Factors Influencing Utilization of Cervical Cancer Screening Services in Kenya: the Case of Nyeri County

Globally, cervical cancer continues to be a major cause of mortality and morbidity among women with developing countries accounting for more than 86% of the deaths from the disease. In Kenya, cervical cancer ranks as the second most frequent cancer among women: regrettably, with 80% of the cases presented during the late stages of the disease when the scope of successful treatment is limited. An opportunity to prevent occurrence of cervical cancer exists through cervical cancer screening for early detection and treatment of precancerous lesions before these develop to cancer. However, only a negligible proportion of women benefit from cervical cancer screening services in developing countries, including Kenya. The purpose of this descriptive survey study was to determine the factors influencing utilization of cervical cancer screening services; and focused on the women seeking maternal and family planning services at Central Provincial General Hospital, Kenya. The study established that, as in most developing countries, utilization of cervical cancer screening services was low, regardless of the women's education level, autonomy in decision making and even good family support. The low level of awareness on the need for screening services and the long waiting time at the clinic for those seeking the services were identified as the two key issues that negatively influenced the utilization of the screening services, It is therefore recommended that the Ministry of Health and other agencies, including individuals of good will, collaborate in designing and implementing awareness campaigns through the media and other appropriate avenues, including one-to-one encounters, targeting both men and women in the communities. It is also recommended that the male partners support their women in accessing this vital life-saving service

From the Internet to Action: Women’s Activism in a Digital World

Social media often fosters a toxic, harmful online environment for individuals, particularly women. Paradoxically, features of social media also afford behaviors that further social causes such as women’s advancement, as demonstrated by campaigns such as #MeToo. However, not all such campaigns translate from online popularity to realworld impact. Using a mixed-methods approach, we will draw from feminist theory and the concept of intersectionality and leverage the social media affordances lens to develop an integrated theoretical framework that explains women’s digital movements that have tangible real-world outcomes. We will test the model by collecting and analyzing actual social media behavior and social movement media reports. This work answers calls in the literature to incorporate new methods in social media affordances and increase interdisciplinary research to address social justice research questions. For practice, our research seeks to contribute to the women’s movements by providing an understanding of how social media use can impact social movement success

APPLICATION OF KALMAN FILTER TO ARTIFICIAL NEURAL NETWORKS PREDICTION FOR FOREIGN EXCHANGE RATES

In recent years, artificial neural networks have received increasing attention as a decision making tool when prediction of financial time series is concerned. Modeling issues associated with artificial neural network model like the size of sample data and the general architecture of the model affect the performance of the model. For this reason, artificial neural networks outputs are prone to over-fitting or under-learning resulting to large mean squared errors which affect the accuracy of the prediction. In this paper, we investigate if the application Kalman filter algorithm to artificial neural networks model output can improve the model accuracy through the reduction of the mean squared error. Performance measures for prediction accuracy were used to compare the two models over the datasets for dollar, Euro and Pound exchange rates in Kenya Shilling for a period of five years. In the entire cases artificial neural networks model performed better than artificial neural networks with Kalman filter model. Keywords: Artificial Neural Networks, Currency, Exchange Rates, Kalman Filter, Multi-Layer Perceptro

The Dantu blood group prevents parasite growth in vivo: Evidence from a controlled human malaria infection study

Background: The long co-evolution of Homo sapiens and Plasmodium falciparum has resulted in the selection of numerous human genetic variants that confer an advantage against severe malaria and death. One such variant is the Dantu blood group antigen, which is associated with 74% protection against severe and complicated P. falciparum malaria infections in homozygous individuals, similar to that provided by the sickle haemoglobin allele (HbS). Recent in vitro studies suggest that Dantu exerts this protection by increasing the surface tension of red blood cells, thereby impeding the ability of P. falciparum merozoites to invade them and reducing parasite multiplication. However, no studies have yet explored this hypothesis in vivo. Methods: We investigated the effect of Dantu on early phase P. falciparum (Pf) infections in a controlled human malaria infection (CHMI) study. 141 sickle-negative Kenyan adults were inoculated with 3.2 × 103 aseptic, purified, cryopreserved Pf sporozoites (PfSPZ Challenge) then monitored for blood-stage parasitaemia for 21 days by quantitative polymerase chain reaction (qPCR)analysis of the 18S ribosomal RNA P. falciparum gene. The primary endpoint was blood-stage P. falciparum parasitaemia of ≥500/μl while the secondary endpoint was the receipt of antimalarial treatment in the presence of parasitaemia of any density. On study completion, all participants were genotyped both for Dantu and for four other polymorphisms that are associated with protection against severe falciparum malaria: α+-thalassaemia, blood group O, G6PD deficiency, and the rs4951074 allele in the red cell calcium transporter ATP2B4. Results: The primary endpoint was reached in 25/111 (22.5%) non-Dantu subjects in comparison to 0/27 (0%) Dantu heterozygotes and 0/3 (0.0%) Dantu homozygotes (p=0.01). Similarly, 49/111 (44.1%) non-Dantu subjects reached the secondary endpoint in comparison to only 7/27 (25.9%) and 0/3 (0.0%) Dantu heterozygotes and homozygotes, respectively (p=0.021). No significant impacts on either outcome were seen for any of the other genetic variants under study. Conclusions: This study reveals, for the first time, that the Dantu blood group is associated with high-level protection against early, non-clinical, P. falciparum malaria infections in vivo. Learning more about the mechanisms involved could potentially lead to new approaches to the prevention or treatment of the disease. Our study illustrates the power of CHMI with PfSPZ Challenge for directly testing the protective impact of genotypes previously identified using other methods

The Occurrence of Cereal Aphids in Rainfed Wheat in Kenya: The Problem and Possible Integrated Pest Management Strategies

Cereal aphids cause direct damage to rainfed wheat through sucking of plants sap and cause losses of up to 90%, particularly in dry years in Kenya. The Russian wheat aphid (RWA) is the most destructive and may account for up to 50% yield loss or more depending on the severity and length of infestation. Current control strategies mainly rely on the use of insecticides to control cereal aphids’ infestations. Chemicals improve yields in the short term, but adversely affect the environment, hence the need for development of effective IPM strategies. Early planted crops escape heavy aphid attacks and give good yields. A combination of seed rate of 100 kg and 100 kg N/ha provided the best cultural management of RWA. Ladybird beetles Adonia variegata, lacewings (Chrysoppa spp.) and parasitic wasp Aphidius sp. were the most important natural enemies. Control of cereal aphids can be achieved with systemic insecticides applied as seed dressings or foliar applied insecticides. Four lines of wheat were found to show RWA resistance and crosses with Kenyan wheat made and populations are being evaluated for resistance to cereal aphids

Striga parasitizes transgenic hairy roots of Zea mays and provides a tool for studying plant-plant interactions

Background Striga species are noxious root hemi-parasitic weeds that debilitate cereal production in sub-Saharan Africa (SSA). Control options for Striga are limited and developing Striga resistant crop germplasm is regarded as the best and most sustainable control measure. Efforts to improve germplasm for Striga resistance by a non-Genetic Modification (GM) approach, for example by exploiting natural resistance, or by a GM approach are constrained by limited information on the biological processes underpinning host-parasite associations. Additionaly, a GM approach is stymied by lack of availability of candidate resistance genes for introduction into hosts and robust transformation methods to validate gene functions. Indeed, a majority of Striga hosts, the world’s most cultivated cereals, are recalcitrant to genetic transformation. In maize, the existing protocols for transformation and regeneration are tedious, lengthy, and highly genotype-specific with low efficiency of transformation. Results We used Agrobacterium rhizogenes strain K599 carrying a reporter gene construct, Green Fluorescent Protein (GFP), to generate transgenic composite maize plants that were challenged with the parasitic plant Striga hermonthica. Eighty five percent of maize plants produced transgenic hairy roots expressing GFP. Consistent with most hairy roots produced in other species, transformed maize roots exhibited a hairy root phenotype, the hallmark of A. rhizogenes mediated transformation. Transgenic hairy roots resulting from A. rhizogenes transformation were readily infected by S. hermonthica. There were no significant differences in the number and size of S. hermonthica individuals recovered from either transgenic or wild type roots. Conclusions This rapid, high throughput, transformation technique will advance our understanding of gene function in parasitic plant-host interactions

Spatial models for the rational allocation of routinely distributed bed nets to public health facilities in Western Kenya

BACKGROUND: In high to moderate malaria transmission areas of Kenya, long-lasting insecticidal nets (LLINs) are provided free of charge to pregnant women and infants during routine antenatal care (ANC) and immunization respectively. Quantities of LLINs distributed to clinics are quantified based on a combination of monthly consumption data and population size of target counties. However, this approach has been shown to lead to stock-outs in targeted clinics. In this study, a novel LLINs need quantification approach for clinics in the routine distribution system was developed. The estimated need was then compared to the actual allocation to identify potential areas of LLIN over- or under-allocation in the high malaria transmission areas of Western Kenya. METHODS: A geocoded database of public health facilities was developed and linked to monthly LLIN allocation. A network analysis approach was implemented using the location of all public clinics and topographic layers to model travel time. Estimated travel time, socio-economic and ANC attendance data were used to model clinic catchment areas and the probability of ANC service use within these catchments. These were used to define the number of catchment population who were likely to use these clinics for the year 2015 equivalent to LLIN need. Actual LLIN allocation was compared with the estimated need. Clinics were then classified based on whether allocation matched with the need, and if not, whether they were over or under-allocated. RESULTS: 888 (70%) public health facilities were allocated 591,880 LLINs in 2015. Approximately 682,377 (93%) pregnant women and infants were likely to have attended an LLIN clinic. 36% of the clinics had more LLIN than was needed (over-allocated) while 43% had received less (under-allocated). Increasing efficiency of allocation by diverting over supply of LLIN to clinics with less stock and fully covering 43 clinics that did not receive nets in 2015 would allow for complete matching of need with distribution. CONCLUSION: The proposed spatial modelling framework presents a rationale for equitable allocation of routine LLINs and could be used for quantification of other maternal and child health commodities applicable in different settings. Western Kenya region received adequate LLINs for routine distribution in line with government of Kenya targets, however, the model shows important inefficiencies in the allocation of the LLINs at clinic level

Potential economic and poverty impact of improved chickpea technologies in Ethiopia. Socioeconomics Discussion Paper Series 9

The national agricultural research organization of Ethiopia in collaboration with the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) developed and released a total of 11 improved chickpea varieties between 1974 and 2005. These varieties are high-yielding, stress tolerant, with desirable agronomic and market traits. However, until now there exists no systematic study to assess the economic impact of this research investment in Ethiopia. This information is useful for justifying future donor investments and other collaborative ventures in such projects. The objective of this study is to assess the potential economic and poverty impact of improved chickpea varieties adopted by Ethiopian farmers. The economic surplus model (based on DREAM model) was applied to estimate total benefits. With an annual chickpea production of 175,734 tons, chickpea price of US$164/tonne, a 31$ 111 million for 30 years. Consumers are estimated to get 39% of the benefit and producers 61%.With project costs of US$ 22 million, the benefit cost ratio is estimated at 5:1 and an internal rate of return of 55%, indicating that the investment is profitable. Even with the worst-case scenario i.e. lowest benefit (15%), highest discount rate (13%), lowest elasticities and price the benefit-cost ratio of 2:1, still justified the investment. The generated benefit is expected to lift more than 0.7 million people (both producers and consumers) out of poverty. Thus, further investments in the chickpea and other legume research in Ethiopia is justified as a means of poverty alleviatio

Patient safety in developing countries: retrospective estimation of scale and nature of harm to patients in hospital

OBJECTIVE: To assess the frequency and nature of adverse events to patients in selected hospitals in developing or transitional economies. DESIGN: Retrospective medical record review of hospital admissions during 2005 in eight countries. SETTING: Ministries of Health of Egypt, Jordan, Kenya, Morocco, Tunisia, Sudan, South Africa and Yemen; the World Health Organisation (WHO) Eastern Mediterranean and African Regions (EMRO and AFRO), and WHO Patient Safety. PARTICIPANTS: Convenience sample of 26 hospitals from which 15,548 patient records were randomly sampled. MAIN OUTCOME MEASURES: Two stage screening. Initial screening based on 18 explicit criteria. Records that screened positive were then reviewed by a senior physician for determination of adverse event, its preventability, and the resulting disability. RESULTS: Of the 15,548 records reviewed, 8.2% showed at least one adverse event, with a range of 2.5% to 18.4% per country. Of these events, 83% were judged to be preventable, while about 30% were associated with death of the patient. About 34% adverse events were from therapeutic errors in relatively non-complex clinical situations. Inadequate training and supervision of clinical staff or the failure to follow policies or protocols contributed to most events. CONCLUSIONS: Unsafe patient care represents a serious and considerable danger to patients in the hospitals that were studied, and hence should be a high priority public health problem. Many other developing and transitional economies will probably share similar rates of harm and similar contributory factors. The convenience sampling of hospitals might limit the interpretation of results, but the identified adverse event rates show an estimate that should stimulate and facilitate the urgent institution of appropriate remedial action and also to trigger more research. Prevention of these adverse events will be complex and involves improving basic clinical processes and does not simply depend on the provision of more resources

Paraoxonase1 Genetic Polymorphisms in a Mixed Ancestry African Population

Paraoxonase 1 (PON1) activity is markedly influenced by coding polymorphisms, Q/R at position 192 and M/L at position 55 of the PON1 gene. We investigated the frequencies of these polymorphisms and their effects on PON1 and antioxidant activities in 844 South African mixed ancestry individuals. Genotyping was done using allele-specific TaqMan technology, PON1 activities were measured using paraoxon and phenylacetate, oxidative status was determined by measuring the antioxidant activities of ferric reducing antioxidant power and trolox equivalent antioxidant capacity, and lipid peroxidation markers included malondialdehyde and oxidized LDL. The frequencies of Q192R and L55M were 47.6% and 28.8%, respectively, and the most common corresponding alleles were 192R (60.4%) and 55M (82.6%). The Q192 was significantly associated with 5.8 units’ increase in PON1 concentration and 15.4 units’ decrease in PONase activity after adjustment for age, sex, BMI, and diabetes, with suggestion of differential effects by diabetes status. The PON1 L55 variant was associated with none of the measured indices. In conclusion, we have shown that the Q192R polymorphism is a determinant of both PON1 concentration and activity and this association appeared to be enhanced in subjects with diabetes