehydrogenase; LDH, lactate dehydrogenase; MnSOD, manganese superoxide dismutase; NADP+, nicotinamide adenine dinucleotide phosphate, NO, nitric oxide; ONOO-, peroxynitrite; ROS, reactive oxygen species; SDS, sodium dodecyl sulfate; TCA, tricarboxylic acid; DAB, diaminobenzidine;  PBS, Phosphate buffered saline; dpi, days post infection

The quantification of the extent of flooding on selected major Afrotropical lakes to guide management implications

The extent of flooding in vulnerable inland and lacustrine systems can demonstrate the coverage and the magnitude of such phenomenon for policy enhancement. This study examined the extent of flooding due to rising water levels in selected Afrotropical lakes to guide interventions that would sustain the livelihoods of communities affected. The years that were most prone to flooding (2010 and 2020) were used as a baseline in the extraction of changes in spatial extent and area of lacustrine shoreline, and rainfall and satellite altimetry data, using geospatial and remote sensing technologies. The extent of flooding was strongly but insignificantly related (R2 = 0.63; p = 0.07) to the sizes of the studied lakes and the amount of rainfall. Lakes with the smallest surface areas such as Baringo and Naivasha showed the greatest increase in flooding of 52.63% and 42.62%, respectively. Larger lakes such as Lakes Victoria (1.05%), Turkana (3.77%), and Tanganyika (0.07%) had the lowest increases in areal extent. Furthermore, the topography of the lakes studied further determined the residence time and the extent of flooding, such that lakes such as Edward (−0.09%) and Rukwa (−3.25%) receded during the period when other lakes were flooding. The information and data presented here provides the most up-to-date quantification of flooding to support adaptation strategies for inland lake systems and guide policy implementation

High-resolution bathymetries and shorelines for the Great Lakes of the White Nile basin

This article is licensed under a Creative Commons Attribution 4.0 International License.HRBS-GLWNB 2020 presents the first open-source and high-resolution bathymetry, shoreline, and water level data for Lakes Victoria, Albert, Edward, and George in East Africa. For each Lake, these data have three primary products collected for this project. The bathymetric datasets were created from approximately 18 million acoustic soundings. Over 8,200 km of shorelines are delineated across the three lakes from high-resolution satellite systems and uncrewed aerial vehicles. Finally, these data are tied together by creating lake surface elevation models collected from GPS and altimeter measures. The data repository includes additional derived products, including surface areas, water volumes, shoreline lengths, lake elevation levels, and geodetic information. These data can be used to make allocation decisions regarding the freshwater resources within Africa, manage food resources on which many tens of millions of people rely, and help preserve the region’s endemic biodiversity. Finally, as these data are tied to globally consistent geodetic models, they can be used in future global and regional climate change models.ECU Open Access Publishing Support Fun

Beaten but not down! Exploring resilience among female sex workers (FSWs) in Nairobi, Kenya

Background: In Kenya sex work is illegal and those engaged in the trade are stigmatized and marginalized. We explored how female sex workers in Nairobi, Kenya, utilize different resources to navigate the negative consequences of the work they do. Methods: Qualitative data were collected in October 2019 from 40 FSWs who were randomly sampled from 1003 women enrolled in the Maisha Fiti study, a 3-year longitudinal mixed-methods study exploring the relationship between HIV risk and violence and mental health. All interviews were audio-recorded, transcribed and translated. Data were thematically coded and analyzed using Nvivo 12. Results: Participants’ age range was 18–45 years. Before entry into sex work, all but one had at least one child. Providing for the children was expressed as the main reason the women joined sex work. All the women grew up in adverse circumstances such as poor financial backgrounds and some reported sexual and physical abuse as children. They also continued to experience adversity in their adulthood including intimate partner violence as well as violence at the workplace. All the participants were noted to have utilised the resources they have to build resilience and cope with these adversities while remaining hopeful for the future. Motherhood was mentioned by most as the reason they have remained resilient. Coming together in groups and engaging with HIV prevention and treatment services were noted as important factors too in building resilience. Conclusion: Despite the adverse experiences throughout the lives of FSWs, resilience was a key theme that emerged from this study. A holistic approach is needed in addressing the health needs of female sex workers. Encouraging FSWs to come together and advocating together for their needs is a key resource from which resilience and forbearance can grow. Upstream prevention through strengthening of education systems and supporting girls to stay in school and complete their secondary and/or tertiary education would help them gain training and skills, providing them with options for income generation during their adult lives

Conducting Violence and Mental Health Research with Female Sex Workers during the COVID-19 Pandemic: Ethical Considerations, Challenges, and Lessons Learned from the Maisha Fiti Study in Nairobi, Kenya

Conducting violence and mental health research during the COVID-19 pandemic with vulnerable groups such as female sex workers (FSWs) required care to ensure that participants and the research team were not harmed. Potential risks and harm avoidance needed to be considered as well as ensuring data reliability. In March 2020, COVID-19 restrictions were imposed in Kenya during follow-up data collection for the Maisha Fiti study (n = 1003); hence data collection was paused. In June 2020, the study clinic was re-opened after consultations with violence and mental health experts and the FSW community. Between June 2020 and January 2021, data were collected in person and remotely following ethical procedures. A total of 885/1003 (88.2%) FSWs participated in the follow-up behavioural–biological survey and 47/47 (100%) participated in the qualitative in-depth interviews. A total of 26/885 (2.9%) quantitative surveys and 3/47 (6.4%) qualitative interviews were conducted remotely. Researching sensitive topics like sex work, violence, and mental health must guarantee study participants’ safety and privacy. Collecting data at the height of COVID-19 was crucial in understanding the relationships between the COVID-19 pandemic, violence against women, and mental health. Relationships established with study participants during the baseline survey—before the pandemic—enabled us to complete data collection. In this paper, we discuss key issues involved in undertaking violence and mental health research with a vulnerable population such as FSWs during a pandemic. Lessons learned could be useful to others researching sensitive topics such as violence and mental health with vulnerable populations

Violence across the Life Course and Implications for Intervention Design: Findings from the Maisha Fiti Study with Female Sex Workers in Nairobi, Kenya

We examined violence experiences among Female Sex Workers (FSWs) in Nairobi, Kenya, and how these relate to HIV risk using a life course perspective. Baseline behavioural–biological surveys were conducted with 1003 FSWs June-December 2019. Multivariable logistic regression models were used to estimate the adjusted odds ratio (AOR) and 95% confidence intervals (CI) for associations of life course factors with reported experience of physical or sexual violence in the past 6 months. We found substantial overlap between violence in childhood, and recent intimate and non-intimate partner violence in adulthood, with 86.9% reporting one or more types of violence and 18.7% reporting all three. Recent physical or sexual violence (64.9%) was independently associated with life course factors, including a high WHO Adverse Childhood Experiences (ACE) score (AOR = 7.92; 95% CI:4.93–12.74) and forced sexual debut (AOR = 1.97; 95% CI:1.18–3.29), as well as having an intimate partner (AOR = 1.67; 95% CI:1.25–2.23), not having an additional income to sex work (AOR = 1.54; 95% CI:1.15–2.05), having four or more dependents (AOR = 1.52; 95% CI:0.98–2.34), recent hunger (AOR = 1.39; 95% CI:1.01–1.92), police arrest in the past 6 months (AOR = 2.40; 95% CI:1.71–3.39), condomless last sex (AOR = 1.46; 95% CI:1.02–2.09), and harmful alcohol use (AOR = 3.34; 95% CI:1.74–6.42). Interventions that focus on violence prevention during childhood and adolescence should help prevent future adverse trajectories, including violence experience and HIV acquisition

Africa's cattle diversity why it matters

There is great genetic diversity in the livestock found Africa. This diversity arises from combination of(1) Capture and domestication of pre-existing wild ancestors followed by accumulation of new In taming wild animals,(2) Introduction by migration and trade.( 3) The Selection of desirable traits by nature and man.Resistance or tolerance to local diseases is an attribute that is commonly observed among African livestock. This poster gives a synopsis of some of the work done at ILRI to understand the tolerance of some cattle types to an important and truly African disease, trypanosomiasis

A GIS-based approach for delineating suitable areas for cage fish culture in a lake

We present a GIS-based approach to the delineation of areas that have different levels of suitability for use as tilapia cage culture sites the Kenyan part of Lake Victoria, Africa. The study area was 4,100 km2. The method uses high-resolution bathymetric data, newly collected water quality data from all major fishing grounds and cage culture sites, and existing spatial information from previous studies. The parameters considered are water depth, water temperature, levels of dissolved oxygen, chlorophyll-a concentrations, distances to the lake shoreline and proximity to other constraints on cage culture development. The results indicated that the area most suitable for fish cages comprised about 362 km2, or approximately 9% of the total area; the remaining 91% (i.e., 3,737 km2) was found to be unsuitable for tilapia cage culture. We conclude that the successful implementation of this approach would need stakeholder involvement in the validation and approval of potential sites, and in the incorporation of lake zoning into spatial planning policy and the regulations that support sustainable use while minimising resource use conflicts. The results of this study have broader applicability to the whole of Lake Victoria, other African Great Lakes, and any lakes in the world where tilapia cage culture already occurs or may occur in the future