Improving Self-Management of Diabetes with Culturally Sensitive Interventions

Abstract Adult Latino patients with diabetes may require education and skills that are culturally appropriate to achieve optimum results. The purpose of this DNP project was to improve diabetes self-management among Latino and other at-risk adults. The project used an intervention bundle to streamline screening, education, and improve patients’ self- confidence. Adult patients were screened during triage to obtain vital signs and blood glucose levels per the routine at the clinic and via phone to discuss management of diabetes. Implementation of the project included provision of culturally sensitive diabetes education material, culturally sensitive “traffic light” food guide in English and Spanish. The Diabetes Self-Management Questionnaire was the primary tool used before and after the implementation to determine the effect of the intervention. In total, 44 adults participated in the intervention. The results demonstrate a positive impact of the culturally sensitive “traffic light” food guide in participants’ knowledge and selection of healthy food. The nurse practitioners, physician assistant, prelicensure and nurse practitioner students at the clinic were in favor of continued use of the materials. The findings support the use of culturally sensitive food guide to improve diabetes self-management in Latino and a culturally diverse patient population. Keywords: diabetes, Latino, adults, self- monitoring, blood glucose, A1

Improving Self-Management of Diabetes with Culturally Sensitive Interventions

Abstract Adult Latino patients with diabetes may require education and skills that are culturally appropriate to achieve optimum results. The purpose of this DNP project was to improve diabetes self-management among Latino and other at-risk adults. The project used an intervention bundle to streamline screening, education, and improve patients’ self- confidence. Adult patients were screened during triage to obtain vital signs and blood glucose levels per the routine at the clinic and via phone to discuss management of diabetes. Implementation of the project included provision of culturally sensitive diabetes education material, culturally sensitive “traffic light” food guide in English and Spanish. The Diabetes Self-Management Questionnaire was the primary tool used before and after the implementation to determine the effect of the intervention. In total, 44 adults participated in the intervention. The results demonstrate a positive impact of the culturally sensitive “traffic light” food guide in participants’ knowledge and selection of healthy food. The nurse practitioners, physician assistant, prelicensure and nurse practitioner students at the clinic were in favor of continued use of the materials. The findings support the use of culturally sensitive food guide to improve diabetes self-management in Latino and a culturally diverse patient population. Keywords: diabetes, Latino, adults, self- monitoring, blood glucose, A1

Webometrics Ranking and Its Relationship to Quality Education and Research inAcademic Institutions in Kenya

Examine the relationship between webometrics ranking and the quality of education and research in academic institutions in Kenya; and suggest appropriate solutions to enhance the practice. Descriptive survey design applied quantitative and qualitative research where structured questionnaire and document reviews were used to collect data from the respondents. Webometrics ranking promotes quality of education and research in academic institutions through visibility that showcases research activities and enriches knowledge. Collaboration and partnerships was the leading strategy for high webometrics ranking practice and performance in academic institutions. Numerous strategies were recommended for maintaining and improving webometrics ranking performance including use of web champions, marketing and awareness. Practice of webometrics ranking as a basis for evaluating performance in institutions of higher learning and education is gaining momentum worldwide. Excellence performance based on webometrics matrix provides practical lessons, suggestions and local solutions for other institutions of higher learning. Webometrics ranking promotes quality research and education in institutions of higher learning; provides public information on academic standing and performance; fosters competition in academic institutions; provides evidence that stimulates the evolution of centres of excellence; and enhances additional rationale for allocation of funds. Practice supports teaching, research related activities and scholarly communications that promotes the need for development of standards and policies in higher education and learning. Fundamental in fostering competition and promoting quality education and research through enrichment of knowledge and content repositories. Strategies for sustainable webometrics ranking performance need to be stipulated in achieving excellence performance in higher education and learning

IMPACT OF LIBRARY CONSORTIA ON RESOURCE SHARING IN ACADEMIC LIBRARIES: EVIDENCE FROM THE UNIVERSITY OF NAIROBI LIBRARY

The purpose of the study was to determine the impact of library consortia on resource sharing in academic libraries in Kenya with reference to the University of Nairobi library. The study also sought to propose a framework to enhance resource sharing in academic libraries and employed a descriptive case study design using both qualitative and quantitative approaches to collect and analyse data. The study found out that library consortium model was the dominant method of resource sharing which greatly influenced resource sharing activities. The consortium (KLISC) was shown to be very significant in ensuring wider access to shared information resources, institutional repository development and capacity development for resource sharing. However, resource sharing was shown to be limited to the provision of collectively acquired information resources, with limited emphasis information exchange and inter-library integration. It was recommended that comprehensive standards be adopted to improve prospects of system integration and increased efforts made to improve the proportion of local content in shared information resources. The prioritisation of local content in the development of shared resources was also recommended and a framework for resource sharing was proposed to help tackle identified gaps in existing policies and frameworks

Impact of African Traditional Termite Control Methods on Conservation of Biodiversity: A Review

Termites cause a wide array of damages to plantations, trees and manmade structures. Both industrial and food crops as well as forest trees are attacked by termite. Reports on economic losses caused by termite infestations have been made worldwide. Consequently, need to eliminate and control termites have risen especially by farmers and property owners as a measure to secure their produce and property respectively. Poverty prevalence in Africa limits accessibility to chemical control methods which are expensive and requires expertise to use hence unaffordable. In response, African communities have devised and applied traditional methods in order to eliminate and or control termites in farmlands and homes. However, these methods have not been scientifically proven and the extent of their efficiency is still questionable. On the other hand, there is a feeling that these methods are environmentally friendly and safer for biodiversity conservation as compared to the conventional methods of termite control.  In order to curb loss of biodiversity experienced globally sustainable methods of termite control should be employed. Usually this loss is accelerated by continuous clearing of natural vegetation to accommodate the ever growing population particularly in Africa.  Depending on the methods used biodiversity can either be conserved or lost in the process. This review therefore explores the traditional uses of termites in Africa, elaborate on the common traditional methods used to control them.  It also details the advantages of these methods over conventional methods on biodiversity and environmental conservation. Key words: Termites, Biodiversity, Africa, Traditiona

An Analysis of Loan Portfolio Management on Organization Profitability: Case of Commercial Banks in Kenya

The banking sector in any economy serves as a catalyst for growth and development. Banks are able to perform this role through their crucial functions of financial intermediation, provision of an efficient payment system and facilitating the implementation of monetary policies. Bank profitability is usually expressed as a function of internal and external determinants. The overall performance and profitability of the banking sector in Kenya has improved tremendously over the last 10 years. The aim of this study was to close the gap in knowledge by investigating profitability determinants within commercial banks in Kenya. The determinants studied were loan portfolio, interest expense, and administration costs and assets value. A descriptive survey design was employed in this study. The population of the study was the management employees working for commercial banks in Kenya. The sample was accessed by use of both stratified and simple random sampling. A questionnaire was used to gather the primary information. The questionnaires were self-administered and were served to the respondents by self-introduction. Research assistants were used to follow up on duly completed questionnaires. Statistical package for social sciences (SPSS) was used to analyse primary data while the SAS v.6 of 2009 was used to analyse the secondary data gathered from the banks. Findings of the study showed that public sector banks and private sector banks were not much affected by increasing or decreasing of interest margin. It can therefore be interpreted that the profitability growth of public and private sector banks are not dependent on fluctuation of interest rate although the foreign banks have the benefit of high return due to increase or decrease in interest margin. Key Words: Loan portfolio Management on organization profitability, commercial Banks in Keny

Temporal changes in the positivity rate of common enteric viruses among paediatric admissions in coastal Kenya, during the COVID-19 pandemic, 2019–2022

Background: The non-pharmaceutical interventions (NPIs) implemented to curb the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) early in the coronavirus disease 2019 (COVID-19) pandemic, substantially disrupted the activity of other respiratory viruses. However, there is limited data from low-and-middle income countries (LMICs) to determine whether these NPIs also impacted the transmission of common enteric viruses. Here, we investigated the changes in the positivity rate of five enteric viruses among hospitalised children who presented with diarrhoea to a referral hospital in coastal Kenya, during COVID-19 pandemic period. Methods: A total of 870 stool samples from children under 13 years of age admitted to Kilifi County Hospital between January 2019, and December 2022 were screened for rotavirus group A (RVA), norovirus genogroup II (GII), astrovirus, sapovirus, and adenovirus type F40/41 using real-time reverse-transcription polymerase chain reaction. The proportions positive across the four years were compared using the chi-squared test statistic. Results: One or more of the five virus targets were detected in 282 (32.4%) cases. A reduction in the positivity rate of RVA cases was observed from 2019 (12.1%, 95% confidence interval (CI) 8.7–16.2%) to 2020 (1.7%, 95% CI 0.2–6.0%; p < 0.001). However, in the 2022, RVA positivity rate rebounded to 23.5% (95% CI 18.2%–29.4%). For norovirus GII, the positivity rate fluctuated over the four years with its highest positivity rate observed in 2020 (16.2%; 95% C.I, 10.0–24.1%). No astrovirus cases were detected in 2020 and 2021, but the positivity rate in 2022 was similar to that in 2019 (3.1% (95% CI 1.5%–5.7%) vs. 3.3% (95% CI 1.4–6.5%)). A higher case fatality rate was observed in 2021 (9.0%) compared to the 2019 (3.2%), 2020 (6.8%) and 2022 (2.1%) (p < 0.001). Conclusion: Our study finds that in 2020 the transmission of common enteric viruses, especially RVA and astrovirus, in Kilifi Kenya may have been disrupted due to the COVID-19 NPIs. After 2020, local enteric virus transmission patterns appeared to return to pre-pandemic levels coinciding with the removal of most of the government COVID-19 NPIs

Genomic epidemiology of Human Adenovirus F40 and F41 in Coastal Kenya : a retrospective hospital-based surveillance study (2013-2022)

Human adenovirus species F (HAdV-F) is a leading cause of childhood diarrhoeal deaths. Genomic analysis would be key for understanding transmission dynamics, potential drivers of disease severity, transmission dynamics, and for vaccine development. However, currently there are limited HAdV-F genomic data globally. Here, we sequenced and analysed HAdV-F from stool samples collected in coastal Kenya between 2013 and 2022. The samples were collected at Kilifi County Hospital in coastal, Kenya, from children &amp;lt; 13 years of age who reported a history of ≥ 3 loose stools in the previous 24hrs. The genomes were analyzed together with data from the rest of the world by phylogenetic analysis and mutational profiling. Types and lineages were assigned based on phylogenetic clustering consistent with previously described criteria and nomenclature. Participant clinical and demographic data were linked to genotypic data. Of 91 cases identified using real-time PCR, 88 near-complete genomes were assembled, and these classified into HAdV-F40 (n=41) and F41 (n=47). These types cocirculated throughout the study period. Three and four distinct lineages were observed for HAdV-F40 (Lineage 1-3) and F41 (Lineage 1, 2A, 3A, 3C and 3D). Types F40 and F41 coinfections were observed in five samples, and F41 and B7 in one sample. Two children with F40 and 41 coinfections were also infected with rotavirus and had moderate and severe disease as defined using the Vesikari Scoring System, respectively. Intratypic recombination was found in 4 HAdV-F40 sequences occurring between lineages 1 and 3. None of the HAdV-F41 cases had jaundice. This study provides evidence of extensive genetic diversity, coinfections, and recombination within HAdV-F40 in a rural coastal Kenya that will inform public health policy, vaccine development that includes the locally circulating lineages, and molecular diagnostic assay development. We recommend future comprehensive studies elucidating on HAdV-F genetic diversity and immunity for rational vaccine development

Optimization of the SARS-CoV-2 ARTIC network V4 primers and whole genome sequencing protocol

Introduction: The ARTIC Network's primer set and amplicon-based protocol is one of the most widely used SARS-CoV-2 sequencing protocol. An update to the V3 primer set was released on 18th June 2021 to address amplicon drop-off observed among the Delta variant of concern. Here, we report on an in-house optimization of a modified version of the ARTIC Network V4 protocol that improves SARS-CoV-2 genome recovery in instances where the original V4 pooling strategy was characterized by amplicon drop-offs. Methods: We utilized a matched set of 43 clinical samples and serially diluted positive controls that were amplified by ARTIC V3, V4 and optimized V4 primers and sequenced using GridION from the Oxford Nanopore Technologies'. Results: We observed a 0.5% to 46% increase in genome recovery in 67% of the samples when using the original V4 pooling strategy compared to the V3 primers. Amplicon drop-offs at primer positions 23 and 90 were observed for all variants and positive controls. When using the optimized protocol, we observed a 60% improvement in genome recovery across all samples and an increase in the average depth in amplicon 23 and 90. Consequently, ≥95% of the genome was recovered in 72% (n = 31) of the samples. However, only 60–70% of the genomes could be recovered in samples that had 0.05) correlation between Ct value and genome recovery. Conclusion: Utilizing the ARTIC V4 primers, while increasing the primer concentrations for amplicons with drop-offs or low average read-depth, greatly improves genome recovery of Alpha, Beta, Delta, Eta and non-VOC/non-VOI SARS-CoV-2 variants

Genomic epidemiology of the rotavirus G2P[4] strains in coastal Kenya pre- and post-rotavirus vaccine introduction, 2012 – 2018

The introduction of rotavirus vaccines into the national immunization programme in many countries has led to a decline of childhood diarrhoea disease burden. Coincidentally, the incidence of some rotavirus group A (RVA) genotypes, has increased, which may result from non-vaccine-type replacement. Here we investigate the evolutionary genomics of rotavirus G2P[4] which has shown an increase in countries that introduced the monovalent Rotarix® vaccine. We examined 63 RVA G2P[4] strains sampled from children (aged below 13 years) admitted to Kilifi County Hospital, Coastal Kenya, pre- (2012 to June 2014) and post-(July 2014-2018) rotavirus vaccine introduction. All the 63 genome sequences showed a typical DS-1 like genome constellation G2-P[4]-I2-R2-C2-M2-A2-N2-T2-E2-H2. Pre-vaccine G2 sequences predominantly classified as sub-lineage IVa-3 and co-circulated with low numbers of sub-lineage IVa-1 strains, whereas post-vaccine G2 sequences mainly classified into sub-lineage IVa-3. In addition, in the pre-vaccine period, P[4] sub-lineage IVa strains co-circulated with low numbers of P[4] lineage II strains, but P[4] sub-lineage IVa strains predominated in the post-vaccine period. On the global phylogeny, the Kenyan pre- and post-vaccine G2P[4] strains clustered separately, suggesting that different virus populations circulated in the two periods. However, the strains from both periods exhibited conserved amino acid changes in the known antigenic epitopes, suggesting that replacement of the predominant G2P[4] cluster was unlikely a result of immune escape. Our findings demonstrate that the pre- and post-vaccine G2P[4] strains circulating in Kilifi, coastal Kenya, differed genetically, but likely were antigenically similar. This information informs the discussion on the consequences of rotavirus vaccination on rotavirus diversity