Challenges and Opportunities in Cycling Safety in Nairobi City, Kenya

The road transport in Kenya is the most common means oftransport for people living in both urban and rural areas. The use of bicycles for transport dates back in the pre-colonial time and has been used as a mode of transport until 2008 when the use of motorcycles became a popular mode of travel in the rural and urban areas. However, the use of bicycle as a means of travel has declined consistently over the years until now and many have shifted to the use of car, public transport and most commonly motorcycles which are popularly known as 'boda boda' in Kenya. This modal shift can be attributed to a number of factors identified as challenges in the use of bicycles as a common mode of transport in comparison to other emerging modes of transport both in rural and urban areas. However, despite this modal shift, there are a substantial number of road users who would still prefer to use the bicycle mode amid prevalence in road traffic fatalities and injuries in Kenya. The government of Kenya has established initiatives to provide safe and inclusive transport system by investing in transport infrastructure that includes cycle tracks especially for roads located in the urban cities. This has been enabled by innovation in design, mixed traffic composition, change of legislation and road design standards especially in regards to non-motorized transport in Kenya. Cycling is still low in cities in Kenya despite this effort to improve geometric design of roads. This paper explores these challenges and opportunities in cycling in Kenya focusing on Nairobi city as a case study. [From: Introduction

Stratification of persons with diabetes into risk categories for foot ulceration

Background: Patients with diabetes mellitus are at a higher risk of lower extremity complications as compared to their non-diabetic counterparts.Objective: To study risk factors for diabetic foot ulcer disease and stratify patients with diabetes into risk categories for foot ulceration.Design: Cross-sectional descriptive study over five months period.Setting: Diabetic outpatient clinic, at the Kenyatta National Hospital.Subjects: Two hundred and eighteen ambulatory subjects with diabetes mellitus without active foot lesions.Results: The prevalence of previous foot ulceration was 16% while that of previous amputation was 8%. Neuropathy was present in 42% of the study subjects and was significantly associated with age, male gender, duration of diabetes, random blood sugar, systolic blood pressure and the presence of foot deformity. Peripheral arterial disease was present in 12% and showed significant association with male gender. Foot deformities were observed in 46% of study subjects and were significantly associated with age, male gender, and presence of neuropathy. Subsequently 57% were categorised into IWGDF group 0 - no neuropathy, 10% were placed in group 1- neuropathy alone, 16% were put in group 2 - neuropathy plus either peripheral arterial disease or foot deformity and 17% were placed in risk group 3 - previous foot ulceration/amputation.Conclusion: More than one third (33%) of diabetic patients were found to be at high risk for future foot ulceration (lWGDF groups 2 and 3). Published evidence exists that shows improved outcomes with interventions targeting individual patients with diabetes at high-risk of foot ulceration. Long term prospective studies to determine outcomes for the different risk categories should be carried out locally

Climate variability and change:perceptions, experiences and realities

Farming in the semi-arid tropics, where climatic conditions are marginal and highly variable, is a risky enterprise. The main source of this risk is the variability in rainfall that occurs at many different timescales, ranging from seasons to years to decades and beyond. Farmers operating under these conditions make decisions based on their perceptions and experiences gained from several years of keen observation and practice in the field. However, perceptions are influenced by many factors, both real and subjective. For agriculture, factors like farm productivity, crop, market and local preferences, capacity to invest, willingness to take risks and soil quality play an important role. While the role and significance of some of these factors on productivity and profitability can be perceived more easily due to their relative predictability, extreme variability in climate and the random nature of that variability makes it difficult for farmers to accurately perceive trends in climate. In the absence of detailed measurements, perceptions can be biased and unreliable. Climate information can play an important role in helping farmers better understand this variability and its associated risks, and enhancing their decision-making for effective risk management

Opportunities for Coping with Climate Change and Variability Through Adoption of Soil and Water Conservation Technologies in Semi-arid Eastern Kenya

Scenario analysis using data generated from APSIM model was conducted to investigate the effect of soil and water conservation practices (tied ridges and mulching) on grain yield of improved maize varieties (Katumani and Makueni) generated with and without N fertilizers under below normal (<250 mm), normal (≥250 < 350 mm) and above normal seasons (≥350 mm) in two sites, Katumani and Makindu in Machakos and Makueni counties Eastern Kenya. Results indicate that the yields were significant (<0.01) under the different seasons and treatments with the magnitude of the yields response varied. Highest yields in Katumani (3,370 kg/ha) were obtained during below normal seasons and when both fertilizer and tied ridges were used. In Makindu, however, under all treatments, highest yields were obtained during above normal seasons with 3,708 kg/ha yield when 40 kg N/ha fertilizer was applied. Lowest yields on the other hand, were obtained during normal seasons in both sites with 507 kg/ha in Katumani and 552 kg/ha under tied ridges and mulching + fertilizers in Makindu. Compared with farmers practice (control), the yield increment obtained was 4 kg/ha (0.6 %) and 5 kg/ha (0.7 %) in Katumani; 32 kg/ha (4.6 %) and 33 kg/ha (4.7 %) in Makindu under mulching and tied ridges respectively during below normal seasons otherwise the yield decreased during normal and above normal seasons with up to 19 % in Makindu when tied ridges was practised. Fertilization increased the yields of maize by as high as 2,552 kg/ha (433 %) and 2,319 kg/ha (166 %) in Katumani and Makindu respectively during above normal seasons. However, during normal seasons, there was yield decrease in Makindu by 42 %. When both fertilization and soil and water conservation practices was done, yield increase was 2,335 kg/ha (456 %) and 2,382 kg/ha (465 %) in Katumani during normal seasons under mulching +40 kg N/ha and tied ridges +40 kg N/ha respectively. In Makindu, yields declined during normal seasons, however, increase was by 2,229 kg/ha (160 %) and 2,108 kg/ha (152 %) during above normal seasons under mulching +40 kg N/ha and tied ridges +40 kg N/ha respectively. The results indicate that the use of fertilizers and soil and water conservation are indispensable for ensuring food security in semi-arids where rainfall is very variable

Climate Variability and Change: Farmer Perceptions and Understanding of Intra-Seasonal Variability in Rainfall and Associated Risk in Semi-Arid Kenya

This study examines farmers’ perceptions of short- and long-term variability in climate, their ability to discern trends in climate and how the perceived trends converge with actual weather observations in five districts of Eastern Province in Kenya where the climate is semi-arid with high intra- and inter-annual variability in rainfall. Field surveys to elicit farmers’ perceptions about climate variability and change were conducted in Machakos, Makueni, Kitui, Mwingi and Mutomo districts. Long-term rainfall records from five meteorological stations within a 10 km radius from the survey locations were obtained from the Kenya Meteorological Department and were analysed to compare with farmers’ observations. Farmers’ responses indicate that they are well aware of the general climate in their location, its variability, the probabilistic nature of the variability and the impacts of this variability on crop production. However, their ability to synthesize the knowledge they have gained from their observations and discern longterm trends in the probabilistic distribution of seasonal conditions is more subjective, mainly due to the compounding interactions between climate and other factors such as soil fertility, soil water and land use change that determine the climate’s overall influence on crop productivity. There is a general tendency among the farmers to give greater weight to negative impacts leading to higher risk perception. In relation to long-term changes in the climate, farmer observations in our study that rainfall patterns are changing corroborated well with reported perceptions from other places across the African continent but were not supported by the observed trends in rainfall data from the five study locations. The main implication of our findings is the need to be aware of and account for the risk during the development and promotion of technologies involving significant investments by smallholder farmers and exercise caution in interpreting farmers’ perceptions about long-term climate variability and change

Rationale and study design of a cross sectional study documenting the prevalence of Heart Failure amongst the minority ethnic communities in the UK: the E-ECHOES Study (Ethnic - Echocardiographic Heart of England Screening Study)

Background: Heart failure is an important cause of cardiovascular morbidity and mortality. Studies to date have not established the prevalence heart failure amongst the minority ethnic community in the UK. The aim of the E-ECHOES (Ethnic - Echocardiographic Heart of England Screening Study) is to establish, for the first time, the community prevalence and severity of left ventricular systolic dysfunction (LVSD) and heart failure amongst the South Asian and Black African-Caribbean ethnic groups in the UK.Methods/Design: This is a community based cross-sectional population survey of a sample of South Asian (i.e. those originating from India, Pakistan, Bangladesh) and Black African-Caribbean male and female subjects aged 45 years and over. Data collection undertaken using a standardised protocol comprising a questionnaire incorporating targeted clinical history taking, physical examination, and investigations with resting electrocardiography and echocardiography; and blood sampling with consent. This is the largest study on heart failure amongst these ethnic groups. Full data collection started in September 2006 and will be completed by August 2009.Discussion: The E-ECHOES study will enable the planning and delivery of clinically and cost-effective treatment of this common and debilitating condition within these communities. In addition it will increase knowledge of the aetiology and management of heart failure within minority ethnic communities

"I think my body has become addicted to those tablets" Chronic heart failure patients' understanding of and beliefs about their illness and its treatment: a qualitative longitudinal study from Uganda

Patients with heart failure in Uganda present for health care with advanced structural heart disease, have repeated hospitalizations and poorly controlled disease symptoms. The reasons for these are unclear. Literature from other settings shows that patients' understanding of their illness and their beliefs influence their health related behaviour. The study aimed to explore the beliefs of patients with heart failure, their understanding of their illness and its treatment, and how this influenced their health related behaviour to inform future health education programs, information and palliative care services.Serial qualitative in-depth interviews were conducted with Heart Failure patients who were purposively sampled and recruited in Mulago National Referral Hospital until thematic saturation was reached. In-depth interviews were conducted at three time points over the course of their illness with intervals of 3 months between interviews. A grounded theory approach was used in data analysis. The University of Edinburgh ethics committee, Mulago Hospital Research Ethics committee and the Uganda National Council of Science and Technology (Reference numbers D/GC/178; MREC 33, SS 3083 respectively) approved the research.A total of 40 face to face qualitative longitudinal interviews (36-patient alone, 4 paired-patient and family carer), were conducted with 21 patients. The findings revealed that heart failure patients were unaware of the symptoms of the illness and their definition of illness differed from that of health professionals. Patients understood their diagnosis, cause of illness, prognosis and the importance of the medicines differently from health professionals, and had insufficient information on self-care. Lay beliefs were used to explain many aspects of the illness and treatments. All these influenced where patients sought care and their adherence to treatment, self-care and follow up leading to uncontrolled disease.There is a high level of health illiteracy among heart failure patients in Uganda. Patients rely on lay beliefs to make health decisions and medical information is often miscomprehended. There is an urgent need for health education using culturally appropriate information

Endomyocardial Fibrosis: Still a Mystery after 60 Years

The pathologist Jack N. P. Davies identified endomyocardial fibrosis in Uganda in 1947. Since that time, reports of this restrictive cardiomyopathy have come from other parts of tropical Africa, South Asia, and South America. In Kampala, the disease accounts for 20% of heart disease patients referred for echocardiography. We conducted a systematic review of research on the epidemiology and etiology of endomyocardial fibrosis. We relied primarily on articles in the MEDLINE database with either “endomyocardial fibrosis” or “endomyocardial sclerosis” in the title. The volume of publications on endomyocardial fibrosis has declined since the 1980s. Despite several hypotheses regarding cause, no account of the etiology of this disease has yet fully explained its unique geographical distribution