A comparative analysis of conventional Pap smear cytology, liquid based cytology and colposcopy clinical impression with colposcopy biopsy histology as gold standard in women undergoing colposcopy in Kenyatta National Hospital

Background: Cervical cancer is one of the most common female malignancies worldwide. Since the introduction of conventional Papanicolaou smear mortality from cervical cancer has reduced considerably. Despite its success, it has sensitivity of only 51% and false negative rate of 5-10%. Approved liquid based cytology (LBC) products by FDA claim a 65-percent increased detection rate of high grade squamous intraepithelial lesions (HGSIL) compared with conventional smears, as well as decreased unsatisfactory sample rates. Evidence shows that liquid based preparation is more sensitive and accurate for the detection of both squamous and glandular lesions of the cervix. Studies of the accuracy of liquid based preparations reports sensitivity of 61-66% and specificity of 82-91%. Objective of current study is to compare the performance of conventional Pap smear cytology, liquid based cytology and colposcopy clinical impression with colposcopic biopsy as the gold standard among women eligible for colposcopy in Kenyatta National Hospital, Kenya.Methods: This was a hospital-based comparative cross-sectional study. Convenient sampling over a period of 4 months was used to recruit clients referred to colposcopy clinic with abnormal Pap smear results.Results: A total of 73 patients referred with abnormal pap smears were recruited into the study. The mean age of the patients was 38 yrs (SD ±10). About 45% of the patients interviewed did not have knowledge of Pap smear testing. Both the results of referral Pap smear and repeat Pap smear were predominantly low grade squamous intraepithelial lesions (LGSIL) or HGSIL. With biopsy results being the gold standard, Liquid based cytology had a higher specificity of 75% when compared with conventional pap smears’ 11%.Conclusions: Even though colposcopy clinical impression has the highest agreement with colposcopy biopsy it’s a diagnostic and not a screening test, hence Liquid based cytology showed better performance as a screening test compared to conventional Pap smear. In general, there was good agreement for cytological results of repeat CPAP and LBC. We therefore recommend that for patients referred with abnormal pap smears requiring a repeat pap smear, liquid based cytology is used due to its higher specificity compared to conventional Pap smear

Status and Trends of Agricultural and Rural Development Indicators in the COMESA Region

This report is divided into eight sections, section one provides an introduction about the COMESA region and the structure of the economy in the region. Section two presents trends of various socioeconomic indicators in the region. Section three contains gender related information while section four focuses on food security in COMESA. Some examples of subnational food security situations are also given here. Section five focuses on various indicators related to agriculture in COMESA including agriculture and food production, input utilization in agriculture, and application of irrigation in agriculture. Section six provides information on expenditures in agriculture and agricultural value addition in the region. In section seven, various indicators on trade are reviewed. The last section, section eight, contains summary, conclusions, and policy recommendations

Attempts to identify Cassava Brown Streak Virus in western Democratic Republic of Congo

Open Access ArticleRoot necrosis similar to those of the cassava brown streak disease (CBSD) were observed on cassava in western provinces of the Democratic Republic of Congo (DR.Congo) in the early 2000’s. However molecular laboratory diagnosis were not able to detect any causative agent responsible for the attacks, hence, the disease related to these symptoms was named CBSD-like disease. In order to assess the distribution and the incidence of the CBSD-like disease, surveys were carried out in four western provinces, comprising, Kwango and Kwilu, Sud Ubangi, Kinshasa and Kongo Central. CBSD-like disease was observed in all surveyed provinces on the basis of root symptoms because foliar symptoms were different to those of the documented cases of CBSD in other parts of east Africa. CBSD-like disease incidence was high in Kongo Central and Sud Ubangi, exceeding an average of 50 %, but low in Kwango and Kwilu (32.8%) and in Kinshasa (19.1%). During the surveys, cassava leaf samples were collected for lab identification of the causal agent. PCR diagnosis was done on these samples using primers specific for the two known CBSVs. All samples tested negative with no amplification of DNA fragments of the correct size. Thus, further analysis on the causative organism is needed using Next Generation Sequencing (NGS) approaches. NGS approaches will help also to identify the causative organism in other Central Africa countries (Angola, Congo-Brazzaville and Gabon) where such cassava root necrosis have been reported or are suspected

Enhancement of Grassland Production Through Integration of Forage Legumes in Semi-Arid Rangelands of Kenya

Livestock production in semi-arid rangelands of Kenya is limited by the seasonal quantity and quality of fodder. Kirkman & Carvalho (2003) stated that these inter- and intra-seasonal quality and quantity fluctuations result in nutrient deficits that severely limit livestock production potential. The objective of this experiment was to study the effect of three forage legumes on the production of natural pastures in semi-arid rangelands of Kenya

The impact of non-tariff barriers on maize and beef trade in East Africa

On March 2, 2004, the East African Community (EAC) member states signed the protocol for the establishment of the East African Community Customs Union, which commits them, among others, to eliminate non-tariff barriers (NTBs) to increase intraregional trade. However, several NTBs are still applied by member states, raising concerns among policy makers and the business community. There is, however, no information about the magnitude of the impact of these NTBs. This study identifies the existing NTBs on maize and beef trade in East Africa and quantifies their impact on trade and the welfare of EAC citizens using a Spatial Equilibrium Model (SEM). Data on NTBs were collected from traders and transporters of maize and beef cattle in East Africa. In addition, the study found that the main types of NTBs within the three founding members of the EAC (Kenya, Tanzania and Uganda) are similar. They include administrative requirements (mainly licenses, municipal and council permits), taxes/duties (mainly excise and cess duty), roadblocks, customs barriers, weighbridges, licensing, corruption (e.g., through bribes) and transiting. The results of the welfare analysis vary across the three countries, but the net monetary gains are positive in all cases. A complete abolishment or a reduction of the existing NTBs in maize and beef trade increases intra-EAC maize and beef trade flows, with Kenya importing more maize from both Uganda and Tanzania, while Uganda’s beef exports to Kenya and Tanzania increase. As a result, positive net welfare gains are attained for the entire EAC maize and beef sub-sectors. In all cases, those who gain from the proposed reductions in NTBs can potentially compensate the losers, leading to potential improvements in welfare. These findings give compelling evidence in support of the elimination of NTBs within the EAC customs union. The study recommends taking a regional approach to eliminating the existing NTBs since they are similar across the member countries and across commodities so as to exploit economies of scale. Other policy recommendations include streamlining of administrative procedures at border points to improve efficiency, and speeding up the implementation of procedures at point of origin and at the border points. Finally, the study recommends the need to design and implement monitoring systems to provide feedback to the relevant authorities on the implementation of measures to remove unnecessary barriers to trade within the EAC region

Breadth of CD8 T-cell mediated inhibition of replication of diverse HIV-1 transmitted-founder isolates correlates with the breadth of recognition within a comprehensive HIV-1 Gag, Nef, Env and Pol potential T-cell epitope (PTE) peptide set.

Full characterisation of functional HIV-1-specific T-cell responses, including identification of recognised epitopes linked with functional antiviral responses, would aid development of effective vaccines but is hampered by HIV-1 sequence diversity. Typical approaches to identify T-cell epitopes utilising extensive peptide sets require subjects' cell numbers that exceed feasible sample volumes. To address this, CD8 T-cells were polyclonally expanded from PBMC from 13 anti-retroviral naïve subjects living with HIV using CD3/CD4 bi-specific antibody. Assessment of recognition of individual peptides within a set of 1408 HIV-1 Gag, Nef, Pol and Env potential T-cell epitope peptides was achieved by sequential IFNγ ELISpot assays using peptides pooled in 3-D matrices followed by confirmation with single peptides. A Renilla reniformis luciferase viral inhibition assay assessed CD8 T-cell-mediated inhibition of replication of a cross-clade panel of 10 HIV-1 isolates, including 9 transmitted-founder isolates. Polyclonal expansion from one frozen PBMC vial provided sufficient CD8 T-cells for both ELISpot steps in 12 of 13 subjects. A median of 33 peptides in 16 epitope regions were recognised including peptides located in previously characterised HIV-1 epitope-rich regions. There was no significant difference between ELISpot magnitudes for in vitro expanded CD8 T-cells and CD8 T-cells directly isolated from PBMCs. CD8 T-cells from all subjects inhibited a median of 7 HIV-1 isolates (range 4 to 10). The breadth of CD8 T-cell mediated HIV-1 inhibition was significantly positively correlated with CD8 T-cell breadth of peptide recognition. Polyclonal CD8 T-cell expansion allowed identification of HIV-1 isolates inhibited and peptides recognised within a large peptide set spanning the major HIV-1 proteins. This approach overcomes limitations associated with obtaining sufficient cell numbers to fully characterise HIV-1-specific CD8 T-cell responses by different functional readouts within the context of extreme HIV-1 diversity. Such an approach will have useful applications in clinical development for HIV-1 and other diseases

Genetic determinants of glucose-6-phosphate dehydrogenase activity in Kenya

Background: The relationship between glucose-6-phosphate dehydrogenase (G6PD) deficiency and clinical phenomena such as primaquine-sensitivity and protection from severe malaria remains poorly defined, with past association studies yielding inconsistent and conflicting results. One possibility is that examination of a single genetic variant might underestimate the presence of true effects in the presence of unrecognized functional allelic diversity. Methods: We systematically examined this possibility in Kenya, conducting a fine-mapping association study of erythrocyte G6PD activity in 1828 Kenyan children across 30 polymorphisms at or around the G6PD locus. Results: We demonstrate a strong functional role for c.202G>A (rs1050828), which accounts for the majority of variance in enzyme activity observed (P=1.5 × 10-200, additive model). Additionally, we identify other common variants that exert smaller, intercorrelated effects independent of c.202G>A, and haplotype analyses suggest that each variant tags one of two haplotype motifs that are opposite in sequence identity and effect direction. We posit that these effects are of biological and possible clinical significance, specifically noting that c.376A>G (rs1050829) augments 202AG heterozygote risk for deficiency trait by two-fold (OR = 2.11 [1.12 - 3.84], P=0.014). Conclusions: Our results suggest that c.202G>A is responsible for the majority of the observed prevalence of G6PD deficiency trait in Kenya, but also identify a novel role for c.376A>G as a genetic modifier which marks a common haplotype that augments the risk conferred to 202AG heterozygotes, suggesting that variation at both loci merits consideration in genetic association studies probing G6PD deficiency-associated clinical phenotypes. </p

Responding to Food Price Crisis in Eastern and Southern Africa: Policy Options for National and Regional Action

This paper addresses the magnitude and implications of food price changes in national and regional markets in Eastern and Southern Africa (ESA) with a view to provide the evidence base for effective policy action. Specifically, the paper: - analyses trends and outlooks in country and regional data, presents evidence on the regional food situation, and explores the nexus between high domestic food prices and global food prices, - highlights regional and national dimensions of food price increases and how they are related to food security in the region, and - provides practical short-, medium- and long-term options for governments and other stakeholders for addressing the problem posed by the food price crisis