Linking Farmers to Markets through Modern Information and Communication Technologies in Kenya

This paper highlights a market information and linkage system (MILS) developed and tested by the Kenya Agricultural Commodity Exchange Limited (KACE) that increases the efficiency of agricultural markets to work better for smallholder farmers and other small and medium sized agro-enterprises (SMEs). The MILS involves harnessing modern information and communication technologies (ICTs) to empower farmers with low-cost reliable and timely market information to enhance the bargaining power of the farmer for a better price in the market place, and to link the farmer to markets more efficiently and profitably. The components of the KACE MILS are (www.kacekenya.com): Rural based Market Information Points (MIPs) which are information kiosks located in rural markets, District-level Market Information Centres (MICs), Mobile Phone Short Messaging Service (SMS), Interactive Voice Response (IVR), Internet based database system, rural FM radio and the Central Coordinating Hub in Nairobi. KACE has adopted a business approach to the provision of its services: users pay for the services. For instance it charges: placement fees per initial offer or bid (US$1.5-15), commissions on concluded deals (0.5$ 65 for 6 months or US$125 for 12 months), fees to visiting foreign groups (US$ 2,000-5,000/visit) and revenue sharing agreements with SMS and IVR service providers. When the KACE MILS services are scaled out and widely used by many farmers and SMEs across Kenya, the system will generate sufficient revenue to sustain its services without reliance on development partner funding. To enhance the financial sustainability of the MILS services further, KACE has recently initiated two innovations: franchising MIPs and MICs to local entrepreneurs, and establishing a virtual trading floor to improve the matching of offers and bids through a rural-based FM Radio program. A recent study of the impact of the KACE MILS concluded that the proportion of farmers and traders that say their incomes has increased and their bargaining positions have improved is very high (75% farmers and 60% commodity traders). Furthermore, the study concluded that it was clear that during the years in which the KACE MILS has been operational, market integration improved for two commodities studied (i.e. maize and beans). This study also highlights the challenges faced by the KACE MILS, including poor infrastructure that imposes high transport costs to markets, high costs of mobile phone calls and SMS and small quantities of produce of varying quality offered. Keywords: Information and communication technology, innovations, Kenya,Agribusiness, Agricultural and Food Policy, Consumer/Household Economics, Environmental Economics and Policy, Farm Management, Food Consumption/Nutrition/Food Safety, Food Security and Poverty, Institutional and Behavioral Economics, International Relations/Trade, Land Economics/Use, Marketing, Productivity Analysis, Research and Development/Tech Change/Emerging Technologies, Research Methods/ Statistical Methods,

A Study of Diplostomum Parasites Affecting Oreochromis niloticus in Chepkoilel Fish Farm and Two Dams in Eldoret-Kenya

The Diplostomum parasite completes its life-cycle in fish eating birds, but spends considerable time in the eye vitreous humor of many fresh water fishes. Its infection in fish causes severe ocular pathology, and leads to increased susceptibility to predation. A study on Diplostomum parasites was conducted at Chepkoilel University with an objective of assessing its parasitic indices and effects on O. niloticus. A total of 40 fish were collected from the fish farm and 155 from the dams between November 2010 and January, 2011. Fish were weighed and length measured to ascertain their condition factor. The fish were observed for the Diplostomum parasite to ascertain parasitic indices in the different habitats. The parasite abundance was related to fish size and condition factor to determine parasite’s effect on O. niloticus. Fish were found to have a parasitic prevalence (%) of 100, 84 and 66 in Kerita dam, Kesses dam and Chepkoilel fish farm. Parasite mean intensity was 12, 9 and 14 respectively.The wellbeing of the fish was not compromised by the parasites, as was seen in the correlation between condition factor and parasite abundance. There was a Pearson correlation of P = 0.357, 0.516 and 0.565 in Kerita dam, Kesses dam and Chepkoilel fish farm respectively. The dams and the fish farm did not pose significant difference in the parasitic indices, probably due to their proximity. There was seen equal abundance in both fish sexes, implying no sex preference in infection. Keywords: Diplostomum, Oreochromis niloticus, prevalence, Abundance, Mean intensity, Condition factor

Efficacy of combination therapy using extracts of Aloe secundiflora Eng L and Callistemon citrinus William C. in Leishmania major infected BALB/c mice

Background: Leishmania major causes cutaneous leishmaniasis which leads to painful skin sores in humans. In the current study, efficacy of combination therapy of A. secundiflora and C. citrinus against L. major infected mice treated intra-peritoneally and orally was studied. Pentostam administered intra-peritoneally and phosphate buffered saline intra-peritoneally and orally were used as a controls.Objective: To determine the efficacy of combined therapy of C. citrinus and A. secundiflora extracts in Leishmania major infected BALB/c mice.Design: Experimental-Laboratory based studySetting: Kenya Medical Research Institute (Leishmania Department)Subjects: Eight weeks Male BALB/c MiceResults: The minimum inhibitory concentration (MICs) of aqueous extracts of A. secundiflora (A), and C. citrinus (B) were 2 mg/ml and 5 mg/ml respectively while the IC50 for the same extracts were 467.09μg/ml and 457.88μg/ml respectively. The combination of these extracts at ratio (1:1) supported minimal growth of L. major promastigotes and had IC50 of 58.45μg/ml as compared to MICs of 12.50μg/ml for Pentostam. The combination therapy had Infection rate (IR) of 19% and MI of 52.81% compared to Pentostam (IR=21% and MI=11.64%). The combination therapy reduced the footpad lesion size significantly (P < 0.05) just like the Pentostam control drug and no significant nitric oxide was stimulated. The oral and intra-peritoneal combination treatment reduced spleen amastigotes in mice by 73.46% and 78.12% corresponding to total LDUs of 10.87±0.64 and 8.96±0.82 respectively compared to Pentostam at 94.58% and LDU of 2.22±0.13. The difference between efficacy of Pentostam and that of combined extracts was almost significant (t= 2.653, P= 0.057).Conclusion: The combination therapy was active against L. major parasite, reduced lesion size significantly and did not prevent visceralisation but reduced spleen parasite load significantly

Rifampicin and clarithromycin (extended release) versus rifampicin and streptomycin for limited Buruli ulcer lesions: a randomised, open-label, non-inferiority phase 3 trial.

BACKGROUND: Buruli ulcer is a neglected tropical disease caused by Mycobacterium ulcerans infection that damages the skin and subcutis. It is most prevalent in western and central Africa and Australia. Standard antimicrobial treatment with oral rifampicin 10 mg/kg plus intramuscular streptomycin 15 mg/kg once daily for 8 weeks (RS8) is highly effective, but streptomycin injections are painful and potentially harmful. We aimed to compare the efficacy and tolerability of fully oral rifampicin 10 mg/kg plus clarithromycin 15 mg/kg extended release once daily for 8 weeks (RC8) with that of RS8 for treatment of early Buruli ulcer lesions. METHODS: We did an open-label, non-inferiority, randomised (1:1 with blocks of six), multicentre, phase 3 clinical trial comparing fully oral RC8 with RS8 in patients with early, limited Buruli ulcer lesions. There were four trial sites in hospitals in Ghana (Agogo, Tepa, Nkawie, Dunkwa) and one in Benin (Pobè). Participants were included if they were aged 5 years or older and had typical Buruli ulcer with no more than one lesion (caterories I and II) no larger than 10 cm in diameter. The trial was open label, and neither the investigators who took measurements of the lesions nor the attending doctors were masked to treatment assignment. The primary clinical endpoint was lesion healing (ie, full epithelialisation or stable scar) without recurrence at 52 weeks after start of antimicrobial therapy. The primary endpoint and safety were assessed in the intention-to-treat population. A sample size of 332 participants was calculated to detect inferiority of RC8 by a margin of 12%. This study was registered with ClinicalTrials.gov, NCT01659437. FINDINGS: Between Jan 1, 2013, and Dec 31, 2017, participants were recruited to the trial. We stopped recruitment after 310 participants. Median age of participants was 14 years (IQR 10-29) and 153 (52%) were female. 297 patients had PCR-confirmed Buruli ulcer; 151 (51%) were assigned to RS8 treatment, and 146 (49%) received oral RC8 treatment. In the RS8 group, lesions healed in 144 (95%, 95% CI 91 to 98) of 151 patients, whereas lesions healed in 140 (96%, 91 to 99) of 146 patients in the RC8 group. The difference in proportion, -0·5% (-5·2 to 4·2), was not significantly greater than zero (p=0·59), showing that RC8 treatment is non-inferior to RS8 treatment for lesion healing at 52 weeks. Treatment-related adverse events were recorded in 20 (13%) patients receiving RS8 and in nine (7%) patients receiving RC8. Most adverse events were grade 1-2, but one (1%) patient receiving RS8 developed serious ototoxicity and ended treatment after 6 weeks. No patients needed surgical resection. Four patients (two in each study group) had skin grafts. INTERPRETATION: Fully oral RC8 regimen was non-inferior to RS8 for treatment of early, limited Buruli ulcer and was associated with fewer adverse events. Therefore, we propose that fully oral RC8 should be the preferred therapy for early, limited lesions of Buruli ulcer. FUNDING: WHO with additional support from MAP International, American Leprosy Missions, Fondation Raoul Follereau France, Buruli ulcer Groningen Foundation, Sanofi-Pasteur, and BuruliVac

Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here

Qualitative documentary analysis of guidance on information provision and consent for the introduction of innovative invasive procedures including surgeries within NHS organisations' policies in England and Wales

OBJECTIVE: To review guidance, included in written local UK National Health Service (NHS) organisation policies, on information provision and consent for the introduction of new invasive procedures- including surgeries, and devices (IPs/Ds). DESIGN: A qualitative documentary analysis of data on patient information provision and consent extracted from policies for the introduction of IP/Ds from NHS organisations in England and Wales. SETTING: NHS trusts in England and health boards in Wales, UK. PARTICIPANTS: Between December 2017 and July 2018, 150 acute trusts in England and 7 health boards in Wales were approached for their policies for the introduction of new IP/Ds. In total, 123 policies were received, 11 did not fit the inclusion criteria and a further policy was included from a trust website resulting in 113 policies included for review. RESULTS: From the 113 policies, 22 did not include any statements on informed consent/information provision or lacked guidance on the information to be provided to patients and were hence excluded. Consequently, 91 written local NHS policies were included in the final dataset. Within the guidance obtained, variation existed on disclosure of the procedure’s novelty, potential risks, benefits, uncertainties, alternative treatments and surgeon’s experience. Few policies stated that clinicians should discuss the existing evidence associated with a procedure. Additionally, while the majority of policies referred to patients needing written information, this was often not mandated and few policies specified the information to be included. CONCLUSIONS: Nearly a fifth of all the policies lacked guidance on information to be provided to patients. There was variability in the policy documents regarding what patients should be told about innovative procedures. Further research is needed to ascertain the information and level of detail appropriate for patients when considering innovative procedures. A core information set including patients’ and clinicians’ views is required to address variability around information provision/consent for innovative procedures

Animal-related factors associated with moderate-to-severe diarrhea in children younger than five years in western Kenya: A matched case-control study

Background Diarrheal disease remains among the leading causes of global mortality in children younger than 5 years. Exposure to domestic animals may be a risk factor for diarrheal disease. The objectives of this study were to identify animal-related exposures associated with cases of moderate-to-severe diarrhea (MSD) in children in rural western Kenya, and to identify the major zoonotic enteric pathogens present in domestic animals residing in the homesteads of case and control children. Methodology/Principal findings We characterized animal-related exposures in a subset of case and control children (n = 73 pairs matched on age, sex and location) with reported animal presence at home enrolled in the Global Enteric Multicenter Study in western Kenya, and analysed these for an association with MSD. We identified potentially zoonotic enteric pathogens in pooled fecal specimens collected from domestic animals resident at children’s homesteads. Variables that were associated with decreased risk of MSD were washing hands after animal contact (matched odds ratio [MOR] = 0.2; 95% CI 0.08–0.7), and presence of adult sheep that were not confined in a pen overnight (MOR = 0.1; 0.02–0.5). Variables that were associated with increased risk of MSD were increasing number of sheep owned (MOR = 1.2; 1.0–1.5), frequent observation of fresh rodent excreta (feces/urine) outside the house (MOR = 7.5; 1.5–37.2), and participation of the child in providing water to chickens (MOR = 3.8; 1.2–12.2). Of 691 pooled specimens collected from 2,174 domestic animals, 159 pools (23%) tested positive for one or more potentially zoonotic enteric pathogens (Campylobacter jejuni, C. coli, non-typhoidal Salmonella, diarrheagenic E. coli, Giardia, Cryptosporidium, or rotavirus). We did not find any association between the presence of particular pathogens in household animals, and MSD in children. Conclusions and significance Public health agencies should continue to promote frequent hand washing, including after animal contact, to reduce the risk of MSD. Future studies should address specific causal relations of MSD with sheep and chicken husbandry practices, and with the presence of rodents