Task Sharing and Shifting to Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology and Bone Marrow Aspiration and Trephine Biopsy Training Program

Purpose: Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya. Methods: Between January 2016 and February 2017, we trained pathologists, pathology residents, and technologists from the University of Nairobi and Aga Khan University Hospital, Nairobi, in FNAB and BMAT biopsies, who in turn trained pathologists, medical officers (MO), clinical officers (CO), and technologists at five tertiary public hospitals. The program involved curriculum development, training workshops, the establishment of new and strengthening existing FNAB and BMAT biopsy clinics, interim site visits, audits, and stakeholder workshops. Results: Fifty-one medical personnel at the tertiary hospitals were trained. The FNAB numbers increased by 41% to 1,681, with 139 malignant diagnoses (7.1%). BMAT biopsy numbers increased by 268% to 140, with 34 malignant cases. Between 60% and 100% of the FNAB and BMAT biopsy procedures were performed by MO and CO over the project period. One new FNAB and two new BMAT biopsy clinics were established. Conclusion: This project demonstrates a successful model of task sharing and shifting from specialist pathologists to MO and CO that improved access to important FNAB and BMAT biopsy services in a low-resource setting

Assessing developmental outcomes of children from Kilifi, Kenya following prophylaxis for seizures in Cerebral Malaria

The purpose of the study was to develop a culture-informed measure of developmental outcome and to apply it to detect differences in developmental level between children with cerebral malaria enrolled in a clinical trial to control seizures during the acute phase of the illness. The instrument was administered to a sample of 180 children, three and 12 months after discharge from hospital. The measure demonstrated high internal consistency, good inter-observer reliability, age sensitivity and strong relations with parental report of child functioning. No association was found between performance, or change in performance, with the prophylactic regime administered. The results suggested that the use of Phenobarbital in controlling provoked seizures has no observable effect on cognitive function

The role of indigenous knowledge in fisheries resource management for aquaculture development: A case study of the Kenyan Lake Victoria region

Abstract Indigenous knowledge is critical in the conservation of wild fish genetic resources and consequent development of fish seed for improved aquaculture production. Local fisher communities rely on aquatic resources mainly for livelihood and subsistence and have therefore come up with systems to manage these resources for sustainable use. This study aimed at identifying the role of indigenous people's knowledge in fish conservation as a way of improving aquaculture, with a specific focus on the conservation of aquaculture fish species in Kenya. Data was collected from individual fisherfolk through semi‐structured questionnaires and field observations. Pearson's chi‐square test was performed on variables that were predicted to influence indigenous knowledge. The chi‐square tests revealed a significant relationship between age and indigenous knowledge (χ2 = 15.153, p = 0.004). Results also revealed a significant relationship between an individual's years of residence in the area and indigenous knowledge (χ2 = 17.767, p = 0.003). It was found that the indigenous people use various concepts and strategies for fish conservation and fish production. From the findings of the study, it is recommended that scientists and policy actors should adopt the indigenous people's knowledge as a source of baseline information for fisheries and aquaculture research, and as additional or alternative strategies for the management of fish genetic resources

A review of production, post-harvest handling and marketing of sweetpotatoes in Kenya and Uganda

Sweetpotato (Ipomea batatas) is a versatile crop that serves the roles of food and nutrition security, cash crop in both raw and processed forms. It is a source of livestock feed and has great potential as a raw material for industrial processing. The potential of sweetpotato has been greatly underexploited by the fact that it has been regarded as a poor man’s food and is mainly grown under marginal conditions for subsistence by most producers, who are rural small-scale farmers in developing countries, such as Kenya and Uganda. Losses in the highly perishable root crop and its leaves are exacerbated by lack of appropriate postharvest knowledge, technologies and facilities. Inadequate information on available cultivars also limits the maximum utilization of the crop and leaves. The current review examines production potential, postharvest handling practices, marketing, and physicochemical and nutritional properties of sweetpotatoes