Financial reforms and interest rate spreads in the commercial banking sector in Kenya

Financial reforms were a major component of structural adjustment programs deemed necessary for developing countries in the mid 1980s. These were not only meant to improve the sector, but would ultimately enhance economic growth and help in poverty alleviation. At the top of these reforms was financial liberalisation. Kenya, like many other sub-Saharan African countries, undertook financial liberalisation in 1991, one of the measures was decontrolling interest rates. With market driven interest rates in place it was assumed that there would be increased efficiency in bank lending, as well as growth in credit availability as deposits increased. A key indicator of this improved intermediation process would be a narrowing interest rates spread, that is, the margin between the deposit and lending rate. Paradoxically, however, the expected benefits of these reforms did not accrue to Kenya's banking sector. This study focuses on financial reforms and the spread of interest rates in Kenya's banking sector. Using a trend analysis, spanning the period before and after liberalisation, interest rates spread are shown to have escalated dramatically upwards after liberalisation. An analysis of three macroeconomic variables, namely, the exchange rate, inflation rate and economic growth offer little, or inconclusive evidence, that they were the main causes of the wide interest rate spread. In fact, the spread is closely linked to institutional/structural factors such as non-competitiveness in the banking sector, imprudent lending practices and poor and/or inadequate banking supervision. Policies for improving the institutional infrastructure and thus moderating the spreads are highlighted

Adesão à terapêutica antirretroviral de pessoas vivendo com HIV/aids em um município do interior paulista

RESUMO Objetivo Avaliar a adesão aos antirretrovirais de pessoas vivendo com o HIV/AIDS e identificar sua associação com variáveis sociodemográficas e clínicas. Métodos Estudo analítico transversal que utilizou instrumento sociodemográfico e o CEAT-HIV, com dados coletados no período de 2014 a 2015. Resultados Identificou-se 75,0% com grau de adesão bom/adequado. Verificou-se que os indivíduos com idade entre 40 e 59 anos (p=0,029) e com mais de oito anos de estudo (p=0,043) obtiveram maior grau de adesão, assim como aqueles com diagnóstico de HIV/AIDS há mais de 10 anos (p=0,002), contagem de TCD4 >350 células/mm3 (p<0,001) e carga viral indetectável (p=0,025). Conclusão Nesse estudo, identificou-se uma boa adesão entre os sujeitos e observou-se que indivíduos de maior faixa etária, maior grau de escolaridade, maior tempo de diagnóstico, elevada contagem de células TCD4 e carga viral indetectável estiveram associados a uma maior adesão ao tratamento

Phase 3 evaluation of an innovative simple molecular test for the diagnosis of malaria in different endemic and health settings in sub-Saharan Africa (DIAGMAL)

Background Rapid Diagnostic Tests (RDTs) have become the cornerstone for the management of malaria in many endemic settings, but their use is constrained for several reasons: (i) persistent malaria antigen (histidine-rich protein 2; HRP2) leading to false positive test results; (ii) hrp2 deletions leading to false negative PfHRP2 results; and (iii) limited sensitivity with a detection threshold of around 100 parasites/μl blood (pLDH- and HRP2-based) leading to false negative tests. Microscopy is still the gold standard for malaria diagnosis, and allows for species determination and quantitation, but requires trained microscopists, maintained microscopes and has detection limit issues. Consequently, there is a pressing need to develop and evaluate more sensitive and accurate diagnostic tests. To address this need we have developed a direct on blood mini PCR-NALFIA test that combines the benefits of molecular biology with low infrastructural requirements and extensive training. Methods This is a Phase 3 diagnostic evaluation in 5 African countries. Study sites (Sudan, Ethiopia, Burkina, Kenya and Namibia) were selected to ensure wide geographical coverage of Africa and to address various malaria epidemiological contexts ranging from high transmission to near elimination settings with different clinical scenarios and diagnostic challenges. Study participants will be enrolled at the study health facilities after obtaining written informed consent. Diagnostic accuracy will be assessed following the WHO/TDR guidelines for the evaluation of diagnostics and reported according to STARD principles. Due to the lack of a 100% specific and sensitive standard diagnostic test for malaria, the sensitivity and specificity of the new test will be compared to the available diagnostic practices in place at the selected sites and to quantitative PCR as the reference test. Discussion This phase 3 study is designed to validate the clinical performance and feasibility of implementing a new diagnostic tool for the detection of malaria in real clinical settings. If successful, the proposed technology will improve the diagnosis of malaria. Enrolment started in November 2022 (Kenya) with assessment of long term outcome to be completed by 2023 at all recruitment sites

Public–private partnership in higher education provision in Tanzania: implications for access to and quality of education

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Safety and immunogenicity of ChAdOx1 nCoV-19 (AZD1222) vaccine in adults in Kenya: a phase 1/2 single-blind, randomised controlled trial

Background: There are limited data on the immunogenicity of coronavirus disease 2019 (COVID-19) vaccines in African populations. Here we report the immunogenicity and safety of the ChAdOx1 nCoV-19 (AZD1222) vaccine from a phase 1/2 single-blind, randomised, controlled trial among adults in Kenya conducted as part of the early studies assessing vaccine performance in different geographical settings to inform Emergency Use Authorisation. Methods: We recruited and randomly assigned (1:1) 400 healthy adults aged ≥18 years in Kenya to receive ChAdOx1 nCoV-19 or control rabies vaccine, each as a two-dose schedule with a 3-month interval. The co-primary outcomes were safety, and immunogenicity assessed using total IgG enzyme-linked immunosorbent assay (ELISA) against SARS-CoV-2 spike protein 28 days after the second vaccination. Results: Between 28th October 2020 and 19th August 2021, 400 participants were enrolled and assigned to receive ChAdOx1 nCoV-19 (n=200) or rabies vaccine (n=200). Local and systemic adverse events were self-limiting and mild or moderate in nature. Three serious adverse events were reported but these were deemed unrelated to vaccination. The geometric mean anti-spike IgG titres 28 days after second dose vaccination were higher in the ChAdOx1 group (2773 ELISA units [EU], 95% CI 2447, 3142) than in the rabies vaccine group (61 EU, 95% CI 45, 81) and persisted over the 12 months follow-up. We did not identify any symptomatic infections or hospital admissions with respiratory illness and so vaccine efficacy against clinically apparent infection could not be measured. Vaccine efficacy against asymptomatic SARS-CoV-2 infection was 38.4% (95% CI -26.8%, 70.1%; p=0.188). Conclusions: The safety, immunogenicity and efficacy against asymptomatic infection of ChAdOx1 nCoV-19 among Kenyan adults was similar to that observed elsewhere in the world, but efficacy against symptomatic infection or severe disease could not be measured in this cohort. Pan-African Clinical Trials Registration: PACTR202005681895696 (11/05/2020

Kenya: Between hope and despair, 1963–2011

Kenya: Between hope and despair, 1963–2011, by Daniel Branch. New Haven, CT and London: Yale University Press, 2011. 368 pp. £25.00 (hardback). ISBN 978 0 30014 876 3. Books that purport to explain Kenya’s inner dynamics in the hope of shaping public perceptions of what is and should be their outcome can be interesting. The latest in this line is Daniel Branch’s potentially authoritative study. This potential is undermined by inaccuracies, minor and major, and a tendency to gloss over events, thereby hiding the essence of the story. As a result, the running theme of Kenyan politics appears to be Kikuyu acquisition and abuse of power and the sidelining of the Luo. In the process, the book ends up reading like a refurbished version of Kikuyu-bashing scholarship that can be traced back to Z. A. Marsh and G. Kingsnorth’s Introduction to the History of East Africa (1957, third edition 1965). In part, this may be because Branch seems to be awed by Luo historians Bethwell Allan Ogot and E. S. Atieno Odhiambo. His work seems like an expanded version of Ogot’s ‘Siege of Ramogi’ essay in Building on the Indigenous: selected essays, 1981–1998 (1999). It starts and ends with an Odinga: Jaramogi Oginga Odinga, Kenya’s first Vice-President, and then his son, Raila Odinga, Kenya’s current Prime Minister. Branch throws the Kikuyu in between, and makes them responsible for all sorts of mischief. Although Branch is seemingly widely read on post-colonial Kenya, his selections appear to be limited. This might explain why Branch gets some basic facts wrong, and misspells some names. Kenya’s Minister for Economic Planning, Tom Mboya, for instance, had not been in Kenya for a week before his assassination on 5 July 1969; he had returned from Addis Ababa the day before. And to assert that in 1968 President Jomo Kenyatta appointed Kitili Mwendwa, a Mkamba, Chief Justice so that he could replace ‘Joel’ [sic] Ndolo, another Mkamba, as army commander with a ‘Kikuyu’ (pp. 99–100) is fantasy. At no time did Kenyatta appoint any Kikuyu as army commander. There are, however, some good and interesting revelations in the book. One of them is that Malcolm Macdonald, the newly appointed governor of Kenya, ‘reversed the policy of the Administration in Nairobi’ to deny victory to KANU (p. 5), suggesting the colonial government had been rigging elections. The assertion that KANU’s electoral victory in May 1963 was the triumph of a vision is correct. The claim that the post-colonial elite behave like the former colonialists and jostle ‘to be the gatekeepers’ serving external interests (p. 22) might explain the hankering by some ‘leaders’ for approval by officials in the West. The book also clarifies that the 1969 oathing started early and intensified after Mboya’s death. The merger of Raila Odinga’s NDP with President Daniel arap Moi’s KANU in 2002, Branch correctly notes, was intended to enable Raila to inherit KANU (p. 246). Raila did not inherit, and became politically desperate

Potential of Sodom Apple (Solanum incanum L.) Fruit Extracts in the Management of Chilli Root Knot Disease in Nakuru County, Kenya

Sodom apple (Solanum incanum L.) fruit extracts were tested for their potential to manage root knot disease caused by Meloidogyne spp. in chilli (Capsicum annuum L.). The effect of sodom apple fruit extracts at different concentrations on the plant height, leaf number, stem diameter, number of galls, and nitrogen and phosphorous levels in chilli infected with root knot nematodes was evaluated. The efficacy of sodom apple fruit extracts against the root knot nematodes was tested under glasshouse and field conditions. All treatment effects were determined by one-way ANOVA using SAS program (Version 9.3). Evaluation after treatment of plants with sodom apple fruit extracts showed that there was a significant difference (P=0.05) in plant heights, number of galls, leaf number, and nitrogen levels in chilli. In the field experiment, the highest mean heights were recorded in the 100% treatment (T1) during the first and third reading. Chilli plants that were treated with the sodom apple fruit extract had a significantly high number of leaves. In the greenhouse experiment, the positive control (T6) had the highest mean heights followed by the 50% treatment (T2). Our research results showed that sodom apple fruit extracts have nematicidal compounds with a potential to be used in the management of chilli root knot nematodes

Improving care for residents in long term care facilities experiencing an acute change in health status

Abstract Background Long term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community. Methods/design We will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a standardized LTC-ED care and referral pathway, along with targeted INTERACT® tools. The implementation strategies will be adapted to the local context of each facility and to address potential implementation barriers identified through a staff completed barriers assessment tool. The evaluation will use a mixed-methods approach. The primary outcome will be any change in the rate of transfers to ED from LTC facilities adjusted by resident-days. Secondary outcomes will include a post-implementation qualitative assessment of the pathway. Comparative cost-analysis will be undertaken from the perspective of publicly funded health care. Discussion This study will integrate current resources in the LTC-ED pathway in a manner that will better coordinate and optimize the care for LTC residents experiencing an acute change in health status

Detection and management of milk allergy : Delphi consensus study

Background There is significant overdiagnosis of milk allergy in young children in some countries, leading to unnecessary use of specialized formula. This guidance, developed by experts without commercial ties to the formula industry, aims to reduce milk allergy overdiagnosis and support carers of children with suspected milk allergy. Methods Delphi study involving two rounds of anonymous consensus building and an open meeting between January and July 2021. Seventeen experts in general practice, nutrition, midwifery, health visiting, lactation support and relevant areas of paediatrics participated, located in Europe, North America, Middle East, Africa, Australia and Asia. Five authors of previous milk allergy guidelines and seven parents provided feedback. Findings Participants agreed on 38 essential recommendations through consensus. Recommendations highlighted the importance of reproducibility and specificity for diagnosing milk allergy in children with acute or delayed symptoms temporally related to milk protein ingestion; and distinguished between children directly consuming milk protein and exclusively breastfed infants. Consensus was reached that maternal dietary restriction is not usually necessary to manage milk allergy, and that for exclusively breastfed infants with chronic symptoms, milk allergy diagnosis should only be considered in specific, rare circumstances. Consensus was reached that milk allergy diagnosis does not need to be considered for stool changes, aversive feeding or occasional spots of blood in stool, if there is no temporal relationship with milk protein ingestion. When compared with previous guidelines, these consensus recommendations resulted in more restrictive criteria for detecting milk allergy and a more limited role for maternal dietary exclusions and specialized formula. Interpretation These new milk allergy recommendations from non-conflicted, multidisciplinary experts advise narrower criteria, more prominent support for breastfeeding and less use of specialized formula, compared with current guidelines