Microcredit for people affected by HIV and AIDS: Insights from Kenya

Consequences of HIV and AIDS are exponential in Kenya, touching not only the health of those infected, but also depleting socioeconomic resources of entire families. Access to financial services is one of the important ways to protect and build economic resources. Unfortunately, the norm of financial viability discourages microfinance institutions from targeting people severely impacted by HIV and AIDS. Thus, HIV and AIDS service NGOs have been increasingly getting involved in microcredit activity in recent years for economic empowerment of their clients. Despite limited human resources and funding in the area of microcredit activity, these NGOs have demonstrated that nearly 50% of their microcredit beneficiaries invested money in income-generating activities, resulting in enhancement to their livelihood security. In the short term these NGOs need to improve their current practices. However, this does not mean launching microfinance initiatives within their AIDS-focused programmes, as financial services are best provided by specialised institutions. Longer-term cooperation between microfinance institutions and other AIDS service organisations and donors is necessary to muster appropriate and rapid responses in areas experiencing severe impacts of HIV and AIDS. Keywords: Microcredit, HIV and AIDS, Kenya.SAHARA J Vol. 5 (2) 2008: pp.94-10

Food security in HIV/AIDS response: Insights from Homa Bay, Kenya

This paper examines the viability and effectiveness of a pilot farming initiative in reversing impacts of HIV/AIDS on the most affected households in Homa Bay, Kenya. The paper argues that once patients are stable, they can effectively be engaged in farming with minimal financial and technical support, resulting in enhanced food security of the affected households. More importantly, it helps to reduce HIV/AIDS-related stigma and improve the individual’s self-esteem. Some of the key challenges of the pilot initiative were the limited number of agricultural extension workers and absence of facilities to enable them to deliver services to the farmers, the high cost of farm inputs, the unavailability of farm inputs when they were needed, poorly developed agricultural markets, and the absence of irrigation facilities. The paper recommends the sensitive scaling-up of this approach. However, farming initiatives by HIV/AIDS service NGOs should be linked to at least three key aspects: (a) treatment, care and support to HIV/AIDS affected households; (b) micro grant schemes or subsidies to enable farmers to purchase farming tools and farm inputs; and (c) comprehensive on-farm training support. To ensure effectiveness and wider reach, government needs to view agriculture through an HIV lens and promote a multisectoral approach thatrecognises the relationship between HIV/AIDS and food security. A number of immediate actions are required to strengthen this relationship, such as increased public investment to augment extension services, subsidise farm inputs, and develop infrastructure including agricultural markets.Keywords: HIV and AIDS, food security, agriculture, Kenya

Rates of switching antiretroviral drugs in a primary care service in South Africa before and after introduction of tenofovir

Introduction Antiretroviral changes (single drug substitutions and regimen switches) limit treatment options and introduce challenges such as increased cost, monitoring and adherence difficulties. Patterns of drug substitutions and regimen switches from stavudine (d4T) and zidovudine (AZT) regimens have been well described but data on tenofovir (TDF) are more limited. This study describes the patterns and risk factors for drug changes of these antiretroviral drugs in adults. Method This retrospective cohort study included HIV positive, antiretroviral treatment (ART) naïve adults aged ≥18 years who started ART with two nucleoside reverse transcriptase inhibitors (NRTIs) and a non-nucleoside reverse transcriptase inhibitor. Follow-up was censored at first drug change and analysis focused on NRTI changes only. RESULTS: Between September 2002 and April 2011, 5095 adults initiated ART in Gugulethu. This comprised 948 subjects on TDF, 3438 on d4T and 709 subjects on AZT. Virological suppression rates at 1 year, regimen switching due to virological failure and overall losses to the programme were similar across the three groups. TDF had the lowest incidence rate of drug substitutions (2.6 per 100 P/Ys) compared to 17.9 for d4T and 8.5 per 100 P/Ys for AZT. Adverse drug reactions (ADRs) accounted for the majority of drug substitutions of d4T. Multivariate analysis showed that increasing age, female sex and d4T exposure were associated with increased hazard of drug substitution due to ADRs. Conversely, TDF exposure was associated with a substantially lower risk of substitution (adjusted hazards ratio 0.38; 95% CI 0.20-0.72). CONCLUSION: Regimen switches and virological suppression were similar for patients exposed to TDF, d4T and AZT, suggesting all regimens were equally effective. However, TDF was better tolerated with a substantially lower rate of drug substitutions due to ADRs

Environmental Particle Emissions due to Automated Drilling of Polypropylene Composites and Nanocomposites Reinforced with Talc, Montmorillonite and Wollastonite

In this study, the effect on nanoparticle emissions due to drilling on Polypropylene (PP) reinforced with 20% talc, 5% montmorillonite (MMT) and 5% Wollastonite (WO) is investigated. The study is the first to explore the nanoparticle release from WO and talc reinforced composites and compares the results to previously researched MMT. With 5% WO, equivalent tensile properties with a 10 % weight reduction were obtained relative to the reference 20% talc sample. The materials were fabricated through injection moulding. The nanorelease studies were undertaken using the controlled drilling methodology for nanoparticle exposure assessment developed within the European Commission funded SIRENA Life 11 ENV/ES/506 project. Measurements were taken using CPC and DMS50 equipment for real-time characterization and measurements. The particle number concentration (of particles <1000nm) and particle size distribution (4.87nm - 562.34nm) of the particles emitted during drilling were evaluated to investigate the effect of the silicate fillers on the particles released. The nano-filled samples exhibited a 33% decrease (MMT sample) or a 30% increase (WO sample) on the average particle number concentration released in comparison to the neat polypropylene sample. The size distribution data displayed a substantial percentage of the particles released from the PP, PP/WO and PP/MMT samples to be between 5-20nm, whereas the PP/talc sample emitted larger particle diameters.The work is funded by and part of the European Commission Life project named Simulation of the release of nanomaterials from consumer products for environmental exposure assessment (SIRENA, Pr. No. LIFE 11 ENV/ES/596). The access and use of the facilities at the Flemish Institute for Technological Research (VITO) was funded by QualityNano Project through Transnational Access (TA Application VITO-TAF-382 and VITO-TAF-500) under the European Commission, Grant Agreement No: INFRA-2010-262163. Kristof is also thankful for partial funding by the School of Engineering at Robert Gordon University for his studentship

Treatment of shigella infections: why sulfamethoxazole-trimethoprim, tetracyclines and ampicillin should no longer be used

Background: Bloody diarrhoea results in high morbidity and mortality especially in developing countries with shigellosis being the main cause of acute bloody diarrhoea. The use of appropriate antimicrobial agents in the treatment of acute diarrheal disease shortens the duration of illness and bacterial shedding leading to a reduction in morbidity and mortality. Treatment options for many infections are becoming limited due to globally emerging antibiotic resistance. Globally, resistance of shigella species to trimethoprim-sulfamethoxazole (TMP-SMX), tetracyclines and ampicillin has been reported with subsequent recommendations of not using these antimicrobial drugs for empirical therapy of acute bloody diarrhoea.Objective: To establish the antimicrobial susceptibility patterns and antimicrobial drug use for treatment of shigella species in patients with acute bloody diarrhoea.Design: A hospital based case control study.Setting: Six health facilities, three in Kilifi County and three in Nairobi County.Subject: A total of 284 stool specimens were collected from patients who fitted the standard cases definition for acute bloody diarrhoea.Results: Eighty (28.2%) bacterial isolates were recovered from 284 stool samples collected from cases presenting with acute bloody diarrhoea of which 67 (83.8%) were Shigella species, nine (11.3%) were Enteroinvassive Escherichia coli isolates, three (3.8%) were Salmonella Typhi and one (1.3%) were Yersinia enterocolitica. Shigella isolates had high resistance to sulfamethoxazole-trimethoprim (97%), tetracycline (83.6%) ampicillin (58.2%) and chloramphenicol (20.9%). The isolates showed low resistance to nalidixic (4.5%) and ciprofloxacin (3.0%) while there was no resistance to ceftriaxone. The most common multidrug resistance pattern detected in Shigella strains combined sulfamethoxazole-trimethoprim, amoxicillin/ampicillin and tetracyclines.Antibiotic prescriptions were given to 243(85.6%) of the patients presenting with acute bloody diarrhoea. Among these, 94 (38.7%) were given prescriptions for ciprofloxacin, 53 (21.8%) for sulfamethaxazole-trimethiprin and 36(14.8%) for Tetracyclines. Chloramphenicol, amoxicillin/ampicillin, nalidixic acid and ceftriaxone were prescribed to 10.7 %, 3.7%, 2.9% and 0.4% of the patients respectively. A total of 123 (51%) received antibiotics which were ranked to have high resistance (sulfamethoxazole-trimethoprim, tetracyclines ampicillin and chloramphenicol).Conclusion: The high rates of antimicrobial resistance among the commonly prescribed antimicrobials such as sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol is of major concern. Despite recommendations discouraging the empirical use of sulfamethoxazole-trimethoprim, tetracycline, ampicillin and chloramphenicol for treatment of acute bloody diarrhoea, more than half of the patients with acute bloody diarrhoea were still treated with these antibiotics.There is need to train health care workers on the proper management of acute bloody diarrhoea and the importance of adhering to the clinical guidelines

What unleashes innovations in the Legumes and Cereals farming Systems in the drylands: A gendered perspective

Agricultural and natural resource management innovations have often been introduced, promoted and adopted among local communities / farmers. However, how the innovation process is perceived by men and women, the relationships involved, the distribution of benefits and the differing capacities of women and men to take advantage of the new opportunities in agriculture are not always carefully thought-out. This study examined both community and individual men and women's experiences with agricultural innovations and practices and how these interactions support or hinder the achievement of agricultural innovations across various contexts. By providing robust empirical evidence on the relationship between gender norms, agency and agricultural innovation, the study revealed that sociocultural structures and household dynamics chiefly shapes how individuals negotiate for space, freedom, resources and the capacities needed to innovate

Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya : a prospective comparison of point of care diagnostic methods.

Background: Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Methods: Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Results: Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. Conclusions: POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required

INCIDENCE AND DISTRIBUTION OF INSECT PESTS IN RAIN-FED WHEAT IN EASTERN AFRICA

Insect pests are some of the major constraints limiting yield of wheat ( Triticum aestivum L.) in East Africa. The objective of this study was to determine the species composition and distribution of insect pests, and their natural enemies associated with wheat in Eastern Africa. A survey was conducted in farmers\u2019 fields in Ethiopia, Kenya and Uganda during 2013 and 2014 cropping season. Wheat fields along roadsides were randomly selected at approximately 2 to 10 Km intervals, and in each field, several wheat plants in a cross diagonal line were examined for presence or absence of insect pests and associate natural enemies. Also, the type of insect was identified to species level and in situ population counts recorded. In Ethiopia, only 39% of the fields were infested by tef epilachna, Chnootriba similis Thurnberg (Coleoptera: Coccinellidae); while the remaining wheat fields were free of insect infestation. The Russian Wheat Aphid (RWA), Diuraphis noxia Kurdijumov (Hemiptera: Aphididae), was the most prevalent insect pest of wheat in Kenya and Uganda. The maximum number of RWA per tiller was 58 in Kenya and 38 in Uganda. Moreover, in Kenya the rose wheat (grass) aphid ( Metopolophium dirhodum Walker), oat-bird-cherry aphid ( Rhopalosiphum padi Walker) and corn leaf aphid ( R. maidis Fitch) were prevalent, though at low densities ranging, from 0.1 to 9 per tiller. The greenbug ( Schizaphis graminum Rondani) and the green stink bug ( Nezara viridula L.) were recorded only in Uganda. The general aphid predators Cheilomenes spp., spiders, lacewings and the parasitoid Aphidius spp. were the natural enemies of aphids found in Kenyan wheat. However, the density of these natural enemies was too low to bring the aphid population to a level that causes economic damage.Les insectes nuisibles d\u2019insecte sont certaines des contraintes importantes limitant la production de bl\ue9 ( Triticum aestivum L.) \ue0 Afrique de l\u2019est. L\u2019objectif de cette \ue9tude \ue9tait de d\ue9terminer la composition d\u2019esp\ue8ces et la distribution d\u2019insectes nuisibles d\u2019insecte et de leurs ennemis naturels associ\ue9s au bl\ue9 dans l\u2019Afrique de L\u2019est. Une enqu\ueate a \ue9t\ue9 accomplie dans les champs de fermiers en \uc9thiopie, Kenya et Ouganda pendant 2013 et 2014 en coupant la saison. Les champs de bl\ue9 le long des accotements de route ont \ue9t\ue9 au hasard choisis aux intervalles d\u2019environ 2 \ue0 10 kms et dans chaque champ, plusieurs usines de bl\ue9 \ue0 une ligne diagonale f\ue2ch\ue9e ont \ue9t\ue9 examin\ue9es pour la pr\ue9sence ou l\u2019absence d\u2019insectes nuisibles d\u2019insecte et associent des ennemis naturels. Aussi, le type d\u2019insecte a \ue9t\ue9 identifi\ue9 au niveau d\u2019esp\ue8ces et dans les comptes d\ue9mographiques situ enregistr\ue9s. En \uc9thiopie, seulement 39 % des champs \ue9taient infested par tef epilachna, Chnootriba similis Thurnberg (les col\ue9opt\ue8res : Coccinellidae); pendant que les champs de bl\ue9 restants \ue9taient sans infestation d\u2019insecte. Le Puceron de Bl\ue9 russe (RWA), Diuraphis noxia Kurdijumov (Hemiptera : Aphididae), \ue9tait l\u2019insecte nuisible d\u2019insecte le plus qui pr\ue9vaut de bl\ue9 au Kenya et \ue0 l\u2019Ouganda. Le nombre maximum de RWA par barre \ue9tait 58 au Kenya et 38 en Ouganda. De plus, au Kenya l\u2019est mont\ue9 du bl\ue9 (l\u2019herbe) le puceron ( Metopolophium dirhodum le Promeneur), le puceron rouge cerise d\u2019oiseau d\u2019avoine ( Rhopalosiphum padi le Promeneur) et le puceron de feuille de grain ( R. maidis Fitch) \ue9tait qui pr\ue9vaut, bien qu\u2019aux densit\ue9s basses variant, de 0.1 \ue0 9 par barre. Les greenbug ( Schizaphis graminum Rondani) et le vert puent l\u2019insecte ( Nezara viridula L.) a \ue9t\ue9 enregistr\ue9 seulement en Ouganda. Les pr\ue9dateurs de puceron g\ue9n\ue9raux Cheilomenes spp., les araign\ue9es, lacewings et le parasitoid Aphidius spp. \ue9taient les ennemis naturels de pucerons trouv\ue9s dans le bl\ue9 k\ue9nyan. Pourtant, la densit\ue9 de ces ennemis naturels \ue9tait trop basse pour apporter la population de puceron \ue0 un niveau qui provoque le dommage \ue9conomique

Effect of fibre configurations on mechanical properties of flax/tannin composites.

Flax reinforced tannin-based composites have a potential to be used in vehicle applications due to the environmental advantages and good mechanical properties. In this paper, the effects of fibre configuration on mechanical properties of flax/tannin composites were investigated for nonwoven and woven fabric lay-up angles (UD, [0°, 90°]2 and [0°, +45°, 90°, -45°]2). The tannin/flax composites were prepared by compression moulding. The manufactured specimens were then characterized for quasi-static tensile properties, dynamic mechanical properties and low-energy impact performance. Failure mechanism was further investigated using microscopy and demonstrated the need for further adhesion improvements. The study shows that the UD fabric reinforced composite performs better in tensile strength and modulus whereas [0°, +45°, 90°, -45°]2 composite provides the best impact energy absorption performance