Sentinel Lymph Node Involvement by Epithelial Inclusions Mimicking Metastatic Carcinoma: A Diagnostic Pitfall

Objective: Background: Rare disease An epithelial inclusion cyst within a lymph node denotes a heterotopic phenomenon. Nodal epithelial inclusion cysts have been reported in a variety of anatomical locations including pelvic, abdominal, mediastinal, and axillary regions. While nodal melanocytic nevus (also known as nevus cell aggregates) is the most common heterotopic phenomena involving the axillary lymph nodes, the presence of benign epithelial inclusion cysts in axillary lymph nodes is a rare but well-reported finding. Such documentation is in part due to assessment of sentinel lymph nodes in breast cancer becoming standard of care. These epithelial inclusion cysts offer a diagnostic pitfall in evaluation of sentinel lymph node in the setting of breast carcinoma. They also complicate assessment of sentinel lymph node during intraoperative frozen sections analysis. Case Report: We report a case of co-existent of benign squamous-type and glandular-type epithelial inclusions cysts in 2 sentinel lymph nodes in a patient with grade III invasive ductal carcinoma involving the left breast. There have been at least 4 cases reported in literature in which benign epithelial inclusion cysts in sentinel lymph nodes were first mistakenly diagnosed as metastatic carcinoma both during intraoperative frozen section analysis and during review of permanent sections. The missed diagnosis could potentially occur intraoperatively during frozen section sentinel lymph node analysis secondarily due to lack of availability of the primary tumor for comparison and inability to use immunohistochemical stains. Conclusions: Pathologists should be aware of this pitfall especially in frozen section analysis of sentinel lymph node to avoid misdiagnosis and its associated potential grave consequences

Determinants of Market Participation among Small-scale Pineapple Farmers in Kericho County, Kenya

Marketing agricultural produce is important amongst smallholder farmers because they derive benefits such as income and rural employment. In developing countries like Kenya, most smallholder farmers are characterized by poor market participation because they lack market information on pineapple marketing. In Bureti district; pineapples have been perceived to have high market value, resulting in trade-offs with staple food. Despite pineapples market value, its market participation has not been fully studied and quantified results in poor prices among small-scale farmers. The objectives of the study were: to describe socio-economic characteristics of small-scale pineapple farmers, institutional and market characteristics in Bureti district; to determine the factors influencing market participation and its extent, and; to determine the factors influencing the choice of pineapple marketing outlet in Bureti district. The study was conducted in five locations (Kapkisiara, Kisiara, Tulwet, Getarwet and Tebesonik). Multistage sampling procedure was employed to contact 150 respondents. Semi-structured questionnaires were used to collect data from small-scale pineapple farmers through face to face interview. The data was analyzed using the descriptive statistics, Heckman two-stage selection model and Multinomial Logit model. SPSS and STATA computer programs were used to process the data. The results showed that age, gender, education level and pineapple yields significantly influenced the decision to participate in pineapple marketing. Gender, price information, group marketing, marketing experience, vehicle ownership and marketing under contract significantly influenced the extent of market participation. Further, gender, group marketing, pineapple yield, price information, marketing under contract and vehicle ownership significantly influenced the choice of pineapple marketing outlets. The study recommends that, for holistic market participation among pineapple farmers, proper market infrastructure like pineapple hub must be put in place. The government and other policy makers should increase the marketing information and ability of pineapple farmers through avenues like mass media, extension service, and other means of capacity building

FACTORS AFFECTING EMPLOYEE SATISFACTION IN THE MANUFACTURING SECTOR IN KENYA: A CASE STUDY OF KRONES EAST AFRICA LIMITED

Kenya‟s manufacturing sector that is considered the most vibrant in the East African region has been growing at a slower rate than the economy on average .This kind of growth can be cascaded to firms in the sector among them Krones East Africa Limited whose production dropped from 300 million worth of sales in 2016 to 290million worth of sales in 2017.This study therefore sought to establish if this kind of drop is associated with employee satisfaction. In doing so, the study set out to establish the effect of management style, communication, remuneration and working conditions on employee satisfaction in the manufacturing sector in Kenya with a focus on Krones East Africa Limited. The study utilized descriptive research design in examining the factors affecting employee satisfaction in the manufacturing sector in Kenya. The target population for this study was 450 employees of Krones East Africa Limited categorized into Top Management, Middle Management and Operational staff. The study selected 10% of the target population giving a total sample of 45 respondents for the study. The study utilized structured questionnaires as a data collection tool which comprised both open and closed ended questions. A pilot study was done on five employees not included in the sampled population. The results of the pilot study were used to test the validity and reliability of the research instrument. Primary data was used in this study. Once collected, the data was edited, coded, and analyzed using Statistical Package for Social Science (SPSS). This study was both qualitative and quantitative in nature giving rise to the use of descriptive statistics. The descriptive statistics used in the study included frequencies and mean. The computed frequencies and mean was presented in form of tables, pie charts and bar charts to give a clear picture of the research findings at glance. The study revealed that the management rarely invites employees to participate in the decisionmaking process and that upward communication helps employees to interact with their seniors which improve their level of satisfaction with their job. The study also revealed that adequate pay is the main source of satisfaction for the employees of the firm and that relationship between supervisor and employees is crucial in ensuring employee job satisfaction. The study recommended that themanagement of Krones East Africa limited to embrace participative leadership style and the need to train supervisors and managers on aspects of delegation and communication. The study concluded that concluded that management style, level of remuneration, communication and working environment affect employee job satisfaction at Krones East Africa Limite

Determinants of Market Participation among Small-Scale Pineapple Farmers in Kericho County, Kenya

Pineapple (Ananas comosus) is one of the major cash crops grown in Kericho County, Kenya specifically Bureti district. In the study area, pineapples have been perceived to have high market value, resulting in tradeoffs with staple food. Despite pineapples market value, its market participation has not been studied and quantified. Therefore, this paper aims to determine the factors influencing market participation and its extent. A simple random sampling approach was used to select a sample of 150 small-scale pineapple farmers and primary data was collected using a semi-structured questionnaires. The data was analyzed using the descriptive statistics and Heckman two-stage model. The results showed that age, gender, education level and pineapple yields significantly influenced the decision to participate in pineapple marketing. Further, gender, price information, group marketing, marketing experience, vehicle ownership and marketing under contract significantly influenced the extent of market participation. Based on the findings policy implication was drawn for improving the household income in the study area. Key words: Heckman two-stage model, market participation, small-scale pineapple farmers

Analysis of Market Integration: A Case of Sugar in Selected Markets in Kenya

Market integration is one of the most important aspects that can be used to assess the impacts of market development and liberalization policies. In the study areas, there was thin knowledge whether the sugar markets were integrated or segmented. Therefore, this paper seeks to determine the existence of integration among the selected sugar markets. Secondary data was obtained for average monthly prices of sugar from January 2008 to December 2012. Data was analyzed using Co-integration model. The result revealed that road networks, communication networks, consumers’ purchasing power and the distance between the markets greatly influenced market integration. Based on the findings the policy implication was drawn to enhance sugar market integration in the study areas. Key words: Co-integration model, market integration, selected market

Determinants of Market Participation among Small-scale Pineapple Farmers in Kericho County, Kenya

Marketing agricultural produce is important amongst smallholder farmers because they derive benefits such as income and rural employment. In developing countries like Kenya, most smallholder farmers are characterized by poor market participation because they lack market information on pineapple marketing. In Bureti district; pineapples have been perceived to have high market value, resulting in trade-offs with staple food. Despite pineapples market value, its market participation has not been fully studied and quantified results in poor prices among small-scale farmers. The objectives of the study were: to describe socio-economic characteristics of small-scale pineapple farmers, institutional and market characteristics in Bureti district; to determine the factors influencing market participation and its extent, and; to determine the factors influencing the choice of pineapple marketing outlet in Bureti district. The study was conducted in five locations (Kapkisiara, Kisiara, Tulwet, Getarwet and Tebesonik). Multistage sampling procedure was employed to contact 150 respondents. Semi-structured questionnaires were used to collect data from small-scale pineapple farmers through face to face interview. The data was analyzed using the descriptive statistics, Heckman two-stage selection model and Multinomial Logit model. SPSS and STATA computer programs were used to process the data. The results showed that age, gender, education level and pineapple yields significantly influenced the decision to participate in pineapple marketing. Gender, price information, group marketing, marketing experience, vehicle ownership and marketing under contract significantly influenced the extent of market participation. Further, gender, group marketing, pineapple yield, price information, marketing under contract and vehicle ownership significantly influenced the choice of pineapple marketing outlets. The study recommends that, for holistic market participation among pineapple farmers, proper market infrastructure like pineapple hub must be put in place. The government and other policy makers should increase the marketing information and ability of pineapple farmers through avenues like mass media, extension service, and other means of capacity building

Distance learning approach to train health sciences students at the University of Nairobi

Background: The University of Nairobi (UoN) College of Health Sciences (CHS) established Partnership for Innovative Medical Education in Kenya (PRIME-K) programmeme to enhance health outcomes in Kenya through extending the reach ofmedical training outside Nairobi to help health sciences students enhance their handson skills. The institution partnered with 18 hospitals in rural and urban centers as the UoN teaching hospitals referred to as decentralised training sites and appointed medical staff from these sites as adjunct faculty of the University of Nairobi to train health sciences students on hands-on skills. Webcasts  presentations were conducted by undergraduate students from all the schools at the College of Health Sciences during their elective term and clinical rotations at the decentralised training sites to present on the ground health issues.Objective: To describe how the University of Nairobi (UoN) used the distance  learning platform from the Medical Education Partnership Initiative (MEPI) grant to outspread medical education to the underserved communities located in rural and urban surroundings across the country.Design: A cross-sectional studySetting: The University of Nairobi College of Health SciencesSubjects: Health Sciences students of the College of Health Sciences, University of Nairobi and Hospital staff in 18 hospitals in rural and urban centersResults: A total of 670 health sciences students participated in the decentralised learning, a total of 549 health sciences  students participated in webcast presentations over a period of four years from 2012 to 2015, and a total of 48 medical  consultants and specialists from the decentralised training sites were appointed as Adjunct Faculty of the College of Health Sciences – University of Nairobi.Conclusion: Webcast presentations provided information on priority health conditions afflicting the communities at the  decentralised sites which would not be the case in the institution’s teaching hospital. Adjunct faculty at the decentralised training sites provided a platform enabling students to enhance their practical skills in line of  health profession and offered mentorship on coping in rural settings where there is scarcity of medical equipment and disposable materials in the health facilities and lack of constant electric power supply and clean water among other

Distribution and abundance of key vectors of Rift Valley fever and other arboviruses in two ecologically distinct counties in Kenya

Background Rift Valley fever (RVF) is a mosquito-borne viral zoonosis of ruminants and humans that causes outbreaks in Africa and the Arabian Peninsula with significant public health and economic consequences. Humans become infected through mosquito bites and contact with infected livestock. The virus is maintained between outbreaks through vertically infected eggs of the primary vectors of Aedes species which emerge following rains with extensive flooding. Infected female mosquitoes initiate transmission among nearby animals, which amplifies virus, thereby infecting more mosquitoes and moving the virus beyond the initial point of emergence. With each successive outbreak, RVF has been found to expand its geographic distribution to new areas, possibly driven by available vectors. The aim of the present study was to determine if RVF virus (RVFV) transmission risk in two different ecological zones in Kenya could be assessed by looking at the species composition, abundance and distribution of key primary and secondary vector species and the level of virus activity. Methodology Mosquitoes were trapped during short and long rainy seasons in 2014 and 2015 using CO2 baited CDC light traps in two counties which differ in RVF epidemic risk levels(high risk Tana-River and low risk Isiolo),cryo-preserved in liquid nitrogen, transported to the laboratory, and identified to species. Mosquito pools were analyzed for virus infection using cell culture screening and molecular analysis. Findings Over 69,000 mosquitoes were sampled and identified as 40 different species belonging to 6 genera (Aedes, Anopheles, Mansonia, Culex, Aedeomyia, Coquillettidia). The presence and abundance of Aedes mcintoshi and Aedes ochraceus, the primary mosquito vectors associated with RVFV transmission in outbreaks, varied significantly between Tana-River and Isiolo. Ae. mcintoshi was abundant in Tana-River and Isiolo but notably, Aedes ochraceus found in relatively high numbers in Tana-River (n = 1,290), was totally absent in all Isiolo sites. Fourteen virus isolates including Sindbis, Bunyamwera, and West Nile fever viruses were isolated mostly from Ae. mcintoshi sampled in Tana-River. RVFV was not detected in any of the mosquitoes. Conclusion This study presents the geographic distribution and abundance of arbovirus vectors in two Kenyan counties, which may assist with risk assessment for mosquito borne diseases

Foot Structure and Function in Habitually Barefoot and Shod Adolescents in Kenya.

Habitually barefoot (HB) children from the Kalenjin tribe of Kenya are known for their high physical activity levels. To date, there has been no comprehensive assessment of foot structure and function in these highly active and HB children/adolescents and link with overuse injuries. PURPOSE: The aim of this research is to assess foot structure, foot function, injury and physical activity levels in Kenyan children and adolescents who are HB compared with those who were habitually shod (HS). METHODS: Foot structure, function, injury prevalence, and physical activity levels were studied using two studies with equal numbers of HS and HB. HS and HB children and adolescents were matched for age, sex, and body mass. Foot arch characteristics, foot strength, and lower-limb injury prevalence were investigated in Study 1 (n = 76). Heel bone stiffness, Achilles tendon moment arm length and physical activity levels in Study 2 (n=62). Foot muscle strength was measured using a strength device TKK 3360 and heel bone stiffness by bone ultrasonometry. The moment arm length of the Achilles tendon was estimated from photographs and physical activity was assessed using questionnaires and accelerometers. RESULTS: Foot shortening strength was greater in HB (4.8 ± 1.9 kg vs 3.5 ± 1.8 kg, P < 0.01). Navicular drop was greater in HB (0.53 ± 0.32 cm vs 0.39 ± 0.19 cm, P < 0.05). Calcaneus stiffness index was greater (right 113.5 ± 17.1 vs 100.5 ± 116.8, P < 0.01 left 109.8 ± 15.7 vs 101.7 ± 18.7, P < 0.05) and Achilles tendon moment arm shorter in HB (right, 3.4 ± 0.4 vs 3.6 ± 0.4 cm, P < 0.05; left, 3.4 ± 0.5 vs 3.7 ± 0.4 cm, P < 0.01). Lower-limb injury prevalence was 8% in HB and 61% in HS. HB subjects spent more time engaged in moderate to vigorous physical activity (60 ± 26 min·d vs 31 ± 13 min·d; P < 0.001). CONCLUSIONS: Significant differences observed in foot parameters, injury prevalence and general foot health between HB and HS suggest that footwear conditions may impact on foot structure and function and general foot health. HB children and adolescents spent more time engaged in moderate to vigorous physical activity and less time sedentary than HS children and adolescents

A mixed-methods study to investigate feasibility and acceptability of an early warning score for preterm infants in neonatal units in Kenya: results of the NEWS-K study

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants’ vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation