Out-Patient Prescribing Practices at Mbagathi District Hospital-Nairobi County

Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in Mbagathi Hospital outpatient department. Design: A hospital based retrospective study. Setting: Mbagathi District Hospital outpatient department between 1st January to 30th June 2012. Main outcome measures: Measures used in this study included, total number of medicines in a prescription, proportion of medicines in the essential drug list, proportion in generic names, proportion with injectables and antibiotics and percentage actually dispensed. Results: Total number of drugs prescribed was 1,506. On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an injection. A total of 1,087 drugs were prescribed according to the essential drugs list or formulary, accounting for 72.2% of total number of drugs prescribed (1,506). Only 55.2% of total medicines prescribed were actually dispensed and the rest were out of stock. Conclusion: The prescribing practices in this study are not satisfactory, as suggested by polypharmacy, over prescription of antibiotics, prescribing by brand names and lack of awareness of essential drugs list

Mapping of DBLα Sequence Tags of Field Isolates from Two Malaria Endemic Sites in Kenya

Plasmodium falciparum Erythrocyte Membrane Protein 1 (PfEMP1) found on the surface of infected erythrocytes (IEs) mediate antigenic variation during P. falciparum infection enabling the parasite evade host immune responses and prolong infection. These molecules mediate binding of IEs to host endothelial cells and uninfected erythrocytes. Cytoadhesion of IE to host cells leads to sequestration in tissues and PfEMP1 is thought to play an important role in parasite virulence. Here we analysed 1725 sequence tags sampled from the DBLa region of PfEMP1 encoding “var” genes from 27 patients in two different geographical regions in Kenya, Mbita in Western Kenya and Twiga on the Kenyan coast. The objective of this study was to construct a network to assess the extent of shared position specific polymorphic blocks (PSPBs) in sequences isolated from genomic DNA of field isolates from the two malaria endemic sites in Kenya.. Sequences from Mbita study site and those from Tiwi largely clustered into separate giant networks with only a limited number of sequences from the two sites linking to each other. This observation suggests that the parasite populations from the two endemic sites could be genetically varied and that PfEMP1 sequencing could be a useful tool of understanding the genetics of parasite populations. Thus the network approach of studying relationships between DBLα sequences is a useful tool of uncovering the genetic structure of parasite populations circulating in different malaria endemic regions. Keywords: PfEMP1, Networks, Position Specific Polymorphic Groups, DBLα, Malaria, P. falciparu

Commonly cited incentives in the community implementation of the emergency maternal and newborn care study in western Kenya

Background: Mortality of mothers and newborns is an important public health problem in low-income countries. In the rural setting, implementation of community based education and mobilization are strategies that have sought to reduce these mortalities. Frequently such approaches rely on volunteers within each community. Objective: To assess the perceptions of the community volunteers in rural Kenya as they implemented the EmONC program and to identify the incentives that could result in their sustained engagement in the project. Method: A community-based cross sectional survey was administered to all volunteers involved in the study. Data were collected using a self-administered supervision tool from all the 881 volunteers. Results: 881 surveys were completed. 769 respondents requested some form of incentive; 200 (26%) were for monetary allowance, 149 (19.4%) were for a bicycle to be used for transportation, 119 (15.5%) were for uniforms for identification, 88 (11.4%) were for provision of training materials, 81(10.5%) were for training in Home based Life Saving Skills (HBLSS), 57(7.4%) were for provision of first AID kits, and 39(5%) were for provision of training more facilitators, 36(4.7%) were for provision of free medication. Conclusion: Monetary allowances, improved transportation and some sort of identification are the main incentives cited by the respondents in this context

Determination of seasonal rainfall variability, onset and cessation in semi-arid Tharaka district, Kenya

The study quantified rainfall variability for March–May (MAM) and October–December (OND) seasons in Tharaka district, Kenya. The parameters analysed were inter-annual variability of seasonal rainfall, onset and cessation using daily rainfall data in three agro-ecological zones’ stations. Percentage mean cumulative method was used to determine onset and cessation, and seasonal variability was estimated using rainfall variability indices. Although both seasons are highly variable, OND has been persistently below mean over time while MAM shows high within-season variability. Despite the near uniformity in the mean onset and cessation dates, the former is highly variable on an inter-annual scale. The two rainfall seasons are inherently dissimilar and therefore require specific cropping in agro-ecological zone LM4 and LM4-5. It is possible that farmers in IL5 are missing an opportunity by under-utilising MAM rainfall. The results should be incorporated in implications of climate variability and vulnerability assessment in semi-arid Tharaka district

Partnering to proceed: scaling up adolescent sexual reproductive health programmes in Tanzania. Operational research into the factors that influenced local government uptake and implementation

BACKGROUND: Little is known about how to implement promising small-scale projects to reduce reproductive ill health and HIV vulnerability in young people on a large scale. This evaluation documents and explains how a partnership between a non-governmental organization (NGO) and local government authorities (LGAs) influenced the LGA-led scale-up of an innovative NGO programme in the wider context of a new national multisectoral AIDS strategy. METHODS: Four rounds of semi-structured interviews with 82 key informants, 8 group discussions with 49 district trainers and supervisors (DTS), 8 participatory workshops involving 52 DTS, and participant observations of 80% of LGA-led and 100% of NGO-led meetings were conducted, to ascertain views on project components, flow of communication and decision-making and amount of time DTS utilized undertaking project activities. RESULTS: Despite a successful ten-fold scale-up of intervention activities in three years, full integration into LGA systems did not materialize. LGAs contributed significant human resources but limited finances; the NGO retained control over finances and decision-making and LGAs largely continued to view activities as NGO driven. Embedding of technical assistants (TAs) in the LGAs contributed to capacity building among district implementers, but may paradoxically have hindered project integration, because TAs were unable to effectively transition from an implementing to a facilitating role. Operation of NGO administration and financial mechanisms also hindered integration into district systems. CONCLUSIONS: Sustainable intervention scale-up requires operational, financial and psychological integration into local government mechanisms. This must include substantial time for district systems to try out implementation with only minimal NGO support and modest output targets. It must therefore go beyond the typical three- to four-year project cycles. Scale-up of NGO pilot projects of this nature also need NGOs to be flexible enough to adapt to local government planning cycles and ongoing evaluation is needed to ensure strategies employed to do so really do achieve full intervention integration

Using Magnetically Responsive Tea Waste to Remove Lead in Waters under Environmentally Relevant Conditions

We report the use of a simple yet highly effective magnetite-waste tea composite to remove lead(II) (Pb[superscript 2+]) ions from water. Magnetite-waste tea composites were dispersed in four different types of water–deionized (DI), artificial rainwater, artificial groundwater and artificial freshwater–that mimic actual environmental conditions. The water samples had varying initial concentrations (0.16–5.55 ppm) of Pb[superscript 2+] ions and were mixed with the magnetite-waste tea composite for at least 24 hours to allow adsorption of the Pb[superscript 2+] ions to reach equilibrium. The magnetite-waste tea composites were stable in all the water samples for at least 3 months and could be easily removed from the aqueous media via the use of permanent magnets. We detected no significant leaching of iron (Fe) ions into the water from the magnetite-waste tea composites. The percentage of Pb adsorbed onto the magnetite-waste tea composite ranged from ~70% to 100%; the composites were as effective as activated carbon (AC) in removing the Pb[superscript 2+] ions from water, depending on the initial Pb concentration. Our prepared magnetite-waste tea composites show promise as a green, inexpensive and highly effective sorbent for removal of Pb in water under environmentally realistic conditions.SUTD-MIT International Design Center (Research Grant IDG11200105/IDD11200109)Singapore-MIT Allianc

HIV-1 subtype and viral tropism determination for evaluating antiretroviral therapy options: an analysis of archived Kenyan blood samples

<p>Abstract</p> <p>Background</p> <p>Infection with HIV-1 is characterized by genetic diversity such that specific viral subtypes are predominant in specific geographical areas. The genetic variation in HIV-1 <it>pol </it>and <it>env </it>genes is responsible for rapid development of resistance to current drugs. This variation has influenced disease progression among the infected and necessitated the search for alternative drugs with novel targets. Though successfully used in developed countries, these novel drugs are still limited in resource-poor countries. The aim of this study was to determine HIV-1 subtypes, recombination, dual infections and viral tropism of HIV-1 among Kenyan patients prior to widespread use of antiretroviral drugs.</p> <p>Methods</p> <p>Remnant blood samples from consenting sexually transmitted infection (STI) patients in Nairobi were collected between February and May 2001 and stored. Polymerase chain reaction and cloning of portions of HIV-1 <it>gag</it>, <it>pol </it>and <it>env </it>genes was carried out followed by automated DNA sequencing.</p> <p>Results</p> <p>Twenty HIV-1 positive samples (from 11 females and 9 males) were analyzed. The average age of males (32.5 years) and females (26.5 years) was significantly different (p value < 0.0001). Phylogenetic analysis revealed that 90% (18/20) were concordant HIV-1 subtypes: 12 were subtype A1; 2, A2; 3, D and 1, C. Two samples (10%) were discordant showing different subtypes in the three regions. Of 19 samples checked for co-receptor usage, 14 (73.7%) were chemokine co-receptor 5 (CCR5) variants while three (15.8%) were CXCR4 variants. Two had dual/mixed co-receptor use with X4 variants being minor population.</p> <p>Conclusion</p> <p>HIV-1 subtype A accounted for majority of the infections. Though perceived to be a high risk population, the prevalence of recombination in this sample was low with no dual infections detected. Genotypic co-receptor analysis showed that most patients harbored viruses that are predicted to use CCR5.</p

Dynein light chain 1 functions in somatic cyst cells regulate spermatogonial divisions in Drosophila

Stem cell progeny often undergo transit amplifying divisions before differentiation. In Drosophila, a spermatogonial precursor divides four times within an enclosure formed by two somatic-origin cyst cells, before differentiating into spermatocytes. Although germline and cyst cell-intrinsic factors are known to regulate these divisions, the mechanistic details are unclear. Here, we show that loss of dynein-light-chain-1 (DDLC1/LC8) in the cyst cells eliminates bag-of-marbles (bam) expression in spermatogonia, causing gonial cell hyperplasia in Drosophila testis. The phenotype is dominantly enhanced by Dhc64C (cytoplasmic Dynein) and didum (Myosin V) loss-of-function alleles. Loss of DDLC1 or Myosin V in the cyst cells also affects their differentiation. Furthermore, cyst cell-specific loss of ddlc1 disrupts Armadillo, DE-cadherin and Integrin-βPS localizations in the cyst. Together, these results suggest that Dynein and Myosin V activities, and independent DDLC1 functions in the cyst cells organize the somatic microenvironment that regulates spermatogonial proliferation and differentiation