Modelling interdependencies between the electricity and information infrastructures

The aim of this paper is to provide qualitative models characterizing interdependencies related failures of two critical infrastructures: the electricity infrastructure and the associated information infrastructure. The interdependencies of these two infrastructures are increasing due to a growing connection of the power grid networks to the global information infrastructure, as a consequence of market deregulation and opening. These interdependencies increase the risk of failures. We focus on cascading, escalating and common-cause failures, which correspond to the main causes of failures due to interdependencies. We address failures in the electricity infrastructure, in combination with accidental failures in the information infrastructure, then we show briefly how malicious attacks in the information infrastructure can be addressed

An architecture-based dependability modeling framework using AADL

For efficiency reasons, the software system designers' will is to use an integrated set of methods and tools to describe specifications and designs, and also to perform analyses such as dependability, schedulability and performance. AADL (Architecture Analysis and Design Language) has proved to be efficient for software architecture modeling. In addition, AADL was designed to accommodate several types of analyses. This paper presents an iterative dependency-driven approach for dependability modeling using AADL. It is illustrated on a small example. This approach is part of a complete framework that allows the generation of dependability analysis and evaluation models from AADL models to support the analysis of software and system architectures, in critical application domains

Software dependability modeling using an industry-standard architecture description language

Performing dependability evaluation along with other analyses at architectural level allows both making architectural tradeoffs and predicting the effects of architectural decisions on the dependability of an application. This paper gives guidelines for building architectural dependability models for software systems using the AADL (Architecture Analysis and Design Language). It presents reusable modeling patterns for fault-tolerant applications and shows how the presented patterns can be used in the context of a subsystem of a real-life application

Perceptions of caregivers about health and nutritional problems and feeding practices of infants: a qualitative study on exclusive breast-feeding in Kwale, Kenya

BACKGROUND: Despite the significant positive effect of exclusive breast-feeding on child health, only 32% of children under 6 months old were exclusively breast-fed in Kenya in 2008. The aim of this study was to explore perceptions and feeding practices of caregivers of children under 6 months old with special attention to the caregivers’ indigenous knowledge, perceptions about the health and nutritional problems of their infants, and care-seeking behaviors that affect feeding practices. METHODS: The study was exploratory and used an inductive approach. In all, 32 key informants, including mothers, mothers-in-law, and traditional healers, were interviewed in-depth. The number of participants in free-listing of perceived health problems of babies, in ranking of the perceived severity of these health problems, and in free-listing of food and drink given to children under 6 months old were 29, 28, and 32, respectively. Additionally, 28 babies under 6 months old were observed at home with regard to feeding practices. Data obtained using these methods were triangulated to formulate an ethnomedical explanatory model for mothers who do not practice exclusive breast-feeding. RESULTS: The informants stated that various types of food, drink, and medicine were given to infants under 6 months old. Direct observation also confirmed that 2- to 3-month-old babies were given porridge, water, juice, herbal medicine, and over-the-counter medicine. Mothers’ perceptions of insufficient breast milk production and a lack of proper knowledge about the value of breast milk were identified in key informant interviews, free-listing, and ranking as important factors associating with the use of food and drink other than breast milk; in addition, perceived ill health of babies appears to be associated with suboptimal practice of exclusive breast-feeding. Caregivers used various folk and popular medicines from the drugstore, their own backyard or garden, and traditional healers so that the mother or child would not be exposed to perceived risks during the vulnerable period after birth. CONCLUSIONS: Mothers should be advised during their antenatal and postnatal care about exclusive breast-feeding. This should be done not as a single vertical message, but in relation to their concerns about the health and nutritional problems of their babies

Correlates for cardiovascular diseases among diabetic/hypertensive patients attending outreach clinics in two Nairobi slums, Kenya

Introduction: cardiovascular diseases (CVD) are the leading cause of death in the world. Over 80% of CVD related deaths occur in low- and middle-income countries (LMICs). Diabetes and hypertension, whose prevalence in Kenya is on the rise, are major risk factors for CVD. Despite this, studies indicate that awareness on the management of risk factors for CVD among diabetic/hypertensive patients in African populations is generally low. The aim of the study was to determine the risk factors for CVD among diabetic and/or hypertensive patients attending diabetes and hypertension management clinics in Korogocho and Viwandani slums of Nairobi. Methods: data were collected using questionnaires administered to 206 diabetic/hypertensive patients attending the clinics between July 2010 and February 2011. A review of these patients' medical records was done to determine the history of CVD outcomes such as hypertensive heart diseases, stroke and peripheral arterial diseases. Results: majority (66.5%) of the study participants were females mainly in the 51-65 age category. The study findings revealed that 73 (33.4%) respondents had CVD outcomes. In addition, 41.8% of the respondents were not aware of the causes of diabetes/hypertension. Age category 51-65 years had the highest (43.8%) number of respondents with CVD. Sex of the respondents and awareness of the link between hypertension and CVD were significantly associated with CVD outcomes (p<0.05) among the respondents. Conclusion: measures to improve awareness levels among patients at high risk of CVD outcomes are needed to complement other measures to reduce CVD risk among such patients

Effect of a Community Health Worker Intervention on Uptake of Breast Cancer Screening Services among Women of Reproductive Age in Kitui County, Kenya

IntroductionWhile communicable diseases remain the leading killers in many developing countries, the incidence and mortality from non-communicable diseases such as breast cancer and other cancers is rising rapidly. By 2015, estimated 2.4 Million new cases of breast cancer globally was reported. Screening is one way of improving the survival rate by reducing morbidity and mortality of Breast cancer. The annual incidence of cancer in Kenya was close to 37,000 new cases with annual mortality of over 28,000. Cervical and breast cancer were the leading diseases in women occurring at a rate of 40.1/100,000 and 38.3/100,000. The uptake of cancer screening services in Kenya was as low as 13.5%. Engaging CHWs in health service delivery especially in resource poor countries was found to be an achievement [6, 7] .ObjectivesIn many developing countries, Community Health Workers (CHWs) provide a variety of services including outreach, counseling and patient home care services. This study aim was to assess the effect of a CHW led intervention on uptake of breast cancer screening services among women of reproductive age in Kitui County, Kenya.Materials and methodologyThis was a quasi-experiment with one pre-intervention and a post intervention survey conducted in both intervention (Kitui East ) and control site (Mwingi West) respectively. The intervention site received Community-Based Health Education (CBHE) aimed at promoting awareness and screening of both breast and cervical cancer. A total sample size of 422 participants were identified in each survey, based on Fisher et al 1998 formula. Purposive and simple random sampling method was used in identifying study area and respondents similarly. Data was collected using a research assistant administered questionnaire. Data analysis was done using frequencies and percentages, Z score tests, and ODDs Ratios. The study was subjected to the KNH-UoN Ethics Review committee (ERC) for ethical review and approval.ResultsThe intervention of CHWs increased the proportion of women seeking facility-based breast cancer screening services significantly by 38% in the intervention site. A Difference in Differences(DiD) statistic indicated 33.3% net increase in the proportion of women seeking the services within the 8-month of intervention period. The odds of seeking breast cancer screening services were higher (4.5 times higher) [(crude OR=3.604: 95%CI of OR=2.698-4.813, P<0.05) (Adjusted OR=4.458: 95%CI of OR=3.204-6.202, P<0.05)] in intervention site compared to control site.Conclusion and RecommendationsConclusively, the CBHE intervention improved breast cancer screening among women of reproductive age in Kitui County. To reduce the high prevalence of breast cancer and the economic burden of treating breast cancer cases in Kenya, we recommend adoption of Community based strategies like CBHE's help in promoting early screening and treatment of breast cancer among women of reproductive age. Keywords: Community Health Workers, CBHE, Breast Cancer, Screenin

Antimicrobial Resistance Patterns of bacterial Septicaemia infecting infants in Mbita Subcounty, Western region of Kenya

Background: Gram positive bacteria such Escherichia coli, Group B Streptococcus coagulase-negative staphylococci, Staphylococcus aureus, and Gram-negative bacteria such as Klebsiella and Pseudomonas species are listed as some of the bacteria etiologies for pediatric septicemia. These bacteria are rapidly becoming multi drug resistant to penicillin (or aminopenicillin), gentamicin, the pragmatic antibiotic treatment regimens.  Further, the ever-increasing burden of bacteria septicemia infection due to extended-spectrum β-lactamase (ESBL) producing Gram negative bacteria cumulatively presents a major health concern in the management and treatment of bacterial septicemia. In this study we present data on the prevalence and type of antimicrobial resistant patterns among children with bacterial septicemia in Mbita Sub county Hospital, Western region of Kenya. Methods: Blood samples were obtained from 248 children whose parents/guardian consented. The bacterial isolation and characterization were done using the automated BACTEC 9240 system, conventional culture using morphology, Gram stain and biochemical identification. Further identification and resistant gene detection were determined using Polymerase Chain Reaction (PCR). Descriptive statistics were used to present data. Results: Eighty-four (33.9%) patients had septicemia where Staphylococcus epidermidis (28.6%), S. aureus (13.1%), Escherichia coli (13.1%) and single Salmonella Paratyphi B, Citrobacter freundii, Gemella morbillorum, Klebsiella pneumoniae, Lactococcus lactis cremoris, Pantoea spp, and Pseudomonas putida were implicated. The majority of gram-negative bacteria were resistant to penicillin (Ampicillins) 100%, 96.1% to tetracyclin, 84.6% to sulphonamides (Trimethoprim/sulfamethoxazole), 73.1% Aminoglycosides (Gentamicin) 73.1% and 19.2% to Quinolone (Ciprofloxacin). For gram positive bacteria majority 96.7% were resistant to sulphonamides (Trimethoprim/sulfamethoxazole) followed by tetracycline 76.7%, penicillin (Oxacilline) 73.3% and least resistant to Quinolone (Ciprofloxacin) 30%. Various antimicrobial resistant genes mecA, SulII, blaTEM, TetA aac (3) were identified. Conclusion. In this geographically defined region of Kenya, of the 33.9% children with septicemia, gram positive bacteria were the leading cause septicemia. High level resistance due to various resistant genes were seen all type of antibiotics by both Gram positive and negative bacteria. Rapid antibiotic resistant testing is encouraged for appropriate treatment and management of septicemia infection. Keywords: bacterial Septicemia, Epidemiology, Children under five, South Nyanza, Kenya DOI: 10.7176/JNSR/10-10-07 Publication date:May 31st 202

Infant feeding knowledge and practices among lactating mothers in Kwale County, Kenya

Background: Lactating mother’s knowledge on infant feeding and its practices are key determinants of children’s nutritional status and future food habits. In Kenya, stunting rates among children below five years is 26 %. Objective: To assess infant feeding knowledge and practices among lactating mothers in Kwale County where stunting stands at 29%.Design: A cohort study. Setting: Maternal and Child Health clinics or respective households.Subjects: Lactating mothers who were part of the baseline survey.Results: One hundred and ninety-seven lactating mothers were interviewed. Most mothers (65.3%) had knowledge of breastfeeding within the first hour and majority (91.8%), gave colostrum to the newly born. Majority (84%) had no knowledge on expressing a mother’s milk for later use. Complementary feeds had been introduced by 48.2% of which more than a quarter gave before six months. Maize meal porridge was the common weaning food in addition to mother’s milk. There was a significant relationship between: breast feeding advice given during antenatal care and use of colostrum (r = 0.165, N = 197, p = 0.021); breastfeeding initiation and pre-lacteal feeding (r = - 0.264, N = 197, p = 0.0001); parity and place of birth (r = 0.184, N = 197, p = 0.001) as well as pre- lacteal feeding and use of colostrum (r = - 0.289, N = 197, p = 0.0001).Conclusion: There was poor knowledge of preservation of mother’s milk and dietary diversity during complementary feeding. There is need for an intervention to empower mothers on best practices for optimal growth and development of infants

Epidemiology of bacterial Septicemia among children under five in Mbita Subcounty, South Nyanza, Kenya

Background: Septicaemia is a major cause of mortality and morbidity, especially in sub-Saharan Africa leading to complications marked by bodily inflammation referred as sepsis. This is a systemic disease associated with presence of pathogenic microorganisms (viral, parasitic and bacterial) or their toxins in the blood. Bacterial septicaemia is the most fatal and prevalent in hospitalised cases. Globally, 76% of children under five years die due to septicaemia. In East Africa a mortality rate of 40% have been reported. In Kenya, South Nyanza regions have reported higher morbidity and mortality cases among children. We hypothesis that apart from immunosuppressive diseases, septicaemia could contribute significantly to this prevalence in the region. Methods: Blood samples were obtained from 248 children whose guardian consented and a detailed sociodemographic questionnaire was administered. Bacterial isolation and characterization were done using the automated BACTEC 9240 system. Results: The mean age of the participants was 27.9 (SD ±20.7) months. The majority (30.6%) were aged between 1 to 12 months, 50.8% were males, 58.9% had body temperatures above 37.6 OC while only 8.1% were HIV seropositive. The mean white blood cells (WBC) of the participants were 17720.9 (SD 8929.1) cells/ml with 5.2% had leucopenia. A total of 84 of the 248 (33.9%) of the children had septicaemia with the majority (28.6%) caused by Staphylococcus epidermidis followed by Staphylococcus aureus and Escherichia coli each at 13.1%. Bacteria that were reported singly included Salmonella Paratyphi B, Citrobacter freundii, Gemella morbillorum, Klebsiella pneumoniae, Lactococcus lactis cremoris, Pantoea spp, and Pseudomonas putida. In multivariate regression analysis, female gender (OR 0.6; 95% confidence interval (CI) 0.4 to 0.9), co-infection with malaria (OR 2.7; 95% CI 1.1 to 6.7) and gastrointestinal disorders (OR 2.9, 95% CI 1.3 – 7.3) were independently associated with bacterial septicemia infection. Conclusion: Significantly higher proportion of the children in this region are infected with septicaemia. Majority of the cases were caused by Gram positive bacteria. Age and other c-infection contribute significantly to septicaemia infection in this region. Rapid testing and etiological characterisation of children with suspected symptoms of septicaemia is key in this region in order to institute appropriate treatment and management. Keywords: bacterial Septicemia, Epidemiology, Children under five, South Nyanza, Kenya DOI: 10.7176/JNSR/10-10-06 Publication date:May 31st 202