Breast self examination and breast cancer: Knowledge and practice among female medical students in a Kenyan university

Background: Medical students play an important role in creating a supportive environment within their communities for screening behaviours in health promotion. Medical students must possess the appropriate knowledge concerning breast self examination (BSE) and breast cancer to be effective health educators. objective: To investigate the level of knowledge concerning BSE and breast cancer and to evaluate the practice of BSE among female medical students. Materials and methods: A crosssectional descriptive study conducted between March and June 2008 involving female students drawn from schools within the College of Health sciences, University of Nairobi. The questionnaires contained items on the biodata, knowledge and practice of BSE and knowledge on breast cancer. Responses on awareness on breast cancer were weighed using a 3-point Likert’s scale. Results: A total of 169 respondents were interviewed. Majority (94.6%) had heard about BSE with 114 (69.9%) having ever practiced it. Less than 20% of the respondents performed BSE regularly. There were no significant differences between clinical and preclinical students. Mass media was the most common source of information (45.2%). Relatives an formal lectures formed the least (7%) source of information for the respondents. Significant interschool differences on knowledge and practice are presented. Conclusion: Despite being aware, a significant proportion of female medical students do not practice BSE. Information dissemination regarding breast health is underprovided among family members. Recommendation: Programs targeting improved propagation of information and BSE especially among medical trainees should be instituted so as to strengthen health promotion in the community. Key words: Breast self examination, breast cancer, female medical student

Risk of nontyphoidal Salmonella bacteraemia in African children is modified by STAT4

Nontyphoidal Salmonella (NTS) is a major cause of bacteraemia in Africa. The disease typically affects HIV-infected individuals and young children, causing substantial morbidity and mortality. Here we present a genome-wide association study (180 cases, 2677 controls) and replication analysis of NTS bacteraemia in Kenyan and Malawian children. We identify a locus in STAT4, rs13390936, associated with NTS bacteraemia. rs13390936 is a context-specific expression quantitative trait locus for STAT4 RNA expression, and individuals carrying the NTS-risk genotype demonstrate decreased interferon-gamma (IFN gamma) production in stimulated natural killer cells, and decreased circulating IFN gamma concentrations during acute NTS bacteraemia. The NTS-risk allele at rs13390936 is associated with protection against a range of autoimmune diseases. These data implicate interleukin-12-dependent IFN gamma-mediated immunity as a determinant of invasive NTS disease in African children, and highlight the shared genetic architecture of infectious and autoimmune disease.Peer reviewe

A global horizon scan of issues impacting marine and coastal biodiversity conservation

The biodiversity of marine and coastal habitats is experiencing unprecedented change. While there are well-known drivers of these changes, such as overexploitation, climate change and pollution, there are also relatively unknown emerging issues that are poorly understood or recognized that have potentially positive or negative impacts on marine and coastal ecosystems. In this inaugural Marine and Coastal Horizon Scan, we brought together 30 scientists, policymakers and practitioners with transdisciplinary expertise in marine and coastal systems to identify new issues that are likely to have a significant impact on the functioning and conservation of marine and coastal biodiversity over the next 5–10 years. Based on a modified Delphi voting process, the final 15 issues presented were distilled from a list of 75 submitted by participants at the start of the process. These issues are grouped into three categories: ecosystem impacts, for example the impact of wildfires and the effect of poleward migration on equatorial biodiversity; resource exploitation, including an increase in the trade of fish swim bladders and increased exploitation of marine collagens; and new technologies, such as soft robotics and new biodegradable products. Our early identification of these issues and their potential impacts on marine and coastal biodiversity will support scientists, conservationists, resource managers and policymakers to address the challenges facing marine ecosystems

Understanding the carriage and transmission of non-typhoidal Salmonella infections in Kenya.

Non-typhoidal Salmonellae (NTS) are responsible for enteric disease characterized by self- limiting enterocolitis in most parts of the world. In Africa, however, they cause severe invasive disease and a high case fatality ratio. The serotypes responsible for >80% of invasive NTS disease (iNTS) are S. Typhimurium and S. Enteritidis. Control efforts against these NTS serotypes are limited by a lack of understanding of their transmission - both mode and rates of transmission. This PhD was designed to improve the understanding of the epidemiology of carriage of NTS and its rate of transmission to enable efficient design of effective control strategies, including vaccination. Through a cross-sectional study of faecal carriage and seroprevalence in 3 locations in Kenya with varying incidence of iNTS, I observed that Kilifi, had the highest carriage prevalence despite the lowest incidence of disease. However, the majority serotypes were neither S. Typhimurium nor S. Enteritidis. At all sites, older children and adults had the highest carriage. Analysis of anti-Salmonella antibodies showed a decay of maternal antibodies in 4-5 months and a rapid acquisition of NTS infections among infants thereafter. A catalytic model of the seroprevalence data estimated the force of infection (FOI) with Group O:4,5 serotypes and Group O:9 serotypes as ranging from 0.2 to 0.5 episodes/person/year- both were highest in Kilifi. I carried out an additional longitudinal seroprevalence study retrospectively on archived samples in Kilifi. I observed that the FOI of Group O:9 serotypes had decreased over time concurrently with a documented decrease in iNTS incidence while the FOI of Group O:4,5 increased as iNTS incidence decreased in one of the locations. These suggest that interrupting transmission can be a strategy for control of iNTS caused by these serotypes, possibly through vaccines which reduce faecal carriage. Such measures can be focused on older children and adults who are the reservoirs for infection, especially in households with infants who have the highest incidence of infection and are at highest risk of invasive disease. For control of S. Typhimurium disease, host risk factors will need to be addressed. The parameters we have estimated such as FOI could be used to inform dynamic transmission models to predict vaccine effectiveness and cost-effectiveness analyses of different potential vaccination strategies including vaccination of pregnant mothers, infants, or older children

Meiofauna and macrofauna community structure in relation to sediment composition at the Iberian margin compared to the Goban Spur (NE Atlantic)

Meiofauna and macrofauna communities and several sediment characteristics were compared between a slope situated far from the coast (Goban Spur) and two transects across the Iberian Margin with steep slopes and close to the shore. The northern Galician transect (off La Coruña) was situated in an area subjected to wind-induced upwelling events. The western Galician transect was also subjected to upwelling, was additionally influenced by outflows of water rich in organic matter from the Rías Bajas. This transect also included the Galicia Bank. Macrofauna density decreased exponentially from the shelf edge (154 m) to the abyssal plain (4951 m) and different communities occurred on the shelf, the upper- and lower slope and on the abyssal plain. Apart from two extremely low-density stations on the Iberian Margin, there were no significant differences in the meiofauna between the Goban Spur and the Iberian Margin. Along the La Coruña-transect a station where meiofaunal densities were low occurred at a depth of 1522 m, where the sediment was characterised by having a high median-grain size, ripple structures, a low Corg and total N content. There were relatively high numbers of macrofaunal filter-feeders but low numbers of crustaceans, indicating a high current velocity regime. On top of the Galicia Bank (~770 m) the sediment consisted mainly of shells of pelagic foraminifers, and had low contents of Corg and N. The macrofauna was dominated by filter-feeding and carnivorous taxa. At both these stations meiofauna densities were low. Meiofauna densities and community structure differed between the Goban Spur and the Iberian Margin. Meiofauna densities on the Galician shelf were more than double those on the Goban Spur shelf. The two deep stations on the La Coruña transect and the deepest station on the Galicia Bank transect all contained meiofaunal densities that were higher than found at similar depths off the Goban Spur. The meiofaunal densities were inversely correlated with %CaCO3 content and, excluding the shelf stations, were positively correlated with both %Corg and total N at the Iberian Margin. Neither upwelling nor the enriched outflows from the rias affected the macrofauna, but meiofaunal densities were greatly enhanced. [KEYWORDS: Meiofauna; macrofauna; benthic community structure; Iberian margin; sediment characteristics]

Size-dependent distribution and feeding habits of <i>Terebralia palustris</i> in mangrove habitats of Gazi Bay, Kenya

The gastropod Terebralia palustris often dominates the surface of muddy to sandy substrates of intertidal mudflats and mangrove forests, where they clearly destabilize the sediment. In the present study, it was investigated whether and to what extent the behaviour of juvenile and adult snails differs among habitats (mudflat vs. mangrove stand) in a Sonneratia alba mangal at Gazi Bay, Kenya. For this purpose we: (1) examined their distribution along three land-sea transects; and (2) applied stable isotope analysis to determine the feeding patterns of different-sized snails from the mangrove and mudflat habitats. Additionally, we investigated if these gastropods exert an impact on microphytobenthic (diatom) biomass, and whether this is size-dependent. The latter objective was met by either enclosing or excluding different-sized snails from experimental cages on the intertidal mudflat and the subsequent assessment of a change in pigment concentration of the sediment surface. In agreement with several previous studies conducted in other mangroves and geographical locations, a spatial segregation was demonstrated between juveniles (more common on the mudflat) and adults (more common in the mangrove forest). On the intertidal mudflat juveniles avoided sediment patches characterized by highly saline water in intertidal pools and a high mud content, while adults tended to dwell on substrates covered by a high amount of leaf litter. Stable carbon isotope analysis of the foot tissue of snails sampled from the S. alba stand and the mudflat indicated a transition in food source when a shell length of 51 mm is reached. Considering the d13C value of juveniles, it seems they might be selecting for microphytobenthos, which might explain their preference for the mudflat. The diet of size classes found in both habitats did not differ significantly, although juveniles inhabiting the mangrove forest were slightly more depleted in 13C compared to those residing on the mudflat. Assuming juveniles feed on benthic microalgae and considering the lower microalgal biomass inside the mangrove forest, this may be a consequence of a higher contribution of other, more 13C depleted organic carbon sources, like phytoplankton, to their diet. Experimental results indicate a negative, but insignificant, impact on benthic diatom biomass by juveniles (due to grazing) and adults (due to physical disturbance). This finding seems to be in agreement with the results of the stable carbon isotope analysis, strongly suggesting the selective feeding of juvenile T. palustris on benthic diatoms