Regulation of dominant firms in South Africa

This research report considers how dominant firms can establish when their competitive strategies are not anti-competitive. It argues that a dominant firm‟s actions can either be pro-competitive, thus conduct which competition law is designed to protect; or, anti-competitive and therefore prohibited. It questions whether there are any key principles that are emerging from South African competition law practice and decided cases that can provide some guidelines to dominant firms on whether planned action is prohibited conduct? It also questions whether the enforcement of the South African Competition Act‟s abuse of dominance provisions may have led to the chilling of competition. The research utilised the following methodologies: expert interviews; case studies; and, review of the competition authorities‟ enforcement actions. The report concludes that abuse of dominance cases are highly fact-intensive, industry specific and outcomes are effects-based. As such, it is difficult to prescribe a general rules-based compliance program to guide dominant firms in their development of competitive strategies. CopyrightDissertation (MBA)--University of Pretoria, 2010.Gordon Institute of Business Science (GIBS)unrestricte

Population structure and pathogenicity evolution of Phytophthora infestans affects epidemiology and management of late blight disease

Sound management of late blight, the disease caused by the notorious oomycete pathogen Phytophthora infestans (Mont.) de Bary, is dependent on the pathogen’s population biology. However, for P. infestans population structure to give guidance for disease management, successful information flow between the researchers and the practitioners is paramount. We analysed the population in eastern-Africa to determine the pathogen genotypes present in the region. We characterized the isolates using microsatellite markers and mitochondrial DNA haplotypes to enable comparisons with global populations. A European lineage, 2_A1 was found to be dominating the population in eastern-Africa. In addition, the 2_A1 lineage was found to be more aggressive in terms of lesion size, latent periods and incubation periods when compared to the old US-1 lineage. We thus concluded that the tested aggressiveness traits could have partly contributed to the quick displacement of US-1 by 2_A1 in the region. In a study predicting host durability of a genetically engineered potato with a stack of three resistance genes as well as a conventionally bred potato with a stack of five resistance genes, the assessment of pathogen effector genes proved valuable to deduce which of the R-genes were functional in the field. From the effector study, it can be concluded that effector genes in target local P. infestans populations should inform selection of breeding materials since globally, pathogen populations are very diverse. An assessment of commonly grown potato cultivars in eastern-Africa to quantify their susceptibility to late blight in the field found out that nearly all cultivars had partial resistance to P. infestans. The growers’ choice of cultivars is to high degree governed by market demands. Unfortunately, many cultivars with good resistance to late blight have other undesirable agronomic traits hence the rationale behind growing cultivars that are highly susceptible to late blight. Disease management practices, host durability prediction tools and potato breeding approaches should be suitably adjusted to the existing pathogen population

Childhood asthma control: Implications of current strategies in sub-Saharan Africa

No abstract

Socio-demographic and treatment-related variables associated with CD4 cell counts in Kenyan HIV patients on second-line regimens

Background: CD4 cell response in patients on second-line therapy has not been evaluated in Kenya. Patients failing second-line are changed to third-line, however, the drugs used for third-line are expensive and unavailable. Therefore, early identification of potential poor responders to treatment would lead to early intervention and thus improve therapy of patients on second-line. Objectives: To identify socio-demographic and treatment related variables that affect CD4 response of HIV-positive patients on second-line regimens in Kenyatta National Hospital (KNH). Methods: A historical cohort study carried out at KNH between January and April 2016 and entailed collection of patient data from the files. The main outcome variable was CD4 cell count.  The predictor variables of interest were sex, age, education level, and ART regimens. Results: All the study participants were on a lopinavir-based regimen. The study involved 84 study participants, 59.5% female study participants and 40.5% male. Male patients had significantly lower baseline CD4 cell counts and lower CD4 cell counts at ART (antiretroviral therapy) switch to second line compared to female patients. Efavirenz-based regimens were significantly associated with low CD4 cell count at ART switch to second-line. Conclusion: Patients should be started on nevirapine-based regimens unless contraindicated. Keywords: CD4 cell count, ART switch, second-lin

Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: A nationwide retrospective cohort study

BACKGROUND: In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. METHODS: We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data. RESULTS: A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators. CONCLUSION: We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics

AGEs Secreted by Bacteria Are Involved in the Inflammatory Response

Advanced Glycated End Products (AGEs) are formed by non-enzymatic protein glycation and are implicated in several physiological aspects including cell aging and diseases. Recent data indicate that bacteria – although short lived – produce, metabolize and accumulate AGEs. Here we show that Escherichia coli cells secret AGEs by the energy-dependent efflux pump systems. Moreover, we show that in the presence of these AGEs there is an upshift of pro-inflammatory cytokins by mammalian cells. Thus, we propose that secretion of AGEs by bacteria is a novel avenue of bacterial-induced inflammation which is potentially important in the pathophysiology of bacterial infections. Moreover, the sensing of AGEs by the host cells may constitute a warning system for the presence of bacteria

Prevalence and Correlates of Dyslipidemia among HIV-1 Infected and HIV-1 Uninfected Individuals in Nairobi, Kenya.

Thesis (Master's)--University of Washington, 2014Background: The burden of cardiovascular disease (CVD) in Sub-Saharan Africa is rising in the background of high prevalence of infectious diseases including HIV. Being HIV infected is associated with lipid imbalance (dyslipidemia), a risk factor for CVD. Whereas the use of certain antiretroviral treatment (ART) drugs has been shown to cause dyslipidemia, little is known about the burden of dyslipidemia in the absence of ART in Sub-Saharan Africa and the factors associated with dyslipidemia, particularly the amount of circulating HIV virus (viral load). Methods: In the parent study, HIV infected individuals who were not on ART and their HIV-uninfected partners were enrolled for a cohort study. At baseline, socio-demographic data and a detailed medical history were obtained and clinical physical examination performed on participants. Whole blood samples were collected, fractionated and stored frozen at -800C. For this nested study, a random sample of the frozen serum samples were thawed and assayed for total cholesterol and high density lipoprotein cholesterol (HDL). The proportion of participants with dyslipidemia, characterized by high total cholesterol or low HDL was compared between HIV-infected and HIV-uninfected individuals. Correlates evaluated for association with dyslipidemia included age, gender, CD4 cell count, viral load, body mass index, blood pressure and smoking. Results: Samples from 196 individuals, collected between 2007 and 2008, were assayed. Median age was 32 years (Interquartile range [IQR] 23-41 years). Of the 99 who were HIV-infected, 47 (47%) were male while 52 (52%) were female and median CD4 count was 393 cells/L (IQR 57-729). The proportion of individuals with dyslipidemia was high in both groups (>75%) though there was no significant difference between HIV-infected and HIV-uninfected individuals (p>0.05).Viral load was an independent risk factor associated with dyslipidemia (OR 6.1, p=0.028) Conclusion: Although there was no significant difference in prevalence of dyslipidemia comparing HIV- infected and HIV-uninfected individuals, the proportion of individuals with dyslipidemia was high irrespective of HIV infection status. Among the HIV-infected, high viral load was associated with increased risk of dyslipidemia. This would be important to consider when choosing the drug regimen during ART initiation

The Last Mile: Use of Innovative Technologies to Attain the UNAIDS 90-90-90 Target

Thesis (Ph.D.)--University of Washington, 2019Introduction Multiple interventions and concerted efforts have led to an overall decline in the incidence of HIV. Despite these gains, new challenges emerge in sustaining the momentum of the fight against HIV. These challenges all call for creative approaches in enhancing implementation of the HIV care cascade to sustain the momentum and safeguard the gains made thus far. Linkage to care following HIV testing and counselling is a critical initial step in the HIV care cascade. However, lack of a unique patient identifier within HIV care services limits utilization of routine programme data due to inaccuracies associated with patient misidentification. e.g. use of testing data to obtain HIV incidence. Attainment and maintenance of viral suppression is the goal of the HIV care cascade. Type 2 diabetes (T2D), as a co-morbidity could affect viral suppression by reduced medication and clinical appointment adherence. With a high prevalence of HIV and an excess risk of T2D in PLHIV, prediabetes is an important target for screening and primary prevention in Sub-Saharan Africa. Methods In the first study, we evaluated feasibility and acceptance of an iris scan biometric system for unique patient identification integrated within the routine HIV care clinics in 4 centres in Kenya. All patients were offered the iris scanning and chose to opt-out. They would then proceed with their routine clinic services. In the second study, we evaluated the prevalence and risk factors for T2D and prediabetes in 2 centres in Central Kenya, using point of care HbA1c and 2nd confirmatory test as per ADA guidelines. We also conducted a budget impact analysis on the cost and affordability of integrating this screening within routine HIV care services. For this, we compared universal screening vs risk-based screening, targeting people with hypertension and obesity. Results For unique identification, we offered biometric scanning to 8,794 unique people and a total of 14,942 scans issued an ID. About 1% of people approached refused to have their iris scanned, often due to privacy and confidentiality concerns. The system sensitivity was 94.7%. The system’s limitation to issuing an ID was lack of internet connectivity. Time taken for the scanning and demographic profiling process was 3.5 min and this improved with time. For HbA1c, among 600 participants, we observed an overall prevalence of 5% and newly diagnosed prevalence of 3.4% for T2D. The prevalence of prediabetes was 14.2%. Risk factors for hyperglycemia were age, familial history, hypertension, central adiposity and combination of Tenofovir/Efavirenz. The unit cost of screening using HbA1c was 2018 USD ($) 42, and a confirmatory test was$6. Risk-based screening was slightly cost-efficient: the unit cost of identifying and confirming T2D per person was $892, needing to screen 21 people to identify one person with T2D, compared to universal screening at$ 1,705 and screening 25 people. Main drivers for unit costs were personnel and reagent costs. Conclusion Iris biometrics scanning is a feasible and highly acceptable among newly tested positive and PLHIV already engaged in care as a unique identifier and can be integrated with existing EMR systems for program implementation and scale-up. Screening for diabetes and prediabetes using POC HbA1c was feasible and showed a high prevalence of prediabetes, a modifiable risk factor for T2D and other cardiovascular conditions. It is also affordable if it were to be integrated within the HIV care program in Central Kenya, more so if it were risk-based. Innovative technologies (iris biometric scanning, point of care HbA1c devices) can therefore be integrated within routine service delivery among PLHIV to improve the HIV care cascade, bring us closer to the end of the epidemic

Macroeconomic developments and banks' behaviour in Kenya: a panel data analysis

This paper examines the effect of macroeconomic developments on performance, credit quality and lending behaviour of banks in Kenya, by estimating a dynamic panel data model using Generalized Method of Moments. The paper finds banks’ behaviour to be largely influenced by macroeconomic developments. During down turns, banks tend to lend less on account of increased credit risk, rationing credit as dictated by macroeconomic developments. The study suggests that banks need to continue pursuing risk sensitive loan pricing policies to ease the extent of procyclical/countercyclical behaviour during economic upswings/downswings respectively, which in turn reduces the chances of supply-driven credit crunch effects.Ce document examine l’effet de l’évolution macro-économique sur les performances; la qualité du crédit et le comportement des banques au Kenya au niveau du prêt; en estimant un modèle de données de panel dynamique en utilisant le ‘Generalized Method of Moments’. Cette étude conclut que le comportement des banques est largement influencé par l’évolution macroéconomique. Lors des virages vers le bas; les banques ont tendance à prêter moins pour l’augmentation du risque du crédit; en rationnant le crédit comme dicté par l’évolution macroéconomique. L’étude suggère que les banques doivent continuer à poursuivre les politiques de loan pricing sensibles au risque afin de faciliter la mesure du comportement procyclique / anticyclique respectivement pendant les périodes de haute conjoncture / ralentissements économiques; ce qui réduit les chances des effets supply-driven de crise de crédit

Dataset for: Yield in all RTB crops in one cropping season along altitude gradients

Yield in potato and sweetpotato in one cropping season along altitude gradients in Tanzani