LECTURER QUALITY IN PUBLIC UNIVERSITIES IN KENYA

Universities play a critical in preparing human resources for sustainable development of nations. There have been persistent concerns that public universities in Kenya are producing graduates inadequately prepared to effectively transition from learning to earning. Lecturers are the core agents in facilitating the development of relevant professional competencies and skills essential for graduates’ successful transition into the workplace. The debate on the quality of the graduate cannot ignore the quality of the lecturer. The purpose of this study is to examine lecturer quality in public universities in Kenya. The study used cross sectional research design. Eight universities representing 36.0% of public universities were sampled. A stratified proportionate random sample of 1,107 third and fourth year undergraduate students responded to the study. Thirty one key informants who included deans of schools, registrars in charge of academic affairs, directors of quality assurance, and chairpersons of students’ union participated in the study. Data were collected using a questionnaire for students and interview guide for key informants. The tools were subjected to validity and reliability analysis. Quantitative data were analysed using factor analysis, Pearson product-moment correlation coefficient and descriptive statistics. Qualitative data were analysed using frequency counts, percentages and content analysis. The research determined two valid and reliable dimensions which accounted for 62.95% of the variations in lecturer quality. The dimensions are lecturer’s professional attributes and instructional practices with professional attributes being the most important. Lecturer’s professional attributes is strongly related to instructional practices (r = 0.597,

Natural resource integrity: A resilient community on the degraded slopes of Mount Elgon takes on mending its broken landscape

The once beautiful foothills of Mount Elgon, in eastern Uganda are today seriously degraded, with excessive water run-offs and landslides becoming regular occurrences. Restoring the health and productive potential of the agroecosystem had become a dire need of those, mostly women, who stayed to farm it. By challenging the status quo and doing things differently, the Kapchorwa District Landcare Chapter (KADLACC) has been helping this farming community over the past fifteen years to manage its natural resources more sustainably, as well as more profitably. By building on the innovation skills of the community, by helping it address local challenges and by empowering the women of the community to manage their natural resources in sustainable ways, the platform has helped to restore much of what has been lost in recent decades. Before the platform was established, crops, properties, infrastructure and even lives were regularly destroyed. Trees and other vegetation were removed indiscriminately to make room for farms and settlements. Fragile soils were exposed to the agents of erosion. Heavily sloped land was tilled. Women, although providing up to 90% of the agricultural labour force, had little decision-making power. Household incomes and food security declined steeply, along with soil fertility and women’s engagement. With the establishment of KADLACC, twin journeys towards land restoration and women’s empowerment began. Community members were quick to support the entire process. Awareness of women’s rights was raised through consultative processes from village to sub-county levels, engaging individual farmers, farmer groups, local government officials and external actors. Community members, through farmer learning cycles, were linked to trained facilitators. This helped farmers and farmer groups consolidate their grassroots understanding of the challenges they faced and the options they could employ to address them. Livelihood goals were linked to conservation goals. Local-level policy reforms helped define and encourage women’s ownership and control over land. Over these 15 years, community by-laws supporting watershed management, land restoration and agroforestry practices have been developed and implemented. Women have been given greater priority in natural resource management decision-making. Some 300 women displaced from their land have been granted access to collective land for organic and horticultural farming. And by improving this community’s access to agricultural and information services, KADLACC has helped this farm community significantly improve its productivity, while restoring the integrity of its natural resource base

Bis(1-tosyl-2-pyrrol­yl)ethyne

The title mol­ecule, C24H20N2O4S2, has crystallographic inversion symmetry with a triple-bond distance of 1.206 (2) Å. The alkyne is not quite linear, with a C—C C angle of 175.78 (16)°. The planar pyrrole rings are parallel but offset from coplanarity by 0.318 (1) Å. The conformation of the sulfonyl group with respect to the pyrrole ring is such that an O atom is nearly eclipsed with this ring, having an O—S—N—C torsion angle of 3.48 (11)°. C—H⋯O inter­actions [C⋯O 3.278 (2) Å, 136° about H] between pyrrole H and sulfonyl O atoms lead to the formation of ladder-like chains

Comparison of demographic and clinical characteristics between pulmonary and extra-pulmonary tuberculosis patients in Kiambu County, 2012-2015

Background: Tuberculosis (TB) continues to be a public health challenge globally. The most common organ to be involved is the lung although it can affect any organ in the body. The diagnosis of extra-pulmonary TB (EPTB) has faced many challenges mainly due to inadequate expertise to diagnose or lack of equipment for diagnosis.Objective: To compare the demographic and clinical characteristics between pulmonary and extrapulmonary tuberculosis in Kiambu CountyDesign: Retrospective cross-sectional studySetting: Kiambu County, KenyaSubjects: Tuberculosis patients notified in TIBU surveillance systemResults: Of the 15, 833 patients analyzed, 2,704 (17%) had extra-pulmonary tuberculosis. Male to female ratio was 1:1.7 in PTB and 1:1.3 in EPTB patients. There was declining trend of TB cases notified over the years for both PTB and EPTB. Pleural TB accounted for 38% with TB lymphadenitis accounting for 14% of the EPTB subtypes. TB-HIV co-infection was higher among EPTB (36%) compared to PTB (30%). The treatment success rate was 85% and 86% among PTB and EPTB cases respectively. The mortality was 10% among EPTB and 5% in PTB cases. The 5-14 age category were more likely to developing EPTB compared to PTB (AOR 4.67 95% CI (1.5-13.99). Kabete zone was most affected with EPTB (AOR 2.11(1.19-2.74) while a protective factor was observed among the HIV positive clients (AOR 0.58 (0.43 - 0.78)Conclusion: There was a general decline in cases for both EPTB and PTB. However, the age category most affected was 5-14 years. The co-infectivity rate was higher among the EPTB patients compared to the PTB patients. High index of suspicion and appropriate diagnostic tools are needed in evaluation particularly in EPTB which will assist in early management of the patients. ART uptake could play a big role in protecting HIV positive clients from getting EPTB

Metagenomic analysis of viruses associated with maize lethal necrosis in Kenya

Background: Maize lethal necrosis is caused by a synergistic co-infection of Maize chlorotic mottle virus (MCMV) and a specific member of the Potyviridae, such as Sugarcane mosaic virus (SCMV), Wheat streak mosaic virus (WSMV) or Johnson grass mosaic virus (JGMV). Typical maize lethal necrosis symptoms include severe yellowing and leaf drying from the edges. In Kenya, we detected plants showing typical and atypical symptoms. Both groups of plants often tested negative for SCMV by ELISA. Methods: We used next-generation sequencing to identify viruses associated to maize lethal necrosis in Kenya through a metagenomics analysis. Symptomatic and asymptomatic leaf samples were collected from maize and sorghum representing sixteen counties. Results: Complete and partial genomes were assembled for MCMV, SCMV, Maize streak virus (MSV) and Maize yellow dwarf virus-RMV (MYDV-RMV). These four viruses (MCMV, SCMV, MSV and MYDV-RMV) were found together in 30 of 68 samples. A geographic analysis showed that these viruses are widely distributed in Kenya. Phylogenetic analyses of nucleotide sequences showed that MCMV, MYDV-RMV and MSV are similar to isolates from East Africa and other parts of the world. Single nucleotide polymorphism, nucleotide and polyprotein sequence alignments identified three genetically distinct groups of SCMV in Kenya. Variation mapped to sequences at the border of NIb and the coat protein. Partial genome sequences were obtained for other four potyviruses and one polerovirus. Conclusion: Our results uncover the complexity of the maize lethal necrosis epidemic in Kenya. MCMV, SCMV, MSV and MYDV-RMV are widely distributed and infect both maize and sorghum. SCMV population in Kenya is diverse and consists of numerous strains that are genetically different to isolates from other parts of the world. Several potyviruses, and possibly poleroviruses, are also involved

The cost‐effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa

Introduction Many HIV‐positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced‐prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 <100 cells/mm3. We investigated the cost‐effectiveness of this enhanced‐prophylaxis package versus other strategies, including using cryptococcal antigen (CrAg) testing, in individuals with CD4 <200 cells/mm3 or <100 cells/mm3 at ART initiation and all individuals regardless of CD4 count. Methods The REALITY trial enrolled from June 2013 to April 2015. A decision‐analytic model was developed to estimate the cost‐effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard‐prophylaxis, enhanced‐prophylaxis, standard‐prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced‐prophylaxis (CrAg‐positive) or standard‐prophylaxis (CrAg‐negative), the second to enhanced‐prophylaxis (CrAg‐positive) or enhanced‐prophylaxis without fluconazole (CrAg‐negative) and the third to standard‐prophylaxis with fluconazole (CrAg‐positive) or without fluconazole (CrAg‐negative). The model estimated costs, life‐years and quality‐adjusted life‐years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results Enhanced‐prophylaxis was cost‐effective at cost‐effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost‐effectiveness ratio (ICER) of US$157 per QALY in the CD4 <200 cells/mm3 population providing enhanced‐prophylaxis components are sourced at lowest available prices. The ICER reduced in more severely immunosuppressed individuals (US$113 per QALY in the CD4 <100 cells/mm3 population) and increased in all individuals regardless of CD4 count (US$722 per QALY). Results were sensitive to prices of the enhanced‐prophylaxis components. Enhanced‐prophylaxis was more effective and less costly than all CrAg testing strategies as enhanced‐prophylaxis still conveyed health gains in CrAg‐negative patients and savings from targeting prophylaxis based on CrAg status did not compensate for costs of CrAg testing. CrAg testing strategies did not become cost‐effective unless the price of CrAg testing fell below US$2.30. Conclusions The REALITY enhanced‐prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost‐effective. Efforts should continue to ensure that components are accessed at lowest available prices

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Late Presentation With HIV in Africa: Phenotypes, Risk, and Risk Stratification in the REALITY Trial.

This article has been accepted for publication in Clinical Infectious Diseases Published by Oxford University PressBackground: Severely immunocompromised human immunodeficiency virus (HIV)-infected individuals have high mortality shortly after starting antiretroviral therapy (ART). We investigated predictors of early mortality and "late presenter" phenotypes. Methods: The Reduction of EArly MortaLITY (REALITY) trial enrolled ART-naive adults and children ≥5 years of age with CD4 counts .1). Results: Among 1711 included participants, 203 (12%) died. Mortality was independently higher with older age; lower CD4 count, albumin, hemoglobin, and grip strength; presence of World Health Organization stage 3/4 weight loss, fever, or vomiting; and problems with mobility or self-care at baseline (all P < .04). Receiving enhanced antimicrobial prophylaxis independently reduced mortality (P = .02). Of five late-presenter phenotypes, Group 1 (n = 355) had highest mortality (25%; median CD4 count, 28 cells/µL), with high symptom burden, weight loss, poor mobility, and low albumin and hemoglobin. Group 2 (n = 394; 11% mortality; 43 cells/µL) also had weight loss, with high white cell, platelet, and neutrophil counts suggesting underlying inflammation/infection. Group 3 (n = 218; 10% mortality) had low CD4 counts (27 cells/µL), but low symptom burden and maintained fat mass. The remaining groups had 4%-6% mortality. Conclusions: Clinical and laboratory features identified groups with highest mortality following ART initiation. A screening tool could identify patients with low CD4 counts for prioritizing same-day ART initiation, enhanced prophylaxis, and intensive follow-up. Clinical Trials Registration: ISRCTN43622374.REALITY was funded by the Joint Global Health Trials Scheme (JGHTS) of the UK Department for International Development, the Wellcome Trust, and Medical Research Council (MRC) (grant number G1100693). Additional funding support was provided by the PENTA Foundation and core support to the MRC Clinical Trials Unit at University College London (grant numbers MC_UU_12023/23 and MC_UU_12023/26). Cipla Ltd, Gilead Sciences, ViiV Healthcare/GlaxoSmithKline, and Merck Sharp & Dohme donated drugs for REALITY, and ready-to-use supplementary food was purchased from Valid International. A. J. P. is funded by the Wellcome Trust (grant number 108065/Z/15/Z). J. A. B. is funded by the JGHTS (grant number MR/M007367/1). The Malawi-Liverpool–Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine (grant number 101113/Z/13/Z) and the Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi (grant number 203077/Z/16/Z) are supported by strategic awards from the Wellcome Trust, United Kingdom. Permission to publish was granted by the Director of KEMRI. This supplement was supported by funds from the Bill & Melinda Gates Foundation