Study protocol for a cluster-randomized controlled trial of an NCD access to medicines initative: Evaluation of Novartis Access in Kenya

INTRODUCTION: Novartis recently launched Novartis Access, an initiative to provide a basket of reduced price medicines for non-communicable diseases (NCDs) to be sold through the public and private nonprofit sectors in programme countries. This study will evaluate the impact of Novartis Access on the availability and price of NCD medicines at health facilities and households in Kenya, the first country to receive the programme. METHODS: This study will be a cluster randomised controlled trial. 8 counties in Kenya will be randomly assigned to the intervention or control group using a covariate constrained randomisation method to maximise balance on demographic and health characteristics. In intervention counties, public and private non-profit health facilities will be able to order Novartis Access NCD medicines from the Mission for Essential Drugs and Supplies (MEDS). Data will be collected from a random sample of 384 health facilities and 800 households at baseline, midline after 1-year of intervention, and end-line after 2 years. Quarterly surveillance data will also be collected from health facilities and a subsample of households through phone-based interviews. Households will be eligible if at least one resident has been previously diagnosed and prescribed a medicine for an NCD addressed by Novartis Access, including hypertension and diabetes. The primary outcomes will be availability and price of NCD medicines at health facilities, and availability, price, and expenditures on NCD medicines at households. Impacts will be estimated using intention-to-treat analysis. ETHICS AND DISSEMINATION: This protocol was approved by the Institutional Review Boards at Strathmore University and at Boston University. Informed consent will be obtained from all participants at the start of the trial. The findings of the trial will be disseminated through peer-reviewed journals, international conferences, and meetings and events organised with local stakeholders

Fluoride removal performance of phosphoric acid treated lime: Breakthrough analysis and point-of-use system performance

Fluoride in drinking water above permissible levels is responsible for dental and skeletal fluorosis. In this study, removal of fluoride ions from water using phosphoric acid treated lime was investigated in continuous and point-of-use system operations. In the continuous column operations, fluoride removal performance was investigated as a function of the fluoride concentration, flow rate and amount of adsorbent mass. Early saturation and lower fluoride removal were observed at higher flow rate and initial concentration, and at lower mass. Two domestic defluoridation point-of-use systems operated intermittently to process 20 ..day.1 of water were used. High fluoride uptake capacity (FUC) from groundwater was observed depicting the suitability of the new media in defluoridation. However, further research is required to optimise the point-ofuse systems performances

Genetic variability of tissue cultured Sorghum bicolor (L) Moench as revealed by morphological traits and simple sequence repeats (SSR) markers

To evaluate their performance for seedling traits at seedling stage (under hydroponics), plant water relations under water stress and ultimately grain yield, and to estimate the genetic variability of the regenerates, the parent plants of local sorghum cultivars in Kenya using simple sequence repeats (SSR) markers were analyzed. The research involved Seredo, El Gardam and Mtama 1 sorghum cultivars. The TC (Tissue culture) regenerates were produced through somatic embryogenesis in Linsmaier and Skoog (LS) media augmented with an osmoticum, NaCl (100 mM) in attempt to improve the parent plant for water stress tolerance. The genetic variability was investigated using five SSR markers and seven morphological traits associated with water stress tolerance. The amplified DNA fragments were screened by gel electrophoresis using 2% agarose. Cluster and principal component analysis (PCA) were done using NTSYS-pc version 2.2. The SSR detected 11 alleles with an average of 2.2 alleles per locus. The number of alleles per locus ranged from two to three and the allelic polymorphism information content (PIC) value ranged from 0.344 for Xcup14 to 0.730 for Xgap72 with an average of 0.559. These results show that the cultivars differed for morphological and SSR markers. The average genetic similarity based on the morphological traits (0.922 with a range of 0.845 to 0.989) was higher than SSR markers (0.625 with a range of 0.306 to 0.944). The results also show that the classification of these sorghum cultivars may be useful to the breeders to plan crosses for preferred traits. The results also show that the sorghum microsatellites can be used to distinguish the cultivars and to estimate genetic diversity due to somaclonal variation. Overall, this study shows that tissue culture technique might not add value in producing somaclonal variation in sorghum.Key words: Cultivars, tissue culture regenerates, water stress tolerance, simple sequence repeats

Determining efficient extraction procedure of phytochemicals from the fruit paste of Ziziphus abyssinica and Tamarindus indica.

Objective: To determine the most effective method of extracting metabolites from the two herbs Ziziphus abyssinica and Tamaridus. Indicus.Methodology and results: The methods used included cold and soxhlet extraction using methanol as the solvent and hot extraction using distilled water. To determine the efficiency in which compounds are extracted TLC was performed on silica gel aluminium plates using ethyl acetate: formic acid: glacial acetic acid: water (100:11:11:27). To determine the quantity of phenolic compounds in the extract, the Folin and Ciocalteau’s method (1927) was used, using Gallic acid in various concentrations. For the total quantity of flavonoid compounds, the method of Miliauskas et al. (2004) was used. To determine the Proanthocyanidin content in the extract a method previously reported by Ayoola et al, 2006 was used. To measure the antioxidant capacity of the extracts the hydrogen donating or free radical scavenging activity, was measured using the stable radical DPPH. The compounds extracted by all the methods were about seven but the difference was noted when the individual compounds were analysed. The cold extraction on the herb extract of Z. abyssinica had significantly high amount of total phenols 1.99g/100g of sample than both soxhlet and water extraction with 1.51g and 0.61g/100g of sample respectively. The results of T. indicus indicate that the extracts from the soxhlet and cold extraction methods contained a significantly low amount of all the three compounds compared to the water extractsConclusion and application of results: The method best suited for obtaining extracts from the two herbs T. indicus and Z. abyssinica is, cold method of extraction with methanol as the solvent for Z. abyssinica and hot extraction using distilled water for T. indicus. The results obtained give guidance to the fact that using both herbs would result in a better preservative than using one herb since the identified compounds would complement each other.Key words: Antimicrobial, antioxidant, phytochemicals and Radical scavenging activity

Critical analysis of tillage practices with fertility levels in maize and populations in beans as adaptation measures to climate change to enhance food security at Kabete

Trials were carried out in 2012/2013 short and 2013 long seasons at Kabete site representing a warm and wet environment in Kenya to determine, the appropriateness of combining fertilizer levels for maize and population levels with tied ridges for beans, as adaptation measures under changing climate. The maize experiment consisted of three fertilizer levels of 0, 20 and 40 kg/ha N while the bean experiment had three spacings of 12, 15 and 20 cm in a split plot design. The experiments were replicated thrice and consisted of conventional tillage and tied ridges as main plots representing the two soil water management practices while the three soil fertility levels (in maize N0, N20 and N40) or spacing options (12, 15 and 20cm) were sub plots in a Completely Randomized Block Design. The ridges were tied at intervals of 1 m and spaced at recommended crop spacings (i.e. 75cm for maize and 45cm for beans) and the crop planted on the slope of the ridge in 6 by 5 m plots. Basal phosphate (P205) fertilizer in the form of Triple Superphosphate was applied at planting time at the rate of 40kg/ha. Nitrogen in the form of Calcium Ammonium Nitrate was applied at 20 Kg/ha in the 20 and 40 N treatments at planting and further 20kg/ha N top dressed in the 40 treatment level. Harvesting was done at physiological maturity of grain which was air dried. Statistical analysis was done of the treatments and comparisons done of the adaptation advantages of the treatments. Tied ridging increased maize yields at the medium fertilizer level of 20 (+5.22%) but were negative under both zero (-15.56%) and 40 kg/ha application of fertilizers (-5.42%). In the short season, increased bean spacing from 12 to 20 decreased yields under normal (-13.6%) and tied ridges (-37.3%) but remained higher at populations of 12 and 15. In the long season increasing bean population from spacing of 12 cm to 20 had no advantage and under tied ridging compared to normal tillage. Tied ridging as a climate change adaptive measure should not be instituted as a blanket recommendation across rainfall regimes, crops, fertilization levels or plant populations and is more advantageous in drier seasons

Methodologies of the 4-beaches Survey and Stakeholder Workshops

As it is clearly indicated in the title of this book section, it overviews the methodologies used in the 4-beaches Survey and in the various Stakeholders' Workshops held in all the three riparian countries of the Lake Victoria

An intensive, active surveillance reveals continuous invasion and high diversity of rhinovirus in households

We report on infection patterns in 5 households (78 participants) delineating the natural history of human rhinovirus (HRV). Nasopharyngeal collections were obtained every 3–4 days irrespective of symptoms, over a 6-month period, with molecular screening for HRV and typing by sequencing VP4/VP2 junction. Overall, 311/3468 (8.9%) collections were HRV positive: 256 were classified into 3 species: 104 (40.6%) HRV-A; 14 (5.5%) HRV-B, and 138 (53.9%) HRV-C. Twenty-six known HRV types (13 HRV-A, 3 HRV-B, and 10 HRV-C) were identified (A75, C1, and C35 being most frequent). We observed continuous invasion and temporal clustering of HRV types in households (range 5–13 over 6 months). Intrahousehold transmission was independent of clinical status but influenced by age. Most (89.0%) of HRV infection episodes were limited to <14 days. Individual repeat infections were frequent (range 1–7 over 6 months), decreasing with age, and almost invariably heterotypic, indicative of lasting type-specific immunity and low cross-type protection

Yellow Fever Outbreak, Southern Sudan, 2003

In May 2003, an outbreak of fatal hemorrhagic fever, caused by yellow fever virus, occurred in southern Sudan. Phylogenetic analysis showed that the virus belonged to the East African genotype, which supports the contention that yellow fever is endemic in East Africa with the potential to cause large outbreaks in humans

Social research on neglected diseases of poverty: Continuing and emerging themes

Copyright: © 2009 Manderson et al.Neglected tropical diseases (NTDs) exist and persist for social and economic reasons that enable the vectors and pathogens to take advantage of changes in the behavioral and physical environment. Persistent poverty at household, community, and national levels, and inequalities within and between sectors, contribute to the perpetuation and re-emergence of NTDs. Changes in production and habitat affect the physical environment, so that agricultural development, mining and forestry, rapid industrialization, and urbanization all result in changes in human uses of the environment, exposure to vectors, and vulnerability to infection. Concurrently, political instability and lack of resources limit the capacity of governments to manage environments, control disease transmission, and ensure an effective health system. Social, cultural, economic, and political factors interact and influence government capacity and individual willingness to reduce the risks of infection and transmission, and to recognize and treat disease. Understanding the dynamic interaction of diverse factors in varying contexts is a complex task, yet critical for successful health promotion, disease prevention, and disease control. Many of the research techniques and tools needed for this purpose are available in the applied social sciences. In this article we use this term broadly, and so include behavioral, population and economic social sciences, social and cultural epidemiology, and the multiple disciplines of public health, health services, and health policy and planning. These latter fields, informed by foundational social science theory and methods, include health promotion, health communication, and heath education

Use of a Semi-field System to Evaluate the Efficacy of Topical Repellents under user Conditions Provides a Disease Exposure free Technique Comparable with Field Data.

Before topical repellents can be employed as interventions against arthropod bites, their efficacy must be established. Currently, laboratory or field tests, using human volunteers, are the main methods used for assessing the efficacy of topical repellents. However, laboratory tests are not representative of real life conditions under which repellents are used and field-testing potentially exposes human volunteers to disease. There is, therefore, a need to develop methods to test efficacy of repellents under real life conditions while minimizing volunteer exposure to disease. A lotion-based, 15% N, N-Diethyl-3-methylbenzamide (DEET) repellent and 15% DEET in ethanol were compared to a placebo lotion in a 200 sq m (10 m x 20 m) semi-field system (SFS) against laboratory-reared Anopheles arabiensis mosquitoes and in full field settings against wild malaria vectors and nuisance-biting mosquitoes. The average percentage protection against biting mosquitoes over four hours in the SFS and field setting was determined. A Poisson regression model was then used to determine relative risk of being bitten when wearing either of these repellents compared to the placebo. Average percentage protection of the lotion-based 15% DEET repellent after four hours of mosquito collection was 82.13% (95% CI 75.94-88.82) in the semi-field experiments and 85.10% (95% CI 78.97-91.70) in the field experiments. Average percentage protection of 15% DEET in ethanol after four hours was 71.29% (CI 61.77-82.28) in the semi-field system and 88.24% (84.45-92.20) in the field. Semi-field evaluation results were comparable to full-field evaluations, indicating that such systems could be satisfactorily used in measuring efficacy of topically applied mosquito repellents, thereby avoiding risks of exposure to mosquito-borne pathogens, associated with field testing