Effect of organic and inorganic phosphorus sources on maize yields in an acid soil in western Kenya

Maize production in western Kenya is commonly limited by P deficiencies and aluminum phytotoxicity. Due to high costs of imported fertilizers and lime, focus is now shifting to solutions that utilize local resources. We tested the effect of three inorganic P sources i.e., triple superphosphate (TSP), Minjingu phosphate rock (MPR) and Busumbu phosphate rock (BPR), each applied in combination with two organic materials (OMs) i.e., farmyard manure (FYM) and Tithonia diversifolia green manure (tithonia), or with urea on soil chemical properties related to soil acidity, P availability and maize yields for three consecutive seasons in western Kenya. The OMs and inorganic P sources were applied to provide 20 and 40 kg P ha-1 respectively in their combination. Where urea was used, the inorganic P sources were applied at 60 kg P ha-1. Maize did not respond to application of TSP, MPR or BPR with urea in the first two seasons. However, after three seasons, maize significantly responded to application of MPR with urea. FYM was more effective than tithonia in increasing the labile inorganic P pools but it gave lower maize yields than tithonia which was more effective in reducing the exchangeable Al. It appears that the ability of an OM to lower the exchangeable Al is more important inincreasing maize yields than its ability to increase P availability. The effectiveness of the inorganic P sources in increasing maize yields followed the order of their effectiveness in increasing available P, i.e., TSP[MPR [BPR, once Al phytotoxicity was reduced by application of tithonia but the difference between TSP and MPR was not significant. The extra maize yield obtained by the additional 40 kg P ha-1 from the inorganic P sources was, however, in most cases not substantial enough to justify their use. Economic considerations may therefore favour the use of tithonia or FYM when applied alone at 20 kg P ha-1 than when combined with any of the inorganic P sources used in this study at a total P rate of 60 kg ha-1

Assessing Responses of \u3ci\u3eBetula papyrifera\u3c/i\u3e to Climate Variability in a Remnant Population along the Niobrara River Valley in Nebraska U.S. through Dendroecological and Remote Sensing Techniques

Remnant populations of Betula papyrifera have persisted in the Great Plains after the Wisconsin Glaciation along the Niobrara River Valley, Nebraska. Population health has declined in recent years, and has been hypothesized to be due to climate change. We used dendrochronological techniques to assess the response of B. papyrifera to microclimate (1950-2014), and satellite imagery [Landsat 5 TM (1985-2011) and MODIS (2000-2014)] derived NDVI as a proxy for population health. Growing-season streamflow and precipitation were positively correlated with raw and standardized tree-ring widths and basal area increment increase. Increasing winter and spring temperatures were unfavorable for tree growth while increasing summer temperatures were favorable in the absence of drought. The strongest predictor for standardized tree-rings was the Palmer Drought Severity Index, suggesting that B. papyrifera is highly responsive to a combination of temperature and water availability. The NDVI from vegetation community was positively correlated with standardized tree-ring growth, indicating the potential of these techniques to be used as a proxy for ex-situ monitoring of B. papyrifera. These results aid in forecasting the dynamics of the species in the face of climate variability and change in both remnant populations and across its current distribution in northern latitudes of North America

Determinants of insulin-related knowledge among healthcare providers at a county referral hospital in Kenya

Background: Insulin is a high alert medication with potential to cause hypoglycaemia if used incorrectly. Inadequate healthcare provider knowledge regarding insulin contributes to errors in its use that may cause patient harm. Objective: To identify the determinants of healthcare provider knowledge regarding insulin use in type 2 diabetes. Methodology: A cross-sectional study was conducted at Thika Level V Hospital in March 2015. A 20-item questionnaire was used to assess insulin knowledge in pharmaceutical, nursing and medical staff working in the outpatient department and the medical wards. The outcomes of interest were the scores on types, prescribing, administration and monitoring of insulin. Descriptive and regression data analyses were performed using IBM SPSS Statistics Version 20. Results: The participants’ mean (±SD) age was 32.6±10.2 years. The mean (±SD) duration of clinical practice was 8.3±9.03 years. Nurses formed the largest (36, 40%) cadre in the study. Determinants of the overall score in the insulin knowledge test were professional cadre (p<0.0001), in-patient care (p=0.044) and reading of journals (p=0.005). Insulin pharmacology scores were correlated with younger age (21-30 years, (p=0.02), clinical experience of <5 years, (p=0.013), use of information from drug representatives (p=0.023) and being a pharmacist intern or medical officer (p=0.002). Good prescribing scores were found among the medical officers, consultants and the clinical pharmacist (p=0.035). Conclusion: Several factors account for the differences in insulin-related knowledge among the healthcare providers evaluated in this study. Interventions are required to address these variations and equip the health workers with knowledge on all areas related to insulin use. Such interventions should include development of a curriculum on certified diabetes education, improved access to journals, collaboration with pharmaceutical companies in provision of drug-related information, continuing medical education and staff duty rotation to ensure that the healthcare providers gain experience in in-patient diabetes care. Keywords: diabetes, healthcare provider, insulin-related knowledg

Phosphorus Sorption and Lime Requirements of Maize Growing Acid Soils of Kenya

In Kenya, maize (Zea mays L.) is mainly grown on acid soils in high rainfall areas. These soils are known for low available phosphorus (P), partly due to its sorption by aluminium (Al) and iron oxides. The study determined soil P sorption, lime requirements and the effects of lime on soil pH, Al levels and available P on the main maize growing acids soils in the highlands east and west of Rift Valley (RV), Kenya. Burnt lime containing 21% calcium oxide was used. The soils were strongly to extremely acid (pH 4.85-4.07), had high exchangeable Al3+ (> 2 cmol Al kg-1) and Al saturation (> 20% Al), which most maize germplasm grown in Kenya are sensitive to. The base cations, cation exchange capacity and available P (< 10 mg P kg-1 bicarbonate extractable P) were low, except at one site in the highlands east of RV indicative with history of high fertilizer applications. Highlands east of RV soils had higher P sorption (343-402 mg P kg-1) than the west (107-258 mg P kg-1), probably because of their high Al3+ ions and also the energies of bonding between the soil colloids and phosphate ions. Highlands east of RV also had higher lime requirements (11.4-21.9 tons lime ha-1) than the west (5.3-9.8 tons lime ha-1). Due to differences in soil acidity, Al levels and P sorption capacities within and between highlands east and west of RV, blanket P fertilizer and lime recommendations may not serve all soils equally well. Keywords: acid soils, phosphorus sorption, lime requirement

Factors affecting haemoglobin dynamics in African children with acute uncomplicated Plasmodium falciparum malaria treated with single low dose primaquine or placebo

Background: Single low-dose primaquine (SLDPQ) effectively blocks the transmission of Plasmodium falciparum malaria, but anxiety remains regarding its haemolytic potential in patients with glucose-6-phopshate dehydrogenase (G6PD) deficiency. We, therefore, examined the independent effects of several factors on haemoglobin (Hb) dynamics in falciparum-infected children with a particular interest in SLDPQ and G6PD status. Methods: This randomised, double-blind, placebo-controlled, safety trial was conducted in Congolese and Ugandan children aged 6 months–11 years with acute uncomplicated P. falciparum and day (D) 0 Hbs ≥ 6 g/dL who were treated with age-dosed SLDPQ/placebo and weight-dosed artemether lumefantrine (AL) or dihydroartemisinin piperaquine (DHAPP). Genotyping defined G6PD (G6PD c.202T allele), haemoglobin S (HbS), and α-thalassaemia status. Multivariable linear and logistic regression assessed factor independence for continuous Hb parameters and Hb recovery (D42 Hb > D0 Hb), respectively. Results: One thousand one hundred thirty-seven children, whose median age was 5 years, were randomised to receive: AL + SLDPQ (n = 286), AL + placebo (286), DHAPP + SLDPQ (283), and DHAPP + placebo (282). By G6PD status, 284 were G6PD deficient (239 hemizygous males, 45 homozygous females), 119 were heterozygous females, 418 and 299 were normal males and females, respectively, and 17 were of unknown status. The mean D0 Hb was 10.6 (SD 1.6) g/dL and was lower in younger children with longer illnesses, lower mid-upper arm circumferences, splenomegaly, and α-thalassaemia trait, who were either G6PDd or heterozygous females. The initial fractional fall in Hb was greater in younger children with higher D0 Hbs and D0 parasitaemias and longer illnesses but less in sickle cell trait. Older G6PDd children with lower starting Hbs and greater factional falls were more likely to achieve Hb recovery, whilst lower D42 Hb concentrations were associated with younger G6PD normal children with lower fractional falls, sickle cell disease, α-thalassaemia silent carrier and trait, and late treatment failures. Ten blood transfusions were given in the first week (5 SLDPQ, 5 placebo). Conclusions: In these falciparum-infected African children, posttreatment Hb changes were unaffected by SLDPQ, and G6PDd patients had favourable posttreatment Hb changes and a higher probability of Hb recovery. These reassuring findings support SLDPQ deployment without G6PD screening in Africa

One-day out-patient prescribing patterns at a national referral hospital in Kenya

Background: Poor prescribing habits lead to ineffective and unsafe treatment for patients, exacerbating or prolonging of illness as well as causing distress and harm to them. Drug utilization studies can help identifying gaps in prescribing and feed the results back to prescribers to enhance future rational use of medicines. Objective: Evaluate outpatient prescribing practices and patterns in a leading national Hospital in Kenya. Methods: A sample of 60 prescriptions was selected by quasi-random sampling. Data was abstracted using a pre-designed data collection form, entered into and analyzed using Excel software. Results: The average number of drugs prescribed per prescription was three with a polypharmacy rate (&gt;4 drugs) of 20%. Only two-thirds (65%) of the prescribed drugs were actually dispensed at the hospital pharmacy due to shortages, principally shortages of originators. Slightly more than half (52%) of the drugs were prescribed by generic name. Prescribing by brand names was highest among medical interns (61%). Almost all drugs prescribed (95%) were consistent with the hospital tender list. Conclusions: There is a need to increase the rate of prescribing of generics to save costs as well as reduce stock-out levels. This can be helped by instigating a comprehensive generics policy. There is also a need to strengthen and empower drugs and therapeutic committees (DTCs) to improve selection and availability of quality generics to win the confidence of prescribers. Keywords: Drug utilisation studies, generics, prescribing patterns, prescribing indicators, polypharmacy, WHO indicators, Keny

Characterising demographics, knowledge, practices and clinical care among patients attending sickle cell disease clinics in Eastern Uganda [version 1; peer review: 1 approved, 1 approved with reservations]

Background: In Uganda to date, there are neither established registries nor descriptions of facility-based sickle cell disease (SCD) patient characteristics beyond the central region. Here, we summarize data on the baseline clinical characteristics and routine care available to patients at four clinics in Eastern Uganda as a prelude to a clinical trial. Methods: Between February and August 2018, we conducted a cross-sectional survey of patients attending four SCD clinics in Mbale, Soroti, Atutur and Ngora, all in Eastern Uganda, the planned sites for an upcoming clinical trial (H-PRIME: ISRCTN15724013). Data on socio-demographic characteristics, diagnostic methods, clinic schedules, the use of prophylactic and therapeutic drugs, clinical complications and patient understanding of SCD were collected using a structured questionnaire. Results: Data were collected on 1829 patients. Their ages ranged from 0 to 64 years with a median (IQR) of 6 (3-11) years. 50.9% of participants were male. The majority (1151; 62.9%) reported a positive family history for SCD. Approximately half knew that SCD is inherited from both parents but a substantial proportion did not know how SCD is transmitted and small numbers believed that it is acquired by either transfusion or from other people. Only 118/1819 (6.5%) participants had heard about or were using hydroxyurea while 356/1794 (19.8%) reported stigmatization. Participants reported a median of three (IQR 1-4) hospital admissions during the preceding 12 months; 80.8% had been admitted at least once, while 14.2% had been admitted more than five times. Pain was the most common symptom, while 83.9% of those admitted had received at least one blood transfusion. Conclusion: The majority of patients attending SCD clinics in Eastern Uganda are children and few are currently being treated with hydroxyurea. The data collected through this facility-based survey will provide background data that will be useful in planning for the H-PRIME trial

Effects of lime, phosphorus and rhizobia on Sesbania sesban performance in a Western Kenyan acid soil

Aluminium (Al) toxicity, phosphorus (P) deficiency and low rhizobia populations limit Sesbania (Sesbania sesban) performance in tropical acid soils. The study determined the i) indigenous rhizobia populations that nodulate sesbania and ii) effects of lime (0 and 4 t/ha), P-fertilizer (0 and 60 kg/ha) and acid tolerant rhizobia (0 and inoculation) on soil and selected sesbania accessions performance in Western Kenya acid soil. Study site had acid soil, low available P, nitrogen (N) and rhizobia populations that nodulate Sesbania (146 cells/g soil). Lime increased soil pH, while both lime and P-fertilizer increased available P. Aluminium toxicity tolerant and P-efficient accessions (SSBSA004, SSUG3, SSUG4 and SSUG5) had faster growth, higher nodulation, shoot P, and shoot N and response to treatments than the sensitive one (SSBSA203). After 7 months of growth, SSUG3 had highest shoot length (306 cm) and dry matter (5.64 tons/ha), hence, most suitable for building poles and fuel wood. SSUG5 accumulated the highest shoot N (222 kg N/ha) and was therefore, most suitable soil N replenishment. Thus, in acid P deficient and low rhizobial population soils of Western Kenya, the use of lime, P-fertilizer, rhizobia inoculation and Al toxicity tolerant Sesbania are important for Sesbania establishment and growth. Key words: Rhizobia, Sesbania, soil acidity, aluminum toxicity, lime, phosphorus