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

Nutrients limiting soybean (glycine max l) growth in acrisols and ferralsols of western Kenya

Low soybean yields in western Kenya have been attributed to low soil fertility despite much work done on nitrogen (N) and phosphorus (P) nutrition leading to suspicion of other nutrient limitations. To investigate this, a nutrient omission trial was set up in the greenhouse at the University of Eldoret-Kenya to diagnose the nutrients limiting soybean production in Acrisols from Masaba central and Butere sub-Counties, and Ferralsols from Kakamega (Shikhulu and Khwisero sub-locations) and Butula sub-Counties and to assess the effect of liming on soil pH and soybean growth. The experiment was laid out in a completely randomized design with ten treatments viz; positive control (complete), negative control (distilled water), complete with lime, complete with N, minus macronutrients P, potassium (K), calcium (Ca), magnesium (Mg) and sulphur (S) and with, micro-nutrients boron (B), molybdenum (Mo), manganese (Mn), copper (Cu) and zinc (Zn) omitted. Visual deficiency symptoms observed included interveinal leaf yellowing in Mg omission and N addition and dark green leaves in P omission. Nutrients omission resulted in their significantly low concentration in plant tissues than the complete treatment. Significantly (P≤ 0.05) lower shoot dry weights (SDWs) than the complete treatment were obtained in different treatments; omission of K and Mg in Masaba and Shikhulu, Mg in Khwisero, K in Butere and, P, Mg and K in Butula. Nitrogen significantly improved SDWs in soils from Kakamega and Butula. Liming significantly raised soil pH by 9, 13 and 11% from 4.65, 4.91 and 4.99 in soils from Masaba, Butere and Butula respectively and soybean SDWs in soils from Butere. The results show that, poor soybean growth was due to K, Mg and P limitation and low pH in some soils. The results also signify necessity of application of small quantities of N for initial soybean use

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

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

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

Safety of age-dosed, single low-dose primaquine in children with glucose-6-phosphate dehydrogenase deficiency who are infected with Plasmodium falciparum in Uganda and the Democratic Republic of the Congo: a randomised, double-blind, placebo-controlled, non-inferiority trial

Background WHO recommends gametocytocidal, single low-dose primaquine for blocking the transmission of Plasmodium falciparum; however, safety concerns have hampered the implementation of this strategy in sub-Saharan Africa. We aimed to investigate the safety of age-dosed, single low-dose primaquine in children from Uganda and the Democratic Republic of the Congo. Methods We conducted this randomised, double-blind, placebo-controlled, non-inferiority trial at the Mbale Regional Referral Hospital, Mbale, Uganda, and the Kinshasa Mahidol Oxford Research Unit, Kinshasa, Democratic Republic of the Congo. Children aged between 6 months and 11 years with acute uncomplicated P falciparum infection and haemoglobin concentrations of at least 6 g/dL were enrolled. Patients were excluded if they had a comorbid illness requiring inpatient treatment, were taking haemolysing drugs for glucose-6-phosphate dehydrogenase (G6PD) deficiency, were allergic to the study drugs, or were enrolled in another clinical trial. G6PD status was defined by genotyping for the G6PD c.202T allele, the cause of the G6PD-deficient A− variant. Participants were randomly assigned (1:1) to receive single low-dose primaquine combined with either artemether–lumefantrine or dihydroartemisinin–piperaquine, dosed by bodyweight. Randomisation was stratified by age and G6PD status. The primary endpoint was the development of profound (haemoglobin <4 g/dL) or severe (haemoglobin <5 g/dL) anaemia with severity features, within 21 days of treatment. Analysis was by intention to treat. The sample size assumed an incidence of 1·5% in the placebo group and a 3% non-inferiority margin. The trial is registered at ISRCTN, 11594437, and is closed to new participants. Findings Participants were recruited at the Mbale Regional Referral Hospital between Dec 18, 2017, and Oct 7, 2019, and at the Kinshasa Mahidol Oxford Research Unit between July 17, 2017, and Oct 5, 2019. 4620 patients were assessed for eligibility. 3483 participants were excluded, most owing to negative rapid diagnostic test or negative malaria slide (n=2982). 1137 children with a median age of 5 years were enrolled and randomly assigned (286 to the artemether–lumefantrine plus single low-dose primaquine group, 286 to the artemether–lumefantrine plus placebo group, 283 to the dihydroartemisinin–piperaquine plus single low-dose primaquine group, and 282 to the dihydroartemisinin–piperaquine plus placebo group). Genotyping of G6PD identified 239 G6PD-c.202T hemizygous males and 45 G6PD-c.202T homozygous females (defining the G6PD-deficient group), 119 heterozygous females, 418 G6PD-c.202C normal males and 299 G6PD-c.202C normal females (defining the non-G6PD-deficient group), and 17 children of unknown status. 67 patients were lost to follow-up and four patients withdrew during the study—these numbers were similar between groups. No participants developed profound anaemia and three developed severe anaemia: from the G6PD-deficient group, none (0%) of 133 patients who received placebo and one (0·66%) of 151 patients who received primaquine (difference −0·66%, 95% CI −1·96 to 0·63; p=0·35); and from the non-G6PD-deficient group, one (0·23%) of 430 patients who received placebo and one (0·25%) of 407 patients who received primaquine (−0·014%, −0·68 to 0·65; p=0·97). Interpretation Gametocytocidal, age-dosed, single low-dose primaquine was well tolerated in children from Uganda and the Democratic Republic of the Congo who were infected with P falciparum, and the safety profile of this treatment was similar to that of the placebo. These data support the wider implementation of single low-dose primaquine in Africa. Funding UK Government Department for International Development, UK Medical Research Council, UK National Institute for Health Research, and the Wellcome Trust Joint Global Health Trials Scheme

Incidence and predictors of hospital readmission in children presenting with severe anaemia in Uganda and Malawi: a secondary analysis of TRACT trial data

Background: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. Methods: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. Results: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63–3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19–1.74), p < 0.001); history of transfusion (1.48(1.13–1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21–1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47–0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47–0.76), p < 0.001); younger-age (1.07 (1.03–1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46–0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23–2.44) and 1.46(1.18–1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. Conclusions: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. Trial registration: ISRCTN ISRCTN84086586. Keywords: Severe anaemia, Readmissio