Exposure of Kenyan population to aflatoxins in foods with special reference to Nandi and Makueni counties

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Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model

Background: Injuries cause five million deaths and 279 Disability Adjusted Life Years (DALYS) each year worldwide. The COSECSA Oxford Orthopaedic Link (COOL) is a multi-country partnership programme that has delivered training in trauma management to nine sub-Saharan countries across a wide-cadre of health-workers using a model of "primary" courses delivered by UK instructors, followed by "cascading" courses led by local faculty. This study examines the impact on knowledge and clinical confidence among health-workers, and compares the performance of "cascading" and "primary" courses delivered in low-resource settings. Methods: Data was collated from 1030 candidates (119 Clinical Officers, 540 Doctors, 260 Nurses and 111 Medical Students) trained over 28 courses (9 "primary" and 19 "cascading" courses) in nine sub-Saharan countries between 2012 and 2013. Knowledge and clinical confidence of candidates were assessed using pre- and post-course MCQs and confidence matrix rating of clinical scenarios. Changes were measured in relation to co-variants of gender, job roles and primary versus cascading courses. Multivariate regression modelling and cost analysis was performed to examine the impact of primary versus cascading courses on candidates' performance. Findings: There was a significant improvement in knowledge (58% to 77%, p < 0.05) and clinical confidence (68% to 90%, p < 0.05) post-course. "Non-doctors" demonstrated a greater improvement in knowledge (22%) and confidence (24%) following the course (p < 0.05). The degree of improvement of MCQ scores differed significantly, with the cascading courses (21%) outperforming primary courses (15%) (p < 0.002). This is further supported by multivariate regression modelling where cascading courses are a strong predictor for improvement in MCQ scores (Coef = 4.83, p < 0.05). Interpretation: Trauma management training of health-workers plays a pivotal role in tackling the ever-growing trauma burden in Africa. Our study suggests cascading PTC courses may be an effective model in delivering trauma training in low-resource settings, however further studies are required to determine its efficacy in improving clinical competence and retention of knowledge and skills in the long term

Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model.

Injuries cause five million deaths and 279 Disability Adjusted Life Years (DALYS) each year worldwide. The COSECSA Oxford Orthopaedic Link (COOL) is a multi-country partnership programme that has delivered training in trauma management to nine sub-Saharan countries across a wide-cadre of health-workers using a model of "primary" courses delivered by UK instructors, followed by "cascading" courses led by local faculty. This study examines the impact on knowledge and clinical confidence among health-workers, and compares the performance of "cascading" and "primary" courses delivered in low-resource settings.Data was collated from 1030 candidates (119 Clinical Officers, 540 Doctors, 260 Nurses and 111 Medical Students) trained over 28 courses (9 "primary" and 19 "cascading" courses) in nine sub-Saharan countries between 2012 and 2013. Knowledge and clinical confidence of candidates were assessed using pre- and post-course MCQs and confidence matrix rating of clinical scenarios. Changes were measured in relation to co-variants of gender, job roles and primary versus cascading courses. Multivariate regression modelling and cost analysis was performed to examine the impact of primary versus cascading courses on candidates' performance.There was a significant improvement in knowledge (58% to 77%, p&lt;0.05) and clinical confidence (68% to 90%, p&lt;0.05) post-course. "Non-doctors" demonstrated a greater improvement in knowledge (22%) and confidence (24%) following the course (p&lt;0.05). The degree of improvement of MCQ scores differed significantly, with the cascading courses (21%) outperforming primary courses (15%) (p&lt;0.002). This is further supported by multivariate regression modelling where cascading courses are a strong predictor for improvement in MCQ scores (Coef=4.83, p&lt;0.05).Trauma management training of health-workers plays a pivotal role in tackling the ever-growing trauma burden in Africa. Our study suggests cascading PTC courses may be an effective model in delivering trauma training in low-resource settings, however further studies are required to determine its efficacy in improving clinical competence and retention of knowledge and skills in the long term

Testing for Antibodies to Brucella abortus in Milk From Consumers and Market Agents in Kenya Using Milk Ring Test and Enzyme Immunoassay

Over 85% of all milk sales on Kenya pass through informal channels. The extent of the risk posed by the sale of this raw milk to human health in respect to brucellosis is unknown. This paper presents the results of a study on the occurrence of antibodies to Brucella abortus in milk from households consuming raw unpasteurized milk and market agent selling the same. Four hundred thirty four (434) raw milk samples from consumer households and 508 from informal market agents were collected between January 1999 and January 2000 from Nakuru /Narok and Nairobi/Kiambu. Milk agents sampled included co-operative societies, milk collecting centers and self-help groups, milk bars, shops and kiosks and mobile traders on foot, bicycle or motorized transport. In addition, 147 samples from the formal market chain (pasteurized) were collected. All the samples from the samples were screened for antibodies to Brucella abortus using ELISA and Milk Ring Test (MRT), except for the formal milk that was tested using ELISA only. Five percent of the consumer household samples and 4% of the samples form informal milk market agents tested positive on ELISA. There was poor agreement between the two antibody surrogate tests (Kappa =0.40, 95% confidence interval =0.19-0.60). ELISA detected 3.2% more samples from consumer households and 0.4% from informal market agents than MRT. Of the formal market samples, 16.4% were positive. Ways of reducing the risk of contracting brucellosis from drinking raw milk are proposed. The Kenya Veterinarian Vol. 27 2004: pp. 18-2

Occurrence of mycotoxins in food, feed and milk in two countries from different agro-ecological zones and with historical outbreak of aflatoxins and fumonisins poisoning in Kenya

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Exposure of Kenyan population to aflatoxins in foods with special reference to Nandi and Makueni counties

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