Archive and Collective Memories: Searching for African Women in the Pan-African Imaginary

In this article focused on archiving, collective memory, and the role of national imaginaries, we argue that although African women have actively been involved in nation building, their political action and lived experiences are often left out of legislative agendas, academic archiving and collective memory. We discuss the sidelining of women through legislation and representation while considering the (present and potential) roles of paper, digital and visual archives. Grounded in a discussion on colonial and postcolonial education in Kenya as a site to reproduce elitism, we consider how women’s participation in citizenship is invisible in the national collective memories of liberation, in global academic discourses about identity formation, knowledge and cultural production academic work as well as in the present policies and leadership. Many women's organizations on the African continent have made a priority of research and documentation work, in efforts to redress inequality/ignorance about women's lives.Ope

Outcomes and associated factors among premature neonates with respiratory distress syndrome managed at Moi Teaching and Referral Hospital, Eldoret, Kenya

Background: Globally, approximately over 4 million newborns die annually and the leading cause of death is directly from preterm complications which account for more than 1 million deaths. The most common complication is Respiratory distress syndrome (RDS).Objective: To determine short-term outcomes of premature neonates with RDS managed in the newborn unit (NBU) at Moi Teaching & Referral Hospital (MTRH), Eldoret.Design: Prospective descriptive study.Setting: Riley Mother Baby Hospital, NBU (MTRH), Eldoret.Participants: All admitted premature neonates clinically diagnosed with RDS.Main outcomes: Death/survival on day 10 and broncho-pulmonary dysplasia (BPD) at 6 weeks.Results: This study enrolled 94 premature neonates with RDS and 54 (57.4%) were females. Gestational age distribution: Below 28weeks (7.5%), 28-32weeks (54.3%) and 33-37 weeks (38.3%). Continuous Positive Airway Pressure was used on 62.8% (95% CI 52.2, 72.5), the rest received oxygen via nasal prongs and none received surfactant. Mortality at day 10 was 61% (0.61 95% CI: 0.51,0.71) with BPD reported in one neonate at 6weeks. Survival was 40% and 25% on day 10 and 40 respectively. Hypothermia and hyperglycemia were found in 65% and 55% respectively whereas suspected sepsis was treated in 77 (81.9%) of the neonates. None of the factors were independently associated with the outcome of death after adjusting by multiple logistic regression.Conclusion: There was a high mortality mainly occurring in the first 10 days of life. Hypothermia, hyperglycemia and neonatal sepsis were common co-morbidities. None of the factors were independently associated with the outcome of death. Chronic complications like BPD were rare

Malaria parasitemia among asymptomatic infants seen in a malaria endemic region of western Kenya

Background: Sustainable Development Goal number three call for complete reversal in the incidence of malaria by 2030. Malaria however remains a health priority in sub-Saharan Africa, with children under five experiencing the highest morbidity and mortality. In clinical settings, management of malaria cases has primarily been  centred on case definition, giving minimal consideration to the asymptomatic  individuals who remain a major reservoir since they do not seek care. In malaria endemic areas, infants are likely to remain asymptomatic since they have partial immunity acquired from the mother.Objective: To determine the proportion of infants with positive parasitemia and  describe their clinical and demographic characteristics.Design: A cross-sectional study.Setting: Webuye District Hospital, Western Kenya.Subjects: Three hundred and eighty four infants.Results: Prevalence of malaria parasitemia among enrolled infants was 61%. Infants born to housewife mothers, born to mothers who attended ANC during pregnancy; those weaned late or with family history of sickle cell disease were more likely tohave malaria parasitemia with p-values of 0.031,0.015,0.007, and 0.025  respectively.Conclusion: Prevalence of malaria parasitemia among asymptomatic infants in  Webuye (Western Kenya) remains high

Adapting health behavior measurement tools for cross-cultural use

Background: Addressing health disparities in the global community requires awareness of how cultural differences in beliefs, traditions, norms, and values shape health problems and behaviors. Review: This paper reviews methods of assessing health behaviors, how these assessments may be affected by cross-cultural differences, and methods of adaptation of health behaviors across cultures. We describe the methods used in appropriate translation processes and pilot-testing for health behavior assessment tools. We also discuss ways to limit literacy demands and incorporate qualitative interviews

Short term survival of premature infants admitted to the new born unit at Moi Teaching and Referral Hospital, Kenya

Background: Short and long term survival rates of premature infants have been well documented in developed countries. However, there are few data in low resource settings describing the survival of preterm infants. Data on short term survival rates of preterm infants may inform clinicians in a resource limited setting when counseling families on expected outcomes of care.Objective: To determine survival to hospital discharge of preterm infants in a public tertiary hospital in Kenya.Design: Prospective hospital cohort study design was used.Setting: Moi Teaching and Referral Hospital New Born Unit, Kenya.Participants: Premature Infants and their mothersInterventions: No study specific interventions were performed. We prospectively evaluated survival from admission until discharge from the hospital of 175 premature infants admitted to the newborn unit at Moi Teaching and Referral Hospital, a tertiary public hospital, between December 2012 and August 2013. We determined the overall survival rate and gestational age and birth weight category survival rates.Main outcome measures and Analysis: Death or discharge was the main outcomes of interest. Cox Proportional Hazards model was used to determine factors associated with survival and Kaplan-Meier survival curves drawn.Results: Of the 175 infants, 53.1% were female, mean birth weight was 1342g (± 355.5) and 37% were born before arrival. There were 15.4% neonates born less than 28 weeks, 30.9% aged 28- 31 weeks and 53.7% above 32-37 weeks. The overall survival to hospital discharge was 60.6% (95% CI 0.53-0.68). The survival rate was 29.6% for infants born less than 28 weeks’ gestation, 50% for those born at 28-31 weeks and 75.5% for those born at or above 32 weeks. Gestation age of ≥ 32 weeks (HR 0.39, 95% CI 0.18-0.8), birth weight >1000g (HR 0.27, 95% CI 0.20-0.78) and maternal antenatal care attendance (HR 0.52, 95% CI 0.3-0.9) were associated with better survival. Caesarian section delivery was associated with increased risk of death (HR 4.26, 95% CI 1.88-9.66). Most of deaths (81%) occurred within the first seven days.Conclusions: Sixty percent of premature infants admitted to MTRH new born unit survived to hospital discharge. The survival limit defined as the gestation at which a prematurely born infant has a 50% chance of survival was at the gestational age category of 28-32 weeks

Pediatric assent for a study of antiretroviral therapy dosing for children in western Kenya: a case study in international research collaboration

Multinational collaborators in health research face particular ethical challenges when conducting studies involving vulnerable populations such as children. We use an example from our first attempt to implement pediatric assent in the context of a longstanding research and clinical partnership between Kenyan and American medical schools to highlight the ethical and procedural issues related to pediatric assent that must be considered for multinational, pediatric studies. We consider relevant domestic, professional, and international guidelines for assent in pediatric research subjects, and we discuss the particular ethical challenges related to pediatric assent in the Kenyan context. Finally, we propose a way forward for approaching pediatric assent within our collaborative research program in Kenya that may apply to other multinational research partnerships.Fogarty International Center at the National Institutes of Health [R25TW006070]; USAID-AMPATH Partnership, United States Agency for International Developmen

An Evaluation of the Effectiveness of Behavioural Intervention Strategies Employed towards the Mitigation of HIV Risky Sexual Behaviour among Students in Institutions of Higher Learning in Western Kenya

Researchers have confirmed that the reason for the relatively high HIV incidence among people between 15-24 years globally is Risky Sexual Behaviour. Researchers subsequently identified a challenge regarding effective mitigation of the behaviour world over. They further identified Institutions of Higher Learning, which host a significant proportion of youth, as fertile breeding grounds for this behaviour. This study consequently evaluated the strategies employed in the mitigation of HIV Risky Sexual Behaviour among students in these institutions in Western Kenya overall, and specifically; evaluated the HIV prevention behavioural. The study employed qualitative and quantitative approaches to ensure triangulation and crosschecking of the research process. Employed were probability and non-probability sampling techniques generally and specifically, cluster sampling then simple random sampling. Chosen was a sample size of 399 students from a population of 13,002 students at seven institutions. Key informants were sampled purposively as follows; 5 NGO officials, 6 county government officials, 6 officials working in health care centers and 6 dean of students and 1 student counsellor. Selection of four Focus Group Discussions was purposive with each FGD having eight purposively selected student leaders from four institutions. An interview administered semi-structured questionnaire was employed to collect data from students, an FGD guide for the FGDs and Key Informant interview guides for the key informants. Descriptive statistics, an index-score, qualitative analysis and chi-square and were done for analysis. The HIV Risky Sexual Behaviour index-score revealed that a majority 269 (67.4%) of the respondents are involved in HIGH HIV Risky Sexual Behaviours. From chi-square tests, regarding behavioural strategies, information provision and counselling and other forms of psycho-social support are found to be statistically significant with p-value = 0.007 and p-value = 0.080 respectively. The study concludes that HIV incidence and prevalence rates in these institutions are likely to double in the near future if stakeholders continue to apply mitigation strategies in the exact manner they are currently doing. At behavioural level, the study thus recommends enhancing counselling and other forms of psychosocial support and stigma, and discrimination reduction programmes. Keywords: Effectiveness, Behavioural Intervention Strategies, Mitigation. HIV, Risky Sexual Behaviour, Students, Institutions, Higher Learning DOI: 10.7176/RHSS/12-16-05 Publication date:August 31st 202

Research Brief 08-01-HNP

Many of the 28 million people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) estimated to be living in sub-Saharan Africa also suffer from malnutrition. Reproductive-aged women, their infants and young children are among the most vulnerable to malnutrition and progression of HIV to AIDS. As seen in eastern and southern Africa, mortality is increased in the malnourished. The HIV Nutrition Project (HNP) researchers will be evaluating the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, the study will determine if meat in the diets of HIV-infected women and their children (1) protects the immune system and prevents severe infection, (2) prevents the loss of lean body mass, enhancing the quality of life among these drug naive women and enabling women to carry out their activities of daily living, and (3) supports the growth and development of their vulnerable children when compared to those given supplements with the same amount of energy, but with either soya or wheat protein. The intervention food with beef protein provides significantly more vitamin B12, lysine and bio-available iron and zinc when compared to the soya and wheat supplements. Deficiencies of these nutrients may hasten HIV disease progression.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-02-HNP

Preliminary evidence suggests that improved nutrition early in human immunodeficiency virus (HIV) infection may delay progression to acquired immunodeficiency syndrome (AIDS) and delay the initiation or improve the effectiveness of antiretroviral drug therapy (ART). The scientific community has evolved in its appreciation of the value of food as an integral component of comprehensive care for individuals with HIV infection and AIDS. It is now well recognized that those who are food insecure and malnourished are more likely to fail drug treatment regimens. Body mass index (BMI) < 18 at the initiation of ART is strongly predictive of death. In addition, weight loss during the first four weeks of ART is also associated with death. A higher BMI is protective and is associated with better responses with ART. Patient response to nutrition intervention, however, may be confounded by the stage of HIV progression and other infections. That is, those who are in the earlier stages of the disease may respond better to aggressive nutrition intervention. The HIV Nutrition Project (HNP), "Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children," will evaluate the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, researchers will study if the inclusion of meat added as an ingredient to a biscuit, when compared to soy or wheat, will best protect the immune system and prevent severe infection, prevent the loss of body mass and enhance the quality of life. These women are not yet receiving antiretroviral drugs and therefore not yet experiencing metabolic inefficiencies associated with AIDS.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-03-HNP

In sub-Saharan Africa, an estimated 28 million people are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In 2001, Moi University in Eldoret, Kenya joined with Kenya’s second national referral hospital, Moi Teaching and Referral Hospital (MTRH) and Indiana University (IU) to establish the Academic Model Providing Access To Healthcare (AMPATH). AMPATH’s missions were to (1) provide high-quality patient care; (2) educate patients and health care providers; and (3) establish a laboratory for clinical research in HIV/AIDS (http://medicine.iupui.edu/kenya/hiv.aids.html). Leveraging the power of an academic medical partnership, AMPATH has quickly become one of the largest and most comprehensive HIV/AIDS control systems in sub-Saharan Africa, providing a comprehensive system of care that has been described as a model of sustainable development (Tobias, 2006). Delivery of services occurs in the public sector through hospitals and health centers run by Kenya’s Ministry of Health. AMPATH currently implements prevention activities that touch the lives of millions of persons in a wide geographic area. The research arm of AMPATH, created to facilitate and manage the international research agenda being generated by Kenyan and US faculty, includes the Global Livestock CRSP’s HIV Nutrition Project (HNP), “Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children,” which is a collaborative initiative between AMPATH and faculty from Moi University, Indiana University and the University of California, Los Angeles.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID