Mathematical Modelling of a Composite Granular Filter of Effluent at Shirere Wastewater Treatment Plant in Kakamega County, Kenya

Insufficient technology for municipal wastewater treatment compromises the quality of effluent discharged into water bodies, elevating the risk of waterborne diseases (e.g., cholera, dysentery, typhoid). Previous research has associated the absence of clean water and sanitation with health issues such as skin problems, eye infections, and diarrhea among community members. Furthermore, studies indicate the proliferation of algae in the Shirere wastewater oxidation ponds, suggesting the presence of toxic cyanobacteria. Therefore, this study aimed to develop a mathematical model representing five critical parameters: COD, BOD, TSS, Phosphates, and Nitrates. Effluent from Shirere WWTP were collected for microbial quality analysis at MMUST and KACUWASCO laboratories. Data analysis involved, regression and correlation, and integration of wastewater mass balance equation using R-Programming and Fourth Order Runga Kutta (RK) method. The research employed  purposeful sampling strategy, with a sample size of 8 of wastewater. The study followed an experimental design. Specifically, for the first season of March – May 2021 at 200mm filtration depth were carried out at effluent flow rate of 0.0032  and volume, 0.234   the model arrived at was . The model results showed minimal variation from the measured values.The first season measured COD as 0.236kg/m3 and model gave 0.2174kg/m3. The model can be used in prediction of parameter concentrations at any given time. The findings of this research will inform wastewater management policies and contribute to the development of sustainable wastewater treatment technologies

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Land use planning using geographic information systems

This study reviews the problems delimiting effective implementation of soil and water conservation projects in developing countries. Alternative approaches to planning and implementation of these projects are also examined. In particular, Catchment Approach Strategy has been identified as having the greater potential for use in effective implementation of soil and water conservation projects in developing countries. Some countries have already incorporated this strategy in their national soil conservation programmes, although a coherent methodology for implementing land use planning on a catchment basis is non-existent. Data on climate, topography, cover and conservation practices were collected from a sample catchment 50 KM2 in area, from Kenya. In addition, TM landsat data for the same study catchment was obtained. These data sets were transformed and subsequently transcribed into Arc/Info GIS for further manipulation and analysis. By overlay modelling using the USLE, the magnitude as well as spatial distribution of erosion rates from the whole catchment were predicted. Under the current landuse, it was ascertained that the average annual soil loss from the whole catchment is about 84,000 tonnes. In an improved land use scenario, the most erodible subsets of the catchment were isolated and treated with a defined conservation package. Under this plan, average annual soil loss, on catchment basis, was predicted to be 20,000 tonnes. Conversely, under the unimproved land use scenario, whereby 50&#37; of the forest land was simulated as converted to cropland, the predicted annual soil loss was 184,000 tonnes, more than twice the present erosion rate.</p

Neonatal mortality in Kenyan hospitals: a multisite, retrospective, cohort study

Background Most of the deaths among neonates in low-income and middle-income countries (LMICs) can be prevented through universal access to basic high-quality health services including essential facility-based inpatient care. However, poor routine data undermines data-informed efforts to monitor and promote improvements in the quality of newborn care across hospitals.Methods Continuously collected routine patients’ data from structured paper record forms for all admissions to newborn units (NBUs) from 16 purposively selected Kenyan public hospitals that are part of a clinical information network were analysed together with data from all paediatric admissions ages 0–13 years from 14 of these hospitals. Data are used to show the proportion of all admissions and deaths in the neonatal age group and examine morbidity and mortality patterns, stratified by birth weight, and their variation across hospitals.Findings During the 354 hospital months study period, 90 222 patients were admitted to the 14 hospitals contributing NBU and general paediatric ward data. 46% of all the admissions were neonates (aged 0–28 days), but they accounted for 66% of the deaths in the age group 0–13 years. 41 657 inborn neonates were admitted in the NBUs across the 16 hospitals during the study period. 4266/41 657 died giving a crude mortality rate of 10.2% (95% CI 9.97% to 10.55%), with 60% of these deaths occurring on the first-day of admission. Intrapartum-related complications was the single most common diagnosis among the neonates with birth weight of 2000 g or more who died. A threefold variation in mortality across hospitals was observed for birth weight categories 1000–1499 g and 1500–1999 g.Interpretation The high proportion of neonatal deaths in hospitals may reflect changing patterns of childhood mortality. Majority of newborns died of preventable causes (&gt;95%). Despite availability of high-impact low-cost interventions, hospitals have high and very variable mortality proportions after stratification by birth weight