Understanding the drivers of change in sexual and reproductive health policy and legislation in Kenya

The thesis explored the drivers and inhibitors of change in sexual and reproductive health (SRH) policy and legislation in Kenya. The overall purpose was to contribute to the limited knowledge on national-level debates that shape how developing countries adapt the SRH agenda, which originated from international processes. The thesis explains how and why some SRH reforms have been realised in Kenya amid contention, while others have been blocked. Guided by a synthesis conceptual framework that emphasised the central role of discursive power in decision-making, the thesis adopted a qualitative case-study design enriched with various anthropological concepts. Three case-studies (two bureaucratic, i.e. adolescent RH policy and national RH policy, and one legislative, i.e. sexual offences law) were deconstructed. Data collection involved semi-structured in-depth interviews with policy actors, observations and note-taking in meetings, and document review. Findings revealed that four influential narratives of SRH – the moral narrative, cultural narrative, medical narrative (with two variations i.e. ‘moralised’ versus ‘comprehensive’ medical narratives), and human rights narrative – underpinned by conflicting actor interests, mediated the interplay of actor networks, knowledge, context and institutions to determine reforms. The findings revealed that the strong entrenchment of the moral and cultural narratives in the Kenyan context (mainly public structures and institutions) was a major barrier to reforms on contested SRH issues. Even then, the hegemonic narratives were in some cases unsettled to make reforms possible. The most important factors in unsettling the hegemonic narratives to facilitate reforms included: a change in the political context that brought in new political actors supportive of reforms, the presence of knowledgeable and charismatic issue champions within political and bureaucratic institutions, the availability of compelling knowledge (scientific or lay) on an issue, sustained evidence-informed advocacy by civil society/non-governmental organisations, donor pressure, and reduced political costs (for politicians and bureaucrats) for supporting reforms. The main contribution of the thesis is three-fold. First, the thesis captures the disconnect between international SRH agreements and national-level realities, showing the need for international actors to consider national-level realities that shape decision-making. Second, its findings provide lessons for informing future SRH reform efforts in Kenya and in other sub-Saharan African countries. Third, its analysis of discursive power contributes to a major theoretical gap in health systems research in developing countries identified as lack of critical analysis of power in decision-making

Identification of Selected Kinetoplastids 18S rRNA Residues required for Efficient Recruitment of Initiator tRNA Met and AUG Selection in silico

High Resolution 18S rRNA structures of kinetoplastids ribosomes from theoretical methods have provided atomic level details about the process of translation. This process entails detailed information on the mRNA and tRNA binding and decoding centers within the 18S rRNA that was previously not very well understood. We identified residues in selected kinetoplastids 18S rRNA critical in recruiting the first methionyl tRNA to the small ribosome subunit during initiation and comparing them to see the differences. The Kozak sequence presence on eukaryotic mRNAs tethers it to the AUG start codon. Kinetoplastids are a closely related group, and the three chosen exhibited differences in the A-site in terms of position and nucleotides found there. Interactions are found at the A-site (543-UUU-546 for T. cruzi, 560-CCUA-563 for T. brucei, and 540-UUUG-543 for Leishmania major), where the different mRNA get complementary sequences at the 16th helix. The current findings show that each messenger RNA has a sequence that is complementary to the appropriate 18S rRNA sequence, tethering the mRNA to the small ribosomal subunit, which then recruits the bigger subunit. When compared to the Kozak region that flanks the AUG start codon, this method effectively promotes start codon placement

Engaging media in communicating research on sexual and reproductive health and rights in sub-Saharan Africa: experiences and lessons learned

Background: The mass media have excellent potential to promote good sexual and reproductive health outcomes, but around the world, media often fail to prioritize sexual and reproductive health and rights issues or report them in an accurate manner. In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners. This paper describes the experiences of the African Population and Health Research Center and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa. Methods: The paper utilizes a case study approach based primarily on the personal experiences and reflections of the authors (who played a central role in developing and implementing the Center’s communication and policy engagement strategies), a survey that the Center carried out with science journalists in Kenya, and literature review. Results: The African Population and Health Research Center’s media strategy evolved over the years, moving beyond conventional ways of communicating research through the media via news releases and newspaper stories, to varying approaches that sought to inspire and build the capacity of journalists to do evidence-based reporting of reproductive health issues. Specifically, the approach included 1) enhancing journalists’ interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting ; 2) building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and 3) establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal meetings between journalists and researchers, organizing field visits for journalists, and building formal partnerships with professional media associations and individual journalists. Conclusion: Our experiences and reflections, and the experiences of others reviewed in this paper, indicate that a sustained mix of strategies that motivate, strengthen capacity of, and build relationships between journalists and researchers can be effective in enhancing quality and quantity of media coverage of research

Preparation of anti-vicinal amino alcohols: asymmetric synthesis of D-erythro-Sphinganine, (+)-spisulosine and D-ribo-phytosphingosine

Two variations of the Overman rearrangement have been developed for the highly selective synthesis of anti-vicinal amino alcohol natural products. A MOM-ether directed palladium(II)-catalyzed rearrangement of an allylic trichloroacetimidate was used as the key step for the preparation of the protein kinase C inhibitor D-erythro-sphinganine and the antitumor agent (+)-spisulosine, while the Overman rearrangement of chiral allylic trichloroacetimidates generated by asymmetric reduction of an alpha,beta-unsaturated methyl ketone allowed rapid access to both D-ribo-phytosphingosine and L-arabino-phytosphingosine

The synthesis and reactivity of 1,5-dioxaspiro[3.2]hexanes

A general synthesis of 1,5-dioxaspiro[3.2]hexanes is described. This was accomplished via epoxidation of 2-methyleneoxetanes with dry dimethyldioxirane. A study on the chemoselectivity of the epoxidation of the double bond of 2-methyleneoxetanes against that of an isolated alkene was undertaken and resulted in the exclusive epoxidation of the enol ether double bond. ^ The efficient access to 1,5-dioxaspiro[3.2]hexanes afforded us the opportunity of exploring the reactivity of these systems. Studies on their ring opening reactions with nucleophiles revealed an interesting dichotomy in reactivity. Most of the nucleophiles employed provided α-substituted, β ′-hydroxyketones in good yields. However, those nucleophiles that incorporated a Lewis acid produced 2,2-disubstituted oxetanes. ^ We were intrigued by the potential application of sequences derived from the mode of ring opening leading to α-substituted, β′ -hydroxyketones. The ease of manipulation of products of this reaction pathway into multifunctionalized compounds was fairly obvious. One class of natural products targeted was the glycosphingolipids, ubiquitous components of cell membranes, involved in virtually all aspects of cellular interactions. Herein, we demonstrate the utility of 3-amino-1,5-dioxaspiro[3.2]hexane in the formal synthesis of an analog of KRN7000, an α-galactosylceramide currently in clinical trials as a chemotherapeutic agent for the treatment of liver tumors.

The contribution of the polio eradication initiative on the operations and outcomes of non-polio public health programs: a survey of programs in the African region

Introduction: the effect of the Global polio eradication initiative (PEI) on public health programs beyond polio is widely debated. PEI contribution to other health programs has been assessed from the perspective of polio-funded personnel, which may introduce bias as PEI staff are probably more likely to show that they have benefited of other programs. We set out to identify and document how public health programs have benefited from the public health capacity that was provided at the country level as part of the PEI program in a systematic and standardized manner. Methods: between July and November 2017, we conducted a mixed-methods cross-sectional study, which combined two methods: a multi-country quantitative survey and a qualitative study. We created a self-administered electronic multi-lingual questionnaire in English, French and Portuguese. The qualitative study, which followed an interim analysis of the quantitative survey, comprised interviews with national and subnational level staff in a few countries. Results: a total of 127 public health workers from 43 of the 47 countries in the African WHO Region responded online. Most of the respondents 56/127 (42.7%) belonged to the immunization sector and 51/127 (38.9%) belonged to the emergencies and outbreaks sector. Respondents who identified themselves with the immunization (50/64 (78%)) and maternal health program (64/82 (78%)) reported the highest level of greatly benefiting from PEI resources. A total of 78/103 (76%) respondents rated PEI’s contribution data management system to their program very high and high. Of the 127 respondents, the majority 91 (71.6%) reported that the withdrawal of PEI resources would result in a weakening of surveillance for other diseases; 88 (62.9%) reported that there would be inadequate resources to carry out planned activities and 80 (62.9%) reported that there would be poor logistics and transport for implementation of activities. Cameroon, DRC, Nigeria and Uganda participated in the qualitative study. Each country had between 7-8 key informants from the national and sub-national level for a total of 31 key informants. Polio funds and other PEI resources have supported various activities in the ministries of health of the four countries especially IDSR, data management, laboratories and development of the public health workforce. Respondents believed that the infrastructure and processes that PEI has created need to be maintained, along with the workforce and they believed that this was an essential role of their governments with support from the partners. Conclusion: there is a high awareness of the PEI program in all the countries and at all levels which should be leveraged into improving other child survival activities for example routine immunizations. Future large-scale programs of this nature should be designed to benefit other public health programs beyond the specific program. The public health workforce, surveillance development, data management and laboratory strengthening that have been developed by PEI need to be maintained

Directed Ring-Opening Of 1,5-Dioxaspiro[3.2]Hexanes: Selective Formation Of 2,2-Disubstituted Oxetanes

1,5-Dioxaspiro[3.2]hexanes undergo ring-opening reactions with many heteroatom nucleophiles to provide alpha-substituted-beta\u27-hydroxy ketones. However, certain Lewis acidic nucleophiles provide 2,2-disubstituted oxetanes. Herein, the results of reactions of 3-phenyl-1,5-dioxaspiro[3.2]hexane with a variety of nitrogen-containing heteroaromatic bases are reported. There appears to be a correlation between the pK(a) of the nucleophile and the reaction outcome with more acidic nucleophiles providing 2,2-disubstituted oxetanes. Moreover, the mode of ring opening can be directed toward the substituted oxetane by the addition of a Lewis acid. These results are rationalized by calculation of stationary points on the potential energy surfaces for the various possible reaction pathways using ab initio molecular orbital methods