The prevalence of glucose intolerance among antenatal clients at Kenyatta National Hospital at, 24-36 weeks of gestation

Objectives: To determine the prevalence of and associated factors for glucose intolerance among antenatal clients at Kenyatta National Hospital at 24-36 weeks of gestation.Design: Cross-sectional analytical study.Setting: Kenyatta National Hospital antenatal clinic.Subjects: One hundred and two (102) antenatal mothers at a gestational age of 24-36 weeks were recruited into the study and underwent a 100g Oral Glucose Tolerance Test (OGTT) after consenting to participate in the study.Results: From the study 37(36%) had glucose intolerance while 65 (64%) had normal glucose tolerance. Among clients with glucose intolerance, 16.7% met the diagnostic criteria for gestational diabetes, 3.9% had impaired glucose tolerance and 15.7% had impaired fasting glycaemia. Of the clients with normal glucose tolerance 22.5% displayed flat curves. Factors significantly associated with glucose intolerance were: BMI > 25;P-value 0.036: OR 0.37 CI (1.06-6.90), history of and treatment for sub-fertility p-value 0.002: OR 8.69 CI (1.74-43.50) and family history of hypertension; p-value 0.037: OR 2.66 CI (1.04-6.78).Conclusion: The prevalence of glucose intolerance was 36%. This is much higher than the 5% previously reported. There is need to screen pregnant women for glucose intolerance to prevent the complications usually associated with it

Lithopedion Causing Intestinal Obstruction

The formation of a mummifi ed intra-abdominal pregnancy (lithopedion) is rare. A 25 year old Para 4 + 0 gravida 5 presented with features of intestinalobstruction and a four year history of an intra abdominal mass. Examination revealed a solid mass in the right upper quadrant. Ultrasound imaging showed a poor echo-calcifi ed mass while an erect abdominal x ray revealed foetal bones within the abdominal cavity. At laparatomy a lithopedion witha normal uterus was found. Her last normal delivery was one year prior to this current presentation. A lithopedion causing a mass effect (intestinal  obstruction) and predating a normal intra uterine pregnancy followed by spontenous vertex delivery has not been reported in Kenya

Lithopaedon Presenting as Intestinal Obstruction with a Previous Co-Existing Intra-Uterine Pregnancy

This is a case report of a 25 year old lady Para 4 + 0 gravida 5, who was referred to Kisii level 5 hospital from a district hospital with a diagnosis of intestinal obstruction and a four year history of an intra-abdominal mass. A year prior to the admission she conceived and delivered vaginally at home but the baby died a few hours after the delivery. On examination on admission there was a solid mass in the right upper quadrant. Ultrasound imaging showed a poor echo-calcified mass suggestive of a colonic metastatic mass and an erect abdominal x ray revealed foetal bones within the abdominal cavity. At laparatomy a lithopedion with a normal uterus was found. The presence of a lithopedion and a normal intra-uterine pregnancy followed by spontaneous vertex delivery has not been reported in Kenya.Patients with lithopaedon can present with intestinal obstruction as a complication but the presence of a co-existing pregnancy is rare

Actuarial Risk Management Practices, Underwriting Risk and Performance of P & C Insurance Firms in East Africa

The purpose of the study was to establish the intervening effect of underwriting risk (loss ratio) on the relationship between actuarial risk management practices (ARMP) and performance of property and casualty (P & C) insurance underwriters in East Africa. Findings from primary and secondary data gathered from 82 general insurers from Kenya, Uganda and Tanzania show that there is a significant positive relationship between ARMP and non-financial performance and that loss ratio significantly mediates this relationship. The relationship with financial performance was however insignificant. The implication is that P & C insurance firms should keenly watch their loss ratios in order to improve their non-financial performance by correctly underwriting, pricing and reinsuring their risks in order to influence their claims ratio and also have a strategic claims management program in place that controls costs and leads to better firm reputation, which in turn will have ripple effect in increasing business volumes and performance. It is recommended that further empirical studies be carried out to establish other factors that especially influence financial performance

Assessing the Socio-economic Impacts of Secure Texting and Anti-Jamming Technologies in Non-Cooperative Networks

Operating securely over 5G (and legacy) infrastructure is a challenge. In non-cooperative networks, malicious actors may try to decipher, block encrypted messages, or specifically jam wireless radio systems. Such activities can disrupt operations, from causing minor inconvenience, through to fully paralyzing the functionality of critical infrastructure. While technological mitigation measures do exist, there are very few methods capable of assessing the socio-economic impacts from different mitigation strategies. This leads to a lack of robust evidence to inform cost-benefit analysis, and thus support decision makers in industry and government. Consequently, this paper presents two open-source simulation models for assessing the socio-economic impacts of operating in untrusted non-cooperative networks. The first focuses on using multiple non-cooperative networks to transmit a message. The second model simulates a case where a message is converted into alternative plain language to avoid detection, separated into different portions and then transmitted over multiple non-cooperative networks. A probabilistic simulation of the two models is performed for a 15 km by 15 km spatial grid with 5 untrusted non-cooperative networks and intercepting agents. The results are used to estimate economic losses for private, commercial, government and military sectors. The highest probabilistic total losses for military applications include US$300, US$150, and US$75, incurred for a 1, 3 and 5 site multi-transmission approach, respectively, for non-cooperative networks when considering 1,000 texts being sent. These results form a framework for deterministic socio-economic impact analysis of using non-cooperative networks and secure texting as protection against radio network attacks. The simulation data and the open-source codebase is provided for reproducibility

Belief Control Practices and Organizational Performances: A Survey of Sugar Industry in Kenya

The sugar industry has experienced poor performance attributed to industry deregulation, poor management and political interference. Adopting the Simons’ Levers of Control framework, this study sought to establish the relationship between belief control practices and organizational performance in the sugar industry in Kenya. Using a census survey of the 45 firms in the sugar industry value-chain in western Kenya registered by the Kenya Sugar Board as at 1 st January 2008, data was collected through self administered questionnaires sent to chief executive officers, finance managers and marketing officers of the target companies. The main finding of the study was that belief control systems are moderately prevalent in firms in the sugar industry and that belief control has a significant positive relationship with organizational performance (β = 0.288, p < 0.05). The findings of this study underscore the need of management to incorporate employees in the company core values and design of strategic control systems to cope with changing internal and external operating business environments. The study advances the extant theory of strategic management control practices by providing evidences from emerging economy and on a focused single lever of management contro

Sustainability assessment of Low Earth Orbit (LEO) satellite broadband mega-constellations

The growth of mega-constellations is rapidly increasing the number of rocket launches required to place new satellites in space. While Low Earth Orbit (LEO) broadband satellites help to connect unconnected communities and achieve the Sustainable Development Goals, there are also a range of negative environmental externalities, from the burning of rocket fuels and resulting environmental emissions. We present sustainability analytics for phase 1 of the three main LEO constellations including Amazon Kuiper (3,236 satellites), OneWeb (648 satellites), and SpaceX Starlink (4,425 satellites). In baseline scenarios over five years, we find a per subscriber carbon dioxide equivalent (CO$_2$eq) of 0.70$\pm$0.34 tonnes for Kuiper, 1.41$\pm$0.71 tonnes for OneWeb and 0.47$\pm$0.15 tonnes CO$_2$eq/subscriber for Starlink. However, in the worst-case emissions scenario these values increase to 3.02$\pm$1.48 tonnes for Kuiper, 1.7$\pm$0.71 tonnes for OneWeb and 1.04$\pm$0.33 tonnes CO$_2$eq/subscriber for Starlink, more than 31-91 times higher than equivalent terrestrial mobile broadband. Importantly, phase 2 constellations propose to increase the number of satellites by an order-of-magnitude higher, highlighting the pressing need to mitigate negative environmental impacts. Strategic choices in rocket design and fuel options can help to substantially mitigate negative sustainability impacts

Liquid chromatography-tandem mass spectrometry for the simultaneous quantitation of ceftriaxone, metronidazole and hydroxymetronidazole in plasma from seriously ill, severely malnourished children.

We have developed and validated a novel, sensitive, selective and reproducible reversed-phase high-performance liquid chromatography method coupled with electrospray ionization mass spectrometry (HPLC-ESI-MS/MS) for the simultaneous quantitation of ceftriaxone (CEF), metronidazole (MET) and hydroxymetronidazole (MET-OH) from only 50 µL of human plasma, and unbound CEF from 25 µL plasma ultra-filtrate to evaluate the effect of protein binding. Cefuroxime axetil (CEFU) was used as an internal standard (IS). The analytes were extracted by a protein precipitation procedure with acetonitrile and separated on a reversed-phase Polaris 5 C18-Analytical column using a mobile phase composed of acetonitrile containing 0.1% (v/v) formic acid and 10 mM aqueous ammonium formate pH 2.5, delivered at a flow-rate of 300 µL/min. Multiple reaction monitoring was performed in the positive ion mode using the transitionsm/z555.1→m/z396.0 (CEF),m/z172.2→m/z128.2 (MET),m/z188.0→m/z125.9 (MET-OH) andm/z528.1→m/z364.0 (CEFU) to quantify the drugs. Calibration curves in spiked plasma and ultra-filtrate were linear (r2≥ 0.9948) from 0.4-300 µg/mL for CEF, 0.05-50 µg/mL for MET and 0.02 - 30 µg/mL for MET-OH. The intra- and inter- assay precisions were less than 9% and the mean extraction recoveries were 94.0% (CEF), 98.2% (MET), 99.6% (MET-OH) and 104.6% (CEF in ultra-filtrate); the recoveries for the IS were 93.8% (in plasma) and 97.6% (in ultra-filtrate). The validated method was successfully applied to a pharmacokinetic study of CEF, MET and MET-OH in hospitalized children with complicated severe acute malnutrition following an oral administration of MET and intravenous administration of CEF over the course of 72 hours

Assessment of community led total sanitation uptake in rural Kenya

Background: Community Led Total Sanitation (CLTS) is an innovative community led drive to set up pit latrines in rural Kenya with an aim of promoting sustainable sanitation through behaviour change. It’s a behaviour change approach based on social capital that triggers households to build pit latrines without subsidy. The Ministry of Health introduced the CLTS campaign in 2007 and the first road map to ODF ended in 2013. Since the commencement of the CLTS Programme in, there is little documentation on assessment of its uptake from triggering to the certification of open defecation free villages.Objective: To assess the magnitude of Community Led Total Sanitation (CLTS) triggering to certification of Open Defecation free (ODF) villages in rural Kenya.Design: A retrospective descriptive study.Setting: The 47 counties in Kenya. Kenya is projected to have a population of 46 million people with the majority as rural populace. The study unit were Villages across the 47 counties from the data generated in the CLTS monitoring and evaluation dataset.Results: The number of triggered villages (11641) compared to those that reached certification stage (3131) reduced significantly. Busia County achieved the 100% target for triggering. There was a significant decline of the proportions per county in the process of claiming, verifying and certifying ODF villages however Busia, Siaya and Vihiga were leading across the counties. The proportion of CLTS facilitators and CLTS certified villages per county were incongruent.Conclusion: There was low uptake of CLTS from the triggering phase to the certification phase due to plausible factors such as inadequate monitoring of the CLTS process, inadequate funding of CLTS programmeming and conflicting work demands on the CLTS facilitators leading to reduced momentum as observed in Uganda