Acute Hepatitis E: Case Report

Hepatitis E viral infection has been reported in North Africa, Western Africa andsome outbreaks in refugee camps in Somalia and Sudan. We present the rare case of a Kenyan health care worker with documented acute viral Hepatitis E infection

Managing extension staff: Two experiments in Kenya

This paper focusses on techniques for managing agricultural extension staff. A system of staff meetings, recording and reporting is described, which was tested in the Mbere Special Rural Development Programme area. The purpose of this system was to provide closer supervision of the routine activities of agricultural extension staff, and its achievements and limitations'in meeting this goal are discussed here. A system of inservice training and planning workshops associated: with new and/or more comprehensive extension activities was tested in Kisii and Homa Bay. This is basically a management system for extension planning which provides a tool for the effective participation of grassroots level field staff. The two management systems are considered complementary, and it is proposed that they be combined to form a useful management tool for agricultural extension

A Check-list and identification key for succulent plants in general cultivation in Nairobi

Volume: 8

Who Wants to be a Surgeon? A Survey of Medical Students at the University of Nairobi, Kenya

Background: In Sub Saharan Africa, surgical conditions account for a significant disease burden. Surgical workforce is however inadequate, and thus strategies such as attracting medical students to surgical specialties could avert the situation. This study determined the proportion of students interested in pursuing surgical career and factors that influence choice of this specialty. Methodology Four hundred and fifty medical students, from first to fifth year of study at the University of Nairobi, were each issued a self administered questionnaire designed to assess their specialty preferences, and factors influencing these choices. Results: The response rate was 385/450(85.6%). Surgery was the most popular specialty with 105(27.3%) students. Majority, 6 (57%), of those who preferred surgery were in the preclinical years. Male students had a two-fold likelihood of selecting a surgical career compared to females. Significant factors that attracted students to surgery instead of non surgical careers were prestige of the specialty (

Factors associated with under-5 mortality in three disadvantaged East African districts

BACKGROUND: The high rate of avoidable child mortality in disadvantaged communities in Africa is an important health problem. This article examines factors associated with mortality in children 6 h away from the nearest health centre (6-23 h: AOR 1.66 [95% CI 1.4-2.0] and ?24 h: AOR 1.43 [95% CI 1.26-1.72]) reported higher mortality rates in children 6 h away from health centres and mothers who received inadequate ANC visits during pregnancy

What's normal? Oligosaccharide concentrations and profiles in milk produced by healthy women vary geographically.

Background: Human milk is a complex fluid comprised of myriad substances, with one of the most abundant substances being a group of complex carbohydrates referred to as human milk oligosaccharides (HMOs). There has been some evidence that HMO profiles differ in populations, but few studies have rigorously explored this variability.Objectives: We tested the hypothesis that HMO profiles differ in diverse populations of healthy women. Next, we examined relations between HMO and maternal anthropometric and reproductive indexes and indirectly examined whether differences were likely related to genetic or environmental variations.Design: In this cross-sectional, observational study, milk was collected from a total of 410 healthy, breastfeeding women in 11 international cohorts and analyzed for HMOs by using high-performance liquid chromatography.Results: There was an effect of the cohort (P 4 times higher in milk collected in Sweden than in milk collected in rural Gambia (mean ± SEM: 473 ± 55 compared with 103 ± 16 nmol/mL, respectively; P < 0.05), and disialyllacto-N-tetraose (DSLNT) concentrations ranged from 216 ± 14 nmol/mL (in Sweden) to 870 ± 68 nmol/mL (in rural Gambia) (P < 0.05). Maternal age, time postpartum, weight, and body mass index were all correlated with several HMOs, and multiple differences in HMOs [e.g., lacto-N-neotetrose and DSLNT] were shown between ethnically similar (and likely genetically similar) populations who were living in different locations, which suggests that the environment may play a role in regulating the synthesis of HMOs.Conclusions: The results of this study support our hypothesis that normal HMO concentrations and profiles vary geographically, even in healthy women. Targeted genomic analyses are required to determine whether these differences are due at least in part to genetic variation. A careful examination of sociocultural, behavioral, and environmental factors is needed to determine their roles in this regard. This study was registered at clinicaltrials.gov as NCT02670278

User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity

BACKGROUND: In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity. METHODS: This survey was conducted in ten hospitals of the Uganda Catholic Medical Bureau to assess differences in user fees policies and to propose changes that would better fit with the social concern explicitly pursued by the Bureau. Through a review of relevant hospital documents and reports, and through interviews with key informants, health workers and users, hospital and non-hospital cost was calculated, as well as overall expenditure and revenues. Lower fees were applied in some pilot hospitals after the survey. RESULTS: The percentage of revenues from user fees varied between 6% and 89% (average 40%). Some hospitals were more successful than others in getting external aid and government subsidies. These hospitals were applying lower fees and flat rates, and were offering free essential services to encourage access, as opposed to the fee-for-service policies implemented in less successful hospitals. The wide variation in user fees among hospitals was not justified by differences in case mix. None of the hospitals had a policy for exemption of the poor; the few users that actually got exempted were not really poor. To pay hospital and non-hospital expenses, about one third of users had to borrow money or sell goods and property. The fee system applied after the survey, based on flat and lower rates, brought about an increase in access and use of hospital services. CONCLUSION: Our results confirm that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible

Rwanda Climate Services for Agriculture: Evaluation of farmers’ awareness, use and impacts

Climate services are important in helping smallholder farmers manage climate-related risks and adapt to climate change, especially for rainfed agricultural production systems. In order to increase the resilience of farmers to the changing climate in Rwanda, the United States Agency for International Development (USAID) funded a four-year project—Rwanda Climate Services for Agriculture (RCSA) from 2016 to 2019. Through the project, climate services were disseminated directly to more than 111,000 farmers in four provinces across Rwanda through Participatory Integrated Climate Services for Agriculture (PICSA), Radio Listeners Clubs (LCs) and cell phones; as well as broadcast by a radio network accessible to about 70% of the population. This report presents analyses of the project end-line survey of 1525 households, sampled across 15 of Rwanda’s 30 districts, in order to assess the influence of PICSA training and LCs on awareness, access and uptake of climate services by smallholder farmers; and their impact on household welfare (i.e., crop productivity, income, food security) on a quasi-experimental sampling design with a non-participant control sample. Analyses show that farmers use climate services to make decisions on the types of crops to grow (75%), the types of crop varieties to plant (58%), timing of planting and land preparation (75%) and when and how to prepare land (65%). Participation in PICSA and LCs, alone and in combination, is associated with a substantial increase in the proportion of farmers that report changing crop, livestock and livelihood management practices in response to weather and climate information. Relative to the control, PICSA participation increased the value of crop production by 24%, and income from crops by 30%. The combination of PICSA and LCs was associated with a 47% increase in the value of crop production, and a 56% increase in income from crops

A method for generating virus-free cassava plants to combat viral disease epidemics in Africa

Here, we report a method to clean cassava plants from viral infections that cause cassava mosaic and brown streak diseases in Africa. Infected plants of resistant or tolerant varieties from Malawi, Mozambique, Kenya, Tanzania and Uganda were cleaned in the UK using a combination of tissue culture, chemotherapy and thermotherapy. In the first cycle of our virus-indexing procedure, we successfully cleaned 27 of the 31 varieties (87%), and after an additional three cleaning cycles, all plants were virus-free. Virus-free tissue-cultured plants were shipped back to Africa for distribution to farmers. This first cross-boundary effort provides important lessons for mitigating the two-major cassava viral diseases

Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey

Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases