Knowledge, Attitude and Perceptions of Village Residents on the Health Risks Posed by Kadhodeki Dumpsite in Nairobi, Kenya.

This study sought to assess the knowledge, attitude and perceptions of the residents of Kadhodeki village on the health risks posed by the Kadhodeki dumpsite. Using households as units of sampling, a descriptive cross sectional survey was carried out in June 2012. Random data were collected using a face-to-face researcher administered structured questionnaire and 323 participants were interviewed. Chi square was used to determine the association between the different variables. Findings indicate that residents possess a significantly low knowledge and a positive attitude (χ2 (1) = 224.03, p < 0.01; χ2 (1) = 8.697, p < 0.01) towards the Kadhodeki dumpsite. They were however no differences in risk perceptions. Participant’s age, duration one had lived in the village and their level of education, were proxy measures of knowledge, attitude and perception. Odds ratio analysis indicates that age and duration did not influence participant’s knowledge, attitude or perceptions. Rudimentary however, education accounted for a non significant 28% variation in respondents’ attitude towards the health risks of the dumpsite (OR= 1.282; CI 0.828- 1.997). Also adequate education significantly accounted for 67% variation in respondents’ health risk perception (OR= 1.671; CI 1.304-2.140). This study would recommend that the ministry of Health come up with health education programmes for the general population on the dangers of uncontrolled waste disposal sites

Evaluation of the shoot regeneration response in tissue culture of pigeonpea (Cajanus cajan [L.] Millsp.) varieties adapted to eastern and southern Africa

Seven varieties of pigeonpea (Cajanus cajan [L.] Millsp.) of varying growth durations and adapted to a wide range of environments across eastern and southern Africa were evaluated for their shoot regeneration response in tissue culture. On a standardized shoot regeneration medium, the shortduration varieties (ICPV 88091 and ICPV 86012) generally responded faster and better than the medium duration (ICEAP 00554 and ICEAP 00557) and long duration (ICEAP 00020, ICEAP 00040 and ICEAP00053) varieties. However, all the tested varieties produced healthy rooted plants in vitro that could be transferred to the greenhouse where they exhibited normal growth, flowering and viable seed set. Thisstudy established the basis for genetic engineering of African pigeonpea varieties

Insecticide-Treated Nets for the Prevention of Malaria in Pregnancy: A Systematic Review of Randomised Controlled Trials

BACKGROUND: Protection from malaria with insecticide-treated bednets (ITNs) during pregnancy is widely advocated, but evidence of benefit has been inconsistent. We undertook a systematic review of randomised trials. METHODS AND FINDINGS: Three cluster-randomised and two individually randomised trials met the inclusion criteria; four from Africa (n = 6,418) and one from Thailand (n = 223). In Africa, ITNs compared to no nets increased mean birth weight by 55 g (95% confidence interval [CI] 21–88), reduced low birth weight by 23% (relative risk [RR] 0.77, 95% CI 0.61–0.98), and reduced miscarriages/stillbirths by 33% (RR 0.67, 0.47–0.97) in the first few pregnancies. Placental parasitaemia was reduced by 23% in all gravidae (RR 0.77, 0.66–0.90). The effects were apparent in the cluster-randomised trials and the one individually randomised trial in Africa. The trial in Thailand, which randomised individuals to ITNs or untreated nets, showed reductions in anaemia and fetal loss in all gravidae, but not reductions in clinical malaria or low birth weight. CONCLUSIONS: ITNs used throughout pregnancy or from mid-pregnancy onwards have a beneficial impact on pregnancy outcome in malaria-endemic Africa in the first few pregnancies. The potential impact of ITNs in pregnant women and their newborns in malaria regions outside Africa requires further research

Association between age, deprivation and specific comorbid conditions and the receipt of major surgery in patients with non-small cell lung cancer in England: A population-based study.

INTRODUCTION: We investigated socioeconomic disparities and the role of the main prognostic factors in receiving major surgical treatment in patients with lung cancer in England. METHODS: Our study comprised 31 351 patients diagnosed with non-small cell lung cancer in England in 2012. Data from the national population-based cancer registry were linked to Hospital Episode Statistics and National Lung Cancer Audit data to obtain information on stage, performance status and comorbidities, and to identify patients receiving major surgical treatment. To describe the association between prognostic factors and surgery, we performed two different analyses: one using multivariable logistic regression and one estimating cause-specific hazards for death and surgery. In both analyses, we used multiple imputation to deal with missing data. RESULTS: We showed strong evidence that the comorbidities 'congestive heart failure', 'cerebrovascular disease' and 'chronic obstructive pulmonary disease' reduced the receipt of surgery in early stage patients. We also observed gender differences and substantial age differences in the receipt of surgery. Despite accounting for sex, age at diagnosis, comorbidities, stage at diagnosis, performance status and indication of having had a PET-CT scan, the socioeconomic differences persisted in both analyses: more deprived people had lower odds and lower rates of receiving surgery in early stage lung cancer. DISCUSSION: Comorbidities play an important role in whether patients undergo surgery, but do not completely explain the socioeconomic difference observed in early stage patients. Future work investigating access to and distance from specialist hospitals, as well as patient perceptions and patient choice in receiving surgery, could help disentangle these persistent socioeconomic inequalities

Evaluation of the shoot regeneration response in tissue culture of pigeonpea (Cajanus cajan [L.] Millsp.) varieties adapted to eastern and southern Africa

Seven varieties of pigeonpea (Cajanus cajan [L.] Millsp.) of varying growth durations and adapted to a wide range of environments across eastern and southern Africa were evaluated for their shoot regeneration response in tissue culture. On a standardized shoot regeneration medium, the short duration varieties (ICPV 88091 and ICPV 86012) generally responded faster and better than the medium duration (ICEAP 00554 and ICEAP 00557) and long duration (ICEAP 00020, ICEAP 00040 and ICEAP 00053) varieties. However, all the tested varieties produced healthy rooted plants in vitro that could be transferred to the greenhouse where they exhibited normal growth, flowering and viable seed set. This study established the basis for genetic engineering of African pigeonpea varieties

Supporting community-based natural resource management in pastoralist societies in East Africa to achieve the UN Sustainable Development Goals

This is the final published report.Sustainable pastoralism provides a wide range of economic, social and ecological value. However, the sustainability of this global food system has been undermined by systemic low investment. The effects of inappropriate development policies, growing population pressure and escalating economic inequalities are all being exacerbated by the increasing climate variability over the past decades. In recent years, community-based natural resource management (CBNRM) has emerged as a potential solution to these challenges. Rangeland areas may be managed more effectively by enabling communities to develop more sustainable livestock practices, restore the quality of rangelands and ecosystem services, improve the quality and market value of livestock, and ultimately aim to increase food security while reducing social inequalities. Such community-based management of economically, socially and ecologically important areas of land therefore addresses at least nine Sustainable Development Goals (SDGs). Here, we outline the challenges facing pastoral systems, how CBNRM provides a potential solution, and the link between pastoral CBNRM and the SDGs. Our collaborative and interdisciplinary research network aims to provide context-driven evidence for pastoral CBNRM that will ultimately underpin co-designed sustainable land management strategies.University of Exeter’s Global Challenges Research Fund (GCRF

The Hominin Sites and Paleolakes Drilling Project:Inferring the environmental context of human evolution from eastern African rift lake deposits

Funding for the HSPDP has been provided by ICDP, NSF (grants EAR-1123942, BCS-1241859, and EAR-1338553), NERC (grant NE/K014560/1), DFG priority program SPP 1006, DFG-CRC-806 “Our way to Europe”, the University of Cologne (Germany), the Hong Kong Research Grants Council (grant no. HKBU201912), the Peter Buck Fund for Human Origins Research (Smithsonian), the William H. Donner Foundation, the Ruth and Vernon Taylor Foundation, Whitney and Betty MacMillan, and the Smithsonian’s Human Origins Program.The role that climate and environmental history may have played in influencing human evolution has been the focus of considerable interest and controversy among paleoanthropologists for decades. Prior attempts to understand the environmental history side of this equation have centered around the study of outcrop sediments and fossils adjacent to where fossil hominins (ancestors or close relatives of modern humans) are found, or from the study of deep sea drill cores. However, outcrop sediments are often highly weathered and thus are unsuitable for some types of paleoclimatic records, and deep sea core records come from long distances away from the actual fossil and stone tool remains. The Hominin Sites and Paleolakes Drilling Project (HSPDP) was developed to address these issues. The project has focused its efforts on the eastern African Rift Valley, where much of the evidence for early hominins has been recovered. We have collected about 2 km of sediment drill core from six basins in Kenya and Ethiopia, in lake deposits immediately adjacent to important fossil hominin and archaeological sites. Collectively these cores cover in time many of the key transitions and critical intervals in human evolutionary history over the last 4 Ma, such as the earliest stone tools, the origin of our own genus Homo, and the earliest anatomically modern Homo sapiens. Here we document the initial field, physical property, and core description results of the 2012–2014 HSPDP coring campaign.Publisher PDFPeer reviewe

Improving educational achievement and anaemia of school children: design of a cluster randomised trial of school-based malaria prevention and enhanced literacy instruction in Kenya

BACKGROUND: Improving the health of school-aged children can yield substantial benefits for cognitive development and educational achievement. However, there is limited experimental evidence on the benefits of school-based malaria prevention or how health interventions interact with other efforts to improve education quality. This study aims to evaluate the impact of school-based malaria prevention and enhanced literacy instruction on the health and educational achievement of school children in Kenya. DESIGN: A factorial, cluster randomised trial is being implemented in 101 government primary schools on the coast of Kenya. The interventions are (i) intermittent screening and treatment of malaria in schools by public health workers and (ii) training workshops and support for teachers to promote explicit and systematic literacy instruction. Schools are randomised to one of four groups: receiving either (i) the malaria intervention alone; (ii) the literacy intervention alone; (iii) both interventions combined; or (iv) control group where neither intervention is implemented. Children from classes 1 and 5 are randomly selected and followed up for 24 months. The primary outcomes are educational achievement and anaemia, the hypothesised mediating variables through which education is affected. Secondary outcomes include malaria parasitaemia, school attendance and school performance. A nested process evaluation, using semi-structured interviews, focus group discussion and a stakeholder analysis will investigate the community acceptability, feasibility and cost-effectiveness of the interventions. DISCUSSION: Across Africa, governments are committed to improve health and education of school-aged children, but seek clear policy and technical guidance as to the optimal approach to address malaria and improved literacy. This evaluation will be one of the first to simultaneously evaluate the impact of health and education interventions in the improvement of educational achievement. Reflection is made on the practical issues encountered in conducting research in schools in Africa. TRIAL REGISTRATION: National Institutes of Health NCT00878007

Cost analysis of school-based intermittent screening and treatment of malaria in Kenya

<p>Abstract</p> <p>Background</p> <p>The control of malaria in schools is receiving increasing attention, but there remains currently no consensus as to the optimal intervention strategy. This paper analyses the costs of intermittent screening and treatment (IST) of malaria in schools, implemented as part of a cluster-randomized controlled trial on the Kenyan coast.</p> <p>Methods</p> <p>Financial and economic costs were estimated using an ingredients approach whereby all resources required in the delivery of IST are quantified and valued. Sensitivity analysis was conducted to investigate how programme variation affects costs and to identify potential cost savings in the future implementation of IST.</p> <p>Results</p> <p>The estimated financial cost of IST per child screened is US$6.61 (economic cost US$ 6.24). Key contributors to cost were salary costs (36%) and malaria rapid diagnostic tests (RDT) (22%). Almost half (47%) of the intervention cost comprises redeployment of existing resources including health worker time and use of hospital vehicles. Sensitivity analysis identified changes to intervention delivery that can reduce programme costs by 40%, including use of alternative RDTs and removal of supervised treatment. Cost-effectiveness is also likely to be highly sensitive to the proportion of children found to be RDT-positive.</p> <p>Conclusion</p> <p>In the current context, school-based IST is a relatively expensive malaria intervention, but reducing the complexity of delivery can result in considerable savings in the cost of intervention.</p> <p>(Costs are reported in US$ 2010).</p

Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas

Malaria in pregnancy is one of the major causes of maternal morbidity and adverse birth outcomes. In high transmission areas, its prevention has recently changed, moving from a weekly or bimonthly chemoprophylaxis to intermittent preventive treatment (IPTp). IPTp consists in the administration of a single curative dose of an efficacious anti-malarial drug at least twice during pregnancy – regardless of whether the woman is infected or not. The drug is administered under supervision during antenatal care visits. Sulphadoxine-pyrimethamine (SP) is the drug currently recommended by the WHO. While SP-IPTp seems an adequate strategy, there are many issues still to be explored to optimize it. This paper reviewed data on IPTp efficacy and discussed how to improve it. In particular, the determination of both the optimal number of doses and time of administration of the drug is essential, and this has not yet been done. As both foetal growth and deleterious effects of malaria are maximum in late pregnancy women should particularly be protected during this period. Monitoring of IPTp efficacy should be applied to all women, and not only to primi- and secondigravidae, as it has not been definitively established that multigravidae are not at risk for malaria morbidity and mortality. In HIV-positive women, there is an urgent need for specific information on drug administration patterns (need for higher doses, possible interference with sulpha-based prophylaxis of opportunistic infections). Because of the growing level of resistance of parasites to SP, alternative drugs for IPTp are urgently needed. Mefloquine is presently one of the most attractive options because of its long half life, high efficacy in sub-Saharan Africa and safety during pregnancy. Also, efforts should be made to increase IPTp coverage by improving the practices of health care workers, the motivation of women and their perception of malaria complications in pregnancy. Because IPTp is not applicable in early pregnancy, which is a period when malaria may also be deleterious for women and their offspring, there is a necessity to integrate this strategy with other preventive measures which can be applied earlier in pregnancy such as insecticide-treated nets