Predictors of non-adherence to antihypertensive therapy in a rural health facility in Kenya

Background: The effectiveness of antihypertensive medicines depends on whether the patient uses the drugs as instructed by the health care provider. Failure to adhere to therapy may lead to uncontrolled blood pressure and possibly preventable complications. The factors which may impact on adherence to medicines among patients in rural health facilities have not been adequately documented. Objective: To determine the predictors of non- adherence to antihypertensive therapy in Murang’a South Sub-county Hospital. Methods: A descriptive cross-sectional study design was used. One hundred and sixty-seven adult hypertensive patients who were on therapy at Murang’a South Sub-county Hospital were included. Participants who satisfied the inclusion criteria were selected using simple random sampling. Data was collected using a researcher administered questionnaire. Analysis was carried out using STATA version 14 statistical software and p</=0.05 was considered statistically significant. Permission to conduct the study was granted by the Kenyatta National Hospital-University of Nairobi Ethical and Research committee and the management of the hospital. Results: There was female predominance (124, 74.3%).One hundred and twelve (67.5%) participants were adherent to medications. The independent predictors of non-adherence were; lack of finances (p=0.000), inadequate knowledge on treatment (p=0.005), long duration of treatment (p=0.001), forgetfulness (p=0.003), side effects of drugs (p=0.019) and fear of dependence (p=0.008). Conclusion: Patient factors were major contributors to non- adherence. Clinicians should be encouraged to provide adequate counseling to improve adherence. Keywords: adherence, antihypertensive therapy, predictor

The Dantu blood group prevents parasite growth in vivo: evidence from a controlled human malaria infection study

Background: The long co-evolution of Homo sapiens and Plasmodium falciparum has resulted in the selection of numerous human genetic variants that confer an advantage against severe malaria and death. One such variant is the Dantu blood group antigen, which is associated with 74% protection against severe and complicated P. falciparum malaria infections in homozygous individuals, similar to that provided by the sickle haemoglobin allele (HbS). Recent in vitro studies suggest that Dantu exerts this protection by increasing the surface tension of red blood cells, thereby impeding the ability of P. falciparum merozoites to invade them and reducing parasite multiplication. However, no studies have yet explored this hypothesis in vivo. Methods: We investigated the effect of Dantu on early phase P. falciparum (Pf) infections in a controlled human malaria infection (CHMI) study. 141 sickle-negative Kenyan adults were inoculated with 3.2 × 103 aseptic, purified, cryopreserved Pf sporozoites (PfSPZ Challenge) then monitored for blood-stage parasitaemia for 21 days by quantitative polymerase chain reaction (qPCR)analysis of the 18S ribosomal RNA P. falciparum gene. The primary endpoint was blood-stage P. falciparum parasitaemia of ≥500/μl while the secondary endpoint was the receipt of antimalarial treatment in the presence of parasitaemia of any density. On study completion, all participants were genotyped both for Dantu and for four other polymorphisms that are associated with protection against severe falciparum malaria: α+-thalassaemia, blood group O, G6PD deficiency, and the rs4951074 allele in the red cell calcium transporter ATP2B4. Results: The primary endpoint was reached in 25/111 (22.5%) non-Dantu subjects in comparison to 0/27 (0%) Dantu heterozygotes and 0/3 (0.0%) Dantu homozygotes (p=0.01). Similarly, 49/111 (44.1%) non-Dantu subjects reached the secondary endpoint in comparison to only 7/27 (25.9%) and 0/3 (0.0%) Dantu heterozygotes and homozygotes, respectively (p=0.021). No significant impacts on either outcome were seen for any of the other genetic variants under study. Conclusions: This study reveals, for the first time, that the Dantu blood group is associated with high-level protection against early, non-clinical, P. falciparum malaria infections in vivo. Learning more about the mechanisms involved could potentially lead to new approaches to the prevention or treatment of the disease. Our study illustrates the power of CHMI with PfSPZ Challenge for directly testing the protective impact of genotypes previously identified using other methods. Funding: The Kenya CHMI study was supported by an award from Wellcome (grant number 107499). SK was supported by a Training Fellowship (216444/Z/19/Z), TNW by a Senior Research Fellowship (202800/Z/16/Z), JCR by an Investigator Award (220266/Z/20/Z), and core support to the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya (203077), all from Wellcome. The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. For the purpose of Open Access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. Clinical trial number: NCT0273976

Power and rights in the community: paralegals as leaders in women's legal empowerment in Tanzania

What can an analysis of power in local communities contribute to debates on women’s legal empowerment and the role of paralegals in Africa? Drawing upon theories of power and rights, and research on legal empowerment in African plural legal systems, this article explores the challenges for paralegals in facilitating women’s access to justice in Tanzania, which gave statutory recognition to paralegals in the Legal Aid Act 2017. Land conflicts represent the single-biggest source of local legal disputes in Tanzania and are often embedded in gendered land tenure relations. This article argues that paralegals can be effective actors in women’s legal empowerment where they are able to work as leaders, negotiating power relations and resisting the forms of violence that women encounter as obstacles to justice. Paralegals’ authority will be realised when their role is situated within community leadership structures, confirming their authority while preserving their independence

'Issues of equity are also issues of rights': Lessons from experiences in Southern Africa

BACKGROUND: Human rights approaches to health have been criticized as antithetical to equity, principally because they are seen to prioritise rights of individuals at the expense of the interests of groups, a core tenet of public health. The objective of this study was to identify how human rights approaches can promote health equity. METHODS: The Network on Equity in Health in Southern Africa undertook an exploration of three regional case studies – antiretroviral access, patient rights charters and civic organization for health. A combination of archival reviews and stakeholder interviews were complemented with a literature review to provide a theoretical framework for the empirical evidence. RESULTS: Critical success factors for equity are the importance of rights approaches addressing the full spectrum from civil and political, through to socio-economic rights, as well as the need to locate rights in a group context. Human rights approaches succeed in achieving health equity when coupled with community engagement in ways that reinforce community capacity, particularly when strengthening the collective agency of its most vulnerable groups. Additionally, human rights approaches provide opportunities for mobilising resources outside the health sector, and must aim to address the public-private divide at local, national and international levels. CONCLUSION: Where it is clear that rights approaches are predicated upon understanding the need to prioritize vulnerable groups and where the way rights are operationalised recognizes the role of agency on the part of those most affected in realising their socio-economic rights, human rights approaches appear to offer powerful tools to support social justice and health equity

How 'universal' is the United Nations' Universal Periodic Review process? An examination of the discussions held on polygamy

In 2006, United Nations Human Rights Council was tasked to establish a new human rights monitoring mechanism: Universal Periodic Review process. The primary aim of this process is to promote and protect the universality of all human rights issues and concerns via a dialogical peer review process. The aim of this investigation isto ask the following question: has this claim of promoting and protecting the universality of the human rights been met, or challenged, during state reviews in the UPR process? The issue of polygamy has been selected as the focus for this investigation to be used, primarily, as a tool to undertake an in-depth analysis of the discussions held during state reviews in the review process. In addition, this paper will employ scholarly debates between universalism and cultural relativism, as well as the sophisticated and nuanced approaches that fall in between the polarised opposites, to analyse the discussions held on human rights during state reviews. Ultimately, the findings and discussion of this investigation will provide a unique and valuable insight to the work and operation of the UPR process, so far

Towards Customary Legal Empowerment

Rule of Law and Development: Formation, Implementation and Improvement of Law and Governance in Developing Countrie

FACTORS INFLUENCING TRAINING COSTS IN UNIVERSITY COLLEGES IN KENYA: A CASE OF MURANG’A UNIVERSITY COLLEGE

The study sought to find out the factors influencing training costs in university colleges in Kenya a case of Murang’a University College. This was occasioned by the fact that the university colleges charge different amounts in terms of the fees apportioned to the varying study programmes. The university colleges have different parameters and standards which they use to determine the amounts of fees charged. The different programmes in the university colleges equally are a motivating factor as regards the training costs determination. There is a government policy guiding and defining the amounts of fees payable for the government sponsored undergraduate programmes while the self sponsored programmes in the university colleges are tailor made to suit the demands and dictates of the target markets mainly from an income generating perspective. This brings along a great variation in the training costs driven by the underlying factors. The variables guiding the study were: - the courses offered, the budgetary provisions, students enrollment and the course duration. The study had an emphasis of finding out how the variables influenced the costing for training. The study employed a descriptive research method and the population of interest to the study were members of the non-teaching staff working in the departments of finance, administration and quality assurance and members of the teaching staff. Data was collected by use of questionnaires to gather primary data and secondary data was accessed by way of interrogating the institution’s records. Data analysis entailed descriptive and inferential statistics. The study had the following findings: - most of the respondents considered the relationship between the demand for programmes and the cost for training to be highly correlated, budgetary appropriations played a significant role on the training costs determination, the students’ enrolment influenced training costs. The enrolment of students into the university colleges assured them of constant and sustained revenue accruing from the fees paid by them for the services offered and the time taken to complete an academic programme had an influence on training costs determination. In the event of long programmes, longer time was taken and the cost of actualizing the programme ultimately went higher when pegged on the periods of time expended in actualizing the services. The study made the following recommendations: - university colleges should structure their training programmes and courses in a manner that appeals to the target niche markets. This is because findings from the current study have confirmed that the clientele have no inhibitions about paying high fees for particular academic programmes that they require. University colleges should seek to have their budgetary appropriations aligned and made to fit the demands of the programmes that they have on offer. They should seek to have all the monies appropriated for particular vote heads strictly adhered to and spent on them to ensure that the consumers of the services get value for money. University colleges should seek to have modalities in place that ensure basic provisions for attracting students to take up their programmes. They should equally ensure that the quality of the services offered is upheld despite of the enrolment levels. The university colleges should seek to synchronize the course duration to the amounts of fees charged. This is driven by the fact that in many instances the university colleges have other underlying factors motivating the amounts of fees charged for particular programmes

Dantu blood group erythrocytes less commonly form large Plasmodium falciparum rosettes

Dantu erythrocytes, which express a hybrid glycophorin B/A protein, are protective against severe malaria. Recent studies have shown that Dantu impairs Plasmodium falciparum invasion by increasing erythrocyte membrane tension, but its effects on pathological host-parasite adhesion interactions such as rosetting, the binding of uninfected erythrocytes to P. falciparum-infected erythrocytes, have not been previously investigated. The expression of several putative rosetting receptors, including glycophorin A (GYPA), glycophorin C (GYPC), complement receptor 1 (CR1) and band 3, which complexes with GYPA to form the Wrightb blood group antigen, are altered on Dantu erythrocytes. Here, we compare receptor expression, and rosetting at both 1 hour (h) and 48h after mixing with mature trophozoite stage Kenyan laboratory-adapted P. falciparum strain 11019 parasites, in Dantu and non-Dantu erythrocytes. Dantu erythrocytes showed lower staining for GYPA and CR1 and higher staining for band 3, as observed previously, while Wrightb and GYPC staining did not vary significantly. No significant between-genotype differences in rosetting were seen after 1h, but the percentage of large rosettes was significantly lower in both Dantu heterozygous (mean 16.4%, SEM 3.2) and homozygous donors (mean 15.4%, standard error of the mean (SEM) 1.4) compared to non-Dantu erythrocytes (mean 32.9%, SEM 7.1, one way ANOVA p=0.025) after 48h. We also found positive correlations between erythrocyte mean corpuscular volume (MCV), the percentage of large rosettes (rs=0.5970, p=0.0043) and mean rosette size (rs=0.5206, p=0.0155). Impaired rosetting, due to altered membrane receptor expression and reduced MCV, might add to the protective effect of Dantu against severe malaria

The Dantu blood group prevents parasite growth <i>in vivo</i>: Evidence from a controlled human malaria infection study.

BackgroundThe long co-evolution of Homo sapiens and Plasmodium falciparum has resulted in the selection of numerous human genetic variants that confer an advantage against severe malaria and death. One such variant is the Dantu blood group antigen, which is associated with 74% protection against severe and complicated P. falciparum malaria infections in homozygous individuals, similar to that provided by the sickle haemoglobin allele (HbS). Recent in vitro studies suggest that Dantu exerts this protection by increasing the surface tension of red blood cells, thereby impeding the ability of P. falciparum merozoites to invade them and reducing parasite multiplication. However, no studies have yet explored this hypothesis in vivo.MethodsWe investigated the effect of Dantu on early phase P. falciparum (Pf) infections in a controlled human malaria infection (CHMI) study. 141 sickle-negative Kenyan adults were inoculated with 3.2 × 103 aseptic, purified, cryopreserved Pf sporozoites (PfSPZ Challenge) then monitored for blood-stage parasitaemia for 21 days by quantitative polymerase chain reaction (qPCR)analysis of the 18S ribosomal RNA P. falciparum gene. The primary endpoint was blood-stage P. falciparum parasitaemia of ≥500/μl while the secondary endpoint was the receipt of antimalarial treatment in the presence of parasitaemia of any density. On study completion, all participants were genotyped both for Dantu and for four other polymorphisms that are associated with protection against severe falciparum malaria: α+-thalassaemia, blood group O, G6PD deficiency, and the rs4951074 allele in the red cell calcium transporter ATP2B4.ResultsThe primary endpoint was reached in 25/111 (22.5%) non-Dantu subjects in comparison to 0/27 (0%) Dantu heterozygotes and 0/3 (0.0%) Dantu homozygotes (p=0.01). Similarly, 49/111 (44.1%) non-Dantu subjects reached the secondary endpoint in comparison to only 7/27 (25.9%) and 0/3 (0.0%) Dantu heterozygotes and homozygotes, respectively (p=0.021). No significant impacts on either outcome were seen for any of the other genetic variants under study.ConclusionsThis study reveals, for the first time, that the Dantu blood group is associated with high-level protection against early, non-clinical, P. falciparum malaria infections in vivo. Learning more about the mechanisms involved could potentially lead to new approaches to the prevention or treatment of the disease. Our study illustrates the power of CHMI with PfSPZ Challenge for directly testing the protective impact of genotypes previously identified using other methods.FundingThe Kenya CHMI study was supported by an award from Wellcome (grant number 107499). SK was supported by a Training Fellowship (216444/Z/19/Z), TNW by a Senior Research Fellowship (202800/Z/16/Z), JCR by an Investigator Award (220266/Z/20/Z), and core support to the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya (203077), all from Wellcome. The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. For the purpose of Open Access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.Clinical trial numberNCT02739763

The Dantu blood group prevents parasite growth in vivo: Evidence from a controlled human malaria infection study.

Peer reviewed: TrueBACKGROUND: The long co-evolution of Homo sapiens and Plasmodium falciparum has resulted in the selection of numerous human genetic variants that confer an advantage against severe malaria and death. One such variant is the Dantu blood group antigen, which is associated with 74% protection against severe and complicated P. falciparum malaria infections in homozygous individuals, similar to that provided by the sickle haemoglobin allele (HbS). Recent in vitro studies suggest that Dantu exerts this protection by increasing the surface tension of red blood cells, thereby impeding the ability of P. falciparum merozoites to invade them and reducing parasite multiplication. However, no studies have yet explored this hypothesis in vivo. METHODS: We investigated the effect of Dantu on early phase P. falciparum (Pf) infections in a controlled human malaria infection (CHMI) study. 141 sickle-negative Kenyan adults were inoculated with 3.2 × 103 aseptic, purified, cryopreserved Pf sporozoites (PfSPZ Challenge) then monitored for blood-stage parasitaemia for 21 days by quantitative polymerase chain reaction (qPCR)analysis of the 18S ribosomal RNA P. falciparum gene. The primary endpoint was blood-stage P. falciparum parasitaemia of ≥500/μl while the secondary endpoint was the receipt of antimalarial treatment in the presence of parasitaemia of any density. On study completion, all participants were genotyped both for Dantu and for four other polymorphisms that are associated with protection against severe falciparum malaria: α+-thalassaemia, blood group O, G6PD deficiency, and the rs4951074 allele in the red cell calcium transporter ATP2B4. RESULTS: The primary endpoint was reached in 25/111 (22.5%) non-Dantu subjects in comparison to 0/27 (0%) Dantu heterozygotes and 0/3 (0.0%) Dantu homozygotes (p=0.01). Similarly, 49/111 (44.1%) non-Dantu subjects reached the secondary endpoint in comparison to only 7/27 (25.9%) and 0/3 (0.0%) Dantu heterozygotes and homozygotes, respectively (p=0.021). No significant impacts on either outcome were seen for any of the other genetic variants under study. CONCLUSIONS: This study reveals, for the first time, that the Dantu blood group is associated with high-level protection against early, non-clinical, P. falciparum malaria infections in vivo. Learning more about the mechanisms involved could potentially lead to new approaches to the prevention or treatment of the disease. Our study illustrates the power of CHMI with PfSPZ Challenge for directly testing the protective impact of genotypes previously identified using other methods. FUNDING: The Kenya CHMI study was supported by an award from Wellcome (grant number 107499). SK was supported by a Training Fellowship (216444/Z/19/Z), TNW by a Senior Research Fellowship (202800/Z/16/Z), JCR by an Investigator Award (220266/Z/20/Z), and core support to the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya (203077), all from Wellcome. The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication. For the purpose of Open Access, the authors have applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. CLINICAL TRIAL NUMBER: NCT02739763