Voluntary medical male circumcision: Safety and satisfacion at Migori County Hospital

Background: The World Health Organization (WHO) recommended Voluntary Medical Male Circumcision (VMMC) as an HIV prevention option for men based on evidence showing a reduction in HIV acquisition of 50% to 60%. Based in this evidence, the rapid expansion of VMMC in sub Saharan Africa has raised concerns on the capacity of VMMC programs to provide sustainable high quality and safe VMMC services.Objective: To determine the rates and correlates of adverse events following VMMC among clients attending Migori County Hospital.Design: Descriptive cross sectional study Setting: Migori County Referral Hospital, Kenya.Subjects: Between November and December 2015, 138 men receiving VMMC services at Migori County hospital were interviewed during their follow up visits within 7 days following the procedure. We systematically sampled every third participant attending their follow up visit. Face to face interviews were conducted to obtain data on demographics and levels of satisfaction, and physical examination to determine any adverse events after circumcision. Fishers exact was used to test for correlates of adverse events among participants.Results: The mean age of participants was 22 years, Standard Deviation (SD) ±5) .About two-thirds (63.8%) had reached secondary level education, 26(18.8%) tertiary level, 23(16.7%) primary level and only 1(0.7%) had no education. The majority 100(72.5%) reported being aware of possible adverse events following male circumcision and almost all 135 (97.8%) participants reported having adhered to wound care instructions. The rate of mild and moderate adverse events was 58.7% and 2.9%, respectively. There was no severe adverse event reported. Bathing and not changing underpants was associated with adverse events. The Majority 137 (99.3%) of participants were highly satisfied with the circumcision procedure and the post-operative care services they received.Conclusion: These results imply that VMMC in this setting can be delivered safely and effectively with high client satisfaction

Teachers’ Perceptions Towards Instructional Supervisory Competences of Educational Quality Assurance and Standards Officers

The main purpose of this study was to assess the existing perceptions of school principals and Heads of Departments (HoDs) towards the instructional supervisory competences of Quality Assurance and Standards Officers (QASOs) in secondary schools in Nairobi and Machakos counties, Kenya. The study aimed to investigate the school principals’ and HoDs’ perceptions towards QASOs’ human, technical and conceptual skills. The study used three types of research instruments, namely; School Principals’ and Heads of Departments’ Questionnaire, Quality Assurance and Standards Officers’ Questionnaire and County Quality Assurance and Standards Officers’ Interview Guide. Data was analyzed used mixed methods, involving qualitative and quantitative techniques. The study revealed that, teachers hold the opinion that QASOs exhibited favorable human relations competences, however, QASOs were found to be partially effective in respect to technical and conceptual competences. The study recommends that the QASOs already in the field to be taken through intensive capacity building trainings in their specific subjects so as to equip them with requisite technical and conceptual competences for conducting instructional supervision. Keywords: Quality Assurance and Standards Officers (QASOs), instructional supervisory competences, Teachers’ perception

Analysis of Blue Chamomile Essential Oil produced by multi-solvent Solvent Extraction Clevenger Distillation Method

Blue colored essential oil samples were obtained from chamomile flowers by a Solvent Extraction Clevenger Distillation (SECD) method and by the standard Clevenger distillation of Chamomile flowers. The solvents used were hexane, acetone, dichloromethane (DCM), ethyl acetate and methanol. The solvents were evaluated in terms of the yield of extract, and the quality of extract (determined by Gas Chromatography-Mass Spectrometry). Of all the SECD extracts, the DCM extract gave the highest yield of the essential oil while the hexane extract gave the lowest yield of the blue essential oil

Effects of Allium Sativum Ethanolic Extract on Trypanosoma brucei brucei Parasites’ Morphometric Parameters and Clinical Outcome in White Albino Laboratory Rats

Background: Trypanosomosis affects humans as well as wild and domestic vertebrates, yet has no successful prophylaxis, chemotherapy nor cure.Objectives: The study was to investigate the effects of Allium sativum extract on Trypanosoma brucei brucei parasites’ morphometric parameters, parasitemia and the clinical outcome in white infected Albino laboratory rats in order to determine its trypanocidal effects.Methodology: The study was conducted at the department of Biological Sciences Laboratory of the Moi University Eldoret. Thirty two (32) mature rats randomly divided into four groups (M, N, P and Q) were kept in four (4) cages in a well ventilated room, with adequate light supply in the day.Sixteen (16) rats were infected with T. b. brucei (1.0 x 104 parasites per rat); eight (8) of which (Group N) were treated with the A. sativum ethanolic  extract on day 5 and day 9 after infection, while the other eight (8)rats (Group Q) received saline treatment on the same days.Sixteen (16) non-infected rats (controls) were also divided into two groups of eight rats each (P and M) and treated as in group N and Q, respectively. The rats were obtained from University of Nairobi, Chiromo Campus.Results: All infected rats became parasitemic two days after infection and reached peak levels on day 4 and 5 post infection. Parasitemia in saline treated infected rats fluctuated between 4025.5 ± 0.05 - 5544.4 ± 0.05 parasites per 200WBC whereas in the extract treated rats parasitemia declinedfrom 6976.6 ± 0.05 - 311.0 ± 0.05 parasites per 200WBC after the first treatment. Uninfected saline treated rats maintained normal Hb level (10.6g/L to 11.8g/L) as compared to the uninfected extract treated rats’ whose Hb levels was at 13.41g/L to 14.36g/L. The haemoglobin level changed to 8.0g/L four days after the infection in the group N rats before rising to 10.2g/L on day 8 post-infection following the extract treatments. Group Qrats’ Hb declined to 6.43g/L by the end of the study. RBC count of the infected saline treated rats declined to 3.38 x 106/μL as compared to 4.93-7.61 x 106/μL in the normal rats by 11 days postinfection. There was however no significant change in WBC, temperature and weight between the saline extract treated rats. The extract produced a shrinking effect on the parasite's body with some of the morphometric parameters appearing  significantly (P<0.05) reduced as observed under a microscope with ocular and stage micrometer scale. The mean nucleus, posterior ends to nucleus centre, the nucleus centre to the anterior end and the body length were reduced from 2.41μm to 1.42μm(P=0.00), 4.42μm to  3.68μm(P=0.017) , 4.65μm to 4.18μm(P=0.001) and 8.58μm to 7.19μm(P=0.001) respectively.Conclusion: In conclusion it was evident that, A. sativum ethanolic extract exhibited Trypanocidal effects that can be exploited to control clinical progression of Trypanosomosis in rats. In addition, the data presented demonstrates the plant extract had the potential to improve the red and white blood cell indices reducing parasitaemia following T. b. brucei infection. These findings suggest that, the garlic extract affected the plasma membrane of the parasites since shrinking was only possible with disrupted membrane biochemistry. Key words:  Trypanosoma brucei brucei, Allium Sativum, Parasitemia, Morphometric parameters

Effects Of Catha edulis’ Leaf Extract on Blood Chemistry and Kidney Tissues in Small East African Male Goats from Rift Valley Province of Kenya

Objectives: To determine the serum electrolytes levels in animals treated with Catha edulis leaf extract.Design: Experimental studySetting: Department of Biological Sciences at the Chepkoilel University College, Moi UniversitySubjects: Fourteen (14) reproductively mature and healthy small East African male goats (Capra aegagrus hircus) from Kerio Valley in Rift Valley province of Kenya.Intervention: Plasma electrolytes (Na+, K+, Ca2+ and Cl-), urea, creatine and glucose levels were investigated in eight control and fourteen experimental small East African male goats before and after treatment with Catha edulis leaf extracts. At the end of the study the animals’ were sacrificed and their kidneys extracted for histological examination.Results: mean sodium and calcium levels were lower in treated animals than nontreated animals (138 v/s 143.6 mmol/L and 3.3 v/s 2.2 mmol/L respectively), p<0.001 Plasma glucose levels also declined from  4.0-4.1mmol/L to 3.3-3.5mmol/L following the Catha edulis leaf extract treatment. However serum nitrogenous metabolites levels increased significantly in Catha edulis treated animals (urea; 6.5 v/s 5.2 mmol/L andcreatine; 69.9 v/s 55.4 mmol/L). Histological examination of renal tissue of Catha edulis treated animals revealed degenerative changes and hypercellularity in the glomeruli as well as interstitial inflammatory cell infiltration. Nuclei of proximal convoluted tubule cells also appeared pyknotic while those of the macula densa appeared granular.Conclusion: The present study showed that Catha edulis treatment was associated with electrolyte imbalance which may have been as a result of degenerative changes in the renal system. The findings are a pointer to the fact that Catha edulis use may predispose the users to renal disorders and subsequent electrolyte imbalance

Antimicrobial resistance and plasmid profiles of Aeromonas hydrophila isolated from River Njoro, Kenya

The purpose of this study was to investigate the presence of Aeromonas hydrophila at commonly used water collection points on the River Njoro and to determine the in-vitro antimicrobial susceptibility and plasmid profiles of isolates. In total, 126 samples were collected and 36.5% of them were positive for A. hydrophila. The A. hydrophila were recovered on membrane filters, cultured on Trypticase Soy agar, Bile aesculin agar and Aeromonas Medium agar. They were further characterized using cytochrome oxidase and API 20E tests. Detection of drug susceptibility was determined using modified disc diffusion method to ampicillin (25 ìg), cefaclor (30 ìg), ceftizoxime (30 ìg), cefixime (5 ìg), cefazidime (30 ìg), gentamicin (200 ìg), streptomycin (25 ìg), chloramphenicol (50 ìg), nalidixic acid (30 ìg) and ciprofloxacin (1 ìg). Most of the isolates showed multi-drug resistance to two or more antibiotics. Chloramphenicol, nalidixic acid, ciprofloxacin, cefazidime and cefixime were the most sensitive drugs with 100% efficacy whereas ampicillin, cefaclor and streptomycin were the most resistant drugs having 100, 67 and 50 resistance, respectively. There was low resistance against ceftizoxime (16.7%) and gentamicin (23.3%). These results indicates that all A. hydrophila isolated from River Njoro had complete resistance to ampicillin and showed variable resistance to cefaclor, streptomycin, gentamycin and ceftizoxime. R-plasmids were extracted from multi-drug resistance strains and separated by agarose gel (0.8%) electrophoresis for profiling. Plasmid profiling revealed that most of the multi-drug resistant isolates contained one plasmid of 21.0 kb. Although some strains exhibited different antimicrobial resistance patterns, all of their plasmids were of the same size (21.0 kb). However, there were no plasmids in the antimicrobial sensitive isolates. This study also indicates that plasmid 21.0 kb is common in A. hydrophila and is important for antimicrobial resistance and virulence. Further studies are required to ascertain the role of this plasmid as a virulence marker.Key words: Aeromonas hydrophila, antimicrobial resistance, plasmid profile

Perceptions of diabetes risk and prevention in Nairobi, Kenya: a qualitative and theory of change development study

Background: Type 2 diabetes is increasing in Kenya, especially in urban settings, and prevention interventions based on local evidence and context are urgently needed. Therefore, this study aimed to explore diabetes risk and co-create a diabetes prevention theory of change in two socioeconomically distinct communities to inform future diabetes prevention interventions. Methods: In-depth interviews were conducted with middle-aged residents in two communities in Nairobi (one low-income (n = 15), one middle-income (n = 14)), and thematically analysed. The theory of change for diabetes prevention was informed by analysis of the in-depth interviews and the Behaviour Change Wheel framework, and reviewed by a sub-set (n = 13) of interviewees. Results: The key factors that influenced diabetes preventive practices in both communities included knowledge and skills for diabetes prevention, understanding of the benefits/consequences of (un)healthy lifestyle, social influences (e.g., upbringing, societal perceptions), and environmental contexts (e.g., access to (un)healthy foods and physical activity facilities). The proposed strategies for diabetes prevention included: increasing knowledge and understanding about diabetes risk and preventive measures particularly in the low-income community; supporting lifestyle modification (e.g., upskilling, goal setting, action planning) in both communities; identifying people at high risk of diabetes through screening in both communities; and creating social and physical environments for lifestyle modification (e.g., positive social influences on healthy living, access to healthy foods and physical activity infrastructure) particularly in the low-income community. Residents from both communities agreed that the strategies were broadly feasible for diabetes prevention but proposed the addition of door-to-door campaigns and community theatre for health education. However, residents from the low-income community were concerned about the lack of government prioritisation for implementing population-level interventions, e.g., improving access to healthy foods and physical activity facilities/infrastructure. Conclusion: Diabetes prevention initiatives in Kenya should involve multicomponent interventions for lifestyle modification including increasing education and upskilling at individual level; promoting social and physical environments that support healthy living at population level; and are particularly needed in low-income communities

A randomized control trial of phototherapy and 20% albumin versus phototherapy and saline in Kilifi, Kenya

Objective: The study evaluated the efficacy of phototherapy and 20% albumin infusion to reduce total serum bilirubin (TSB) in neonates with severe hyperbilirubinemia. The primary outcome was a reduction of TSB at the end of treatment. The secondary outcomes were the need for exchange transfusion, inpatient mortality, neurological outcomes at discharge, and development outcomes at 12-months follow-up. Results: One hundred and eighteen neonates were randomly assigned to phototherapy and 20% albumin (n = 59) and phototherapy and saline (n = 69). The median age at admission was 5 (interquartile range (IQR) 3–6) days, and the median gestation was 36 (IQR 36–38) weeks. No significant differences were found in the change in TSB (Mann–Whitney U =609, p = 0.98) and rate of change in TSB per hour after treatment (Mann–Whitney U = 540, p = 0.39) between the two groups. There were no significant differences between the two groups in the proportion of participants who required exchange transfusion (χ2 (2) = 0.36, p = 0.546); repeat phototherapy (χ2 (2) = 2.37, p = 0.123); and those who died (χ2 (2) = 0.92, p = 0.337). Trial registration The trial was registered in the International Standardized Randomized Controlled Trial Number (ISRCTN); trial registration number ISRCTN89732754

Screening of Indigofera lupatana Baker F. root extracts for antibacterial activities

Herbal remedies as cheap alternatives to conventionalmedicine have contributed significantly to rurallivelihoods. Apart from the traditional healerspracticing herbal medicine, many people are involved incollecting and trading medicinal plants. The WorldHealth Organization (WHO) estimates that 80% of theworld’s population depends on medicinal plants fortheir primary health care (Mothana et al, 2008; Ngoci etal, 2011). The use of traditional medicine has beenexplored globally and is widely used in developingcountries as an alternative or to complementconventional medicine (Rates, 2001; Gupta et al, 2010).Natural products, either as pure compounds or asstandardized plant extracts, provide exceptionalopportunities for new drug leads because of theunmatched chemical diversity of naturally derivedcompounds (Cowan, 1999; Parekh and Chanda, 2007;Mariita et al, 2010; Ngoci et al, 2011). Scientific interestin medicinal plants has burgeoned due to therecognized efficacy of plant derived drugs and everpresentconcerns about the side effects of modernmedicinal substances. This has fuelled the intensiveinvestigation of new molecular structures from theplant kingdom as potential medicinal compounds(Mariita et al, 2010). As a result, drugs derived fromunmodified natural products or semi-synthetic drugsobtained from natural sources accounted for 78% of thenew drugs approved by the United States Food andDrug Administration (FDA) between 1983 and 1994(Suffredini et al, 2006; Ngoci et al, 2011). Thisunderscores the importance of screening naturalproducts.Infectious diseases are a leading cause of human andanimal mortality. This is further aggravated by the rapiddevelopment of multi-drug resistance to available antimicrobialagents (Doughart and Okafor, 2007; Ngoci etal, 2011), their limited anti-microbial spectrum, theirside effects (Huie, 2002), and emergence and reemergenceof opportunistic infections. Therefore,studies aimed at identifying and characterizing of thesubstances that exhibit activity against infectious microorganisms,yet showing no cross resistance withexisting antibiotics, are required (Olila et al, 2001). Inrecent years, pharmaceutical companies have focusedon developing drugs from natural products thatpromises to counter the limitations of conventionalantibiotics (Doughart and Okafor, 2007).The bio-activity of natural products is due tophytochemicals, a group of secondary metabolites oftenelaborated for the plant defense against pests andherbivores or to gain an advantage over competingagents. These phytochemicals inadvertently also protecthumans against pathogens (Ngoci et al, 2011). Somephytochemicals are known to have antimicrobialproperties, immune-modulative properties, providenutrition for normal cell health and repairs, inhibitcarcinogens and act as antioxidants.Indigofera lupatana Baker F., locally called ‘mugiti’ bythe Mbeere community in Kenya, is a woody shrubfound in Acacia-Combretum ecological zones of Mbeere.It is widely used for its perceived medicinal value intreating coughs and diarrhea (Riley and Brokensha,1988; Ngoci et al, 2011), gonorrhea and pleurisy(Kokwaro, 1993; Ngoci et al, 2011).There is apparently no documented scientific report onanti-microbial properties of this plant. This lack ofscientific corroboration has often constituted a majorconstraint to the consideration of the use of herbalremedies in conjunction with or as an affordablealternative to conventional medical treatment (Okeke etal, 2001). Knowledge of the chemical constituents ofplants is desirable not only for the discovery oftherapeutic agents, but also because such informationmay be important in identifying new sources ofsubstances of economic value such as tannins, oils,gums, and precursors for the synthesis of complexchemical substances. In addition, the knowledge of thechemical constituents of plants would further bevaluable in discovering the actual value of folkloricremedies (Mojab et al, 2003).This study was therefore undertaken to determine theantibacterial properties of hexane, ethyl acetate anddichloromethane root extracts of I. lupatana Baker F

HEALTH POLICIES IN KENYA AND THE NEW CONSTITUTION FOR VISION 2030

Abstract Promoting global health ensures progress in basic humanitarian values in saving and improving lives. In recent years, improving global health has proven its advanced value in promoting securit