Prevalence of cervical cytology abnormalities among HIV infected women at Rwanda Military Hospital

Objectives: To establish the prevalence of cervical cytology abnormalities, determine the correlation between CD4+ cell count and abnormal Pap smear, determine the correlation between WHO-HIV staging and abnormal pap smear among HIV infected women attending HIV clinic at Rwanda Military Hospital.Design: Cross-sectional descriptive studySetting: Rwanda Military Hospital Kigali, RwandaSubjects: All HIV-positive women, 18-69 years who had been or were sexually active and were attending the HIV-clinic and consented to participate in the study.Results: Two hundred and ninety three women infected with HIV had cervical smear taken for cytology. Of the 293 women who were recruited for the study, cervical Squamous Intra epithelial Lesion (SIL) were present in 58 (20%). Of those with cervical SIL, 33 (56.89%) women had low-grade SIL, 15(25.86%) had Atypical Squamous Cells of Undetermined Significance (ASCUS), six (10.34%) had high-grade SIL, three (5.17%) had Squamous cell carcinoma ( SCC) and one (1.72%) had Atypical Glandular Cells of Undetermined Significance (AGUS). In the current study, use of ARV drugs was not associated with a reduction in the risk of cervical SILConclusion: A high prevalence of cervical SIL was found among HIV-infected women at Rwanda Military Hospital. Increased immune suppression was significantly associated with cervical SIL

Fumonisin contamination of maize (Zea mays) in aflatoxin ‘hot’ zones in eastern province of Kenya

Natural Fusarium and fumonisin contamination were evaluated in 86 stored maize samples and correlated to damaged kernels (%). Maize samples were collected from selected farmers in Aflatoxin ‘hot’ zones of Eastern province. Samples were collected from Kitui and Kibwezi districts in May to June 2008. Fusarium species were isolated and identified using morphological characteristics at Mycology Laboratory, Kenya Medical Research Institute. Fumonisinquantification was done using ELISA (RIDASCREEN ® ELISA test kit (Art. No.: R3401) at Bora Biotech, Nairobi. Colony Forming Unit (CFU) counts indicated that apart from Aspergillus a common contaminant in maize, Fusarium species infestation was also high. The most common species being F. verticillioides isolated at (39.9 %) in the two districts. Other isolated Fusarium species included, F. proliferatum (15.1 %), F. solani (9.0 %), F. anthophilium (9.0 %), F. oxysporium (15.1 %), and F. Lateritium (12.1 %). Damaged kernels analysed in this study included insect infestation, mouldy kernels, and off coloured kernels. Results showed up to 20 % of the grains were damaged in some samples. Contamination with fumonisin toxin was observed to be high. Most of the samples exceeded 1 mg / kg the maximum tolerable levels recommended by the European commission. Fusarium species count and fumonisin levels showed positive correlation (p < 0.05). In addition, there was a positive correlation between damaged kernels (%) and Fusarium species count (p < 0.05). Positive correlation was also observed between damaged kernels (%) and Fusarium species count (p < 0.05). In general, F. verticillioides and F. proliferatum were isolated in samples with the highest percentage of kernel damage and highest fumonisin concentrations. These findings indicate wide spread infestation and contamination of maize by Fusarium species and fumonisin toxins. It is apparent that apart from aflatoxins contamination there is also high level of fumonisin exposure in the high risk population necessitating urgent intervention measures to curb the long term health consequences in the population. Keywords: Fusarium spp, Mycotoxin, Fumonisin, Zea maize, Aflatoxin ‘Hot’ zone

Emerging azole resistance among Candida albicans from clinical sources in Nairobi, Kenya

In the recent years the number of serious opportunistic yeast infections,particularly in immunocompromised patients has increased significantly. The increased incidence of these infections has paralleled the emergence of HIV/AIDS pandemic that result in lowered resistance of the host. Azole antifungal agents has been extensively used in the management of these yeast infections. Candida albicans is one of the most frequently isolated yeasts in clinical laboratories and accounts for up to 80 % of the yeasts recovered from sites of infection. The study was set out to determine antifungal susceptibility of clinical isolates of Candida albicans and to establish the Minimum Inhibitory Concentrations (MIC) to Fluconazole, Clotrimazole, Nystatin and Amphotericin B. Laboratory based experiment were conducted at Mycology Laboratory, Kenya Medical Research Institute, Nairobi, Kenya. One hundred and thirty clinical isolates of Candida albicans were subjected to antifungal susceptibility testing. Susceptibility to Fluconazole, Clotrimazole, Nystatin and Amphotericin B was done using Broth Microdilution Technique with reference to Clinical laboratory Standard Institute (CLSI). The investigations showed that 16/130 (12.3 %) of the Candida albicans isolates were resistant (MIC ≥ 64 µg/ml) to fluconazole, 121/130 (93.1 %) of the isolates had an MIC ≤ 1 µg/ml to Amphotericin B. Of the isolates 51/130 (39.2 %) had MIC> 1 µg/ml to clotrimazole  whereas 109/130 (83.8 %) of the isolates had MIC . 1 µg/ml to nystatin. The study showed elevated MICs among Candida albicans isolates to fluconazole and clotrimazole and calls for constant antifungal resistance surveillance especially in the context of fluconazole maintenance treatment for opportunistic infections in HIV/AIDS

Control of contagious bovine pleuropneumonia: knowledge, attitudes, perceptions and practices in Narok district of Kenya

CBPP is an important transboundary disease in sub-Saharan Africa whose control is urgent. Participatory data collection involving 52 focus group discussions in 37 village clusters and key informant interviews, a cross-sectional study involving 232 households and a post-vaccination follow up involving 203 households was carried out in 2006–2007 in Narok South district of Kenya. This was to investigate knowledge, attitudes, perceptions and practices (KAPP) associated with control of CBPP as well as the adverse post-vaccination reactions in animals in order to advice the control policy. The community perceived trans-boundary CBPP threat to their cattle. They had traditional disease coping mechanisms and were conversant with CBPP prevention and control with 49.8% (95%CI: 42.8–56.7%) giving priority to CBPP control. However, 12.9% (95%CI: 9.0–18.1%) of pastoralists had no knowledge of any prevention method and 10.0% (95%CI: 6.5–14.7%) would not know what to do or would do nothing in the event of an outbreak. Although 43.5% (95%CI: 37.1–50.2%) of pastoralists were treating CBPP cases with antimicrobials, 62.5% (95%CI: 52.1–71.7%) of them doubted the effectiveness of the treatments. Pastoralists perceived vaccination to be the solution to CBPP but vaccination was irregular due to unavailability of the vaccine. Vaccination was mainly to control outbreaks rather than preventive and exhibited adverse post-vaccination reactions among 70.4% (95%CI: 63.6–76.5%) of herds and 3.8% (95%CI: 3.5–4.2%) of animals. Consequently, nearly 25.2% (95%CI: 18.5–33.2%) of pastoralists may resist subsequent vaccinations against CBPP. Pastoralists preferred CBPP vaccination at certain times of the year and that it is combined with other vaccinations. In conclusion, pastoralists were not fully aware of the preventive measures and interventions and post-vaccination reactions may discourage subsequent CBPP vaccinations. Consequently there is need for monitoring and management of post vaccination reactions and awareness creation on CBPP prevention and interventions and their merits and demerits. CBPP vaccine was largely unavailable to the pastoralists and the preference of the pastoralists was for vaccination at specified times and vaccine combinations which makes it necessary to avail the vaccine in conformity with the pastoralists preferences. In addition, planning vaccinations should involve pastoralists and neighbouring countries. As the results cannot be generalized, further studies on CBPP control methods and their effectiveness are recommended

Susceptibility of Cryptococcus neoformans and Cryptococcus gattii from clinical and environment sources in Nairobi, Kenya

Objective: To determine anti-fungal susceptibility of Cryptococcus neoformans andCryptococcus gattii from environmental and clinical sources in Nairobi, Kenya.Design: Prospective study.Setting: Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya.Subjects: A total of 123 isolates were tested for their susceptibility to fluconazole(FLC), amphotericin B(AMP) and fluorocytosine (5FC). Clinical isolates were 70(66Cryptococcus neoformans and 4 Cryptococcus gattii) while environmental isolates were53(41 C. neoformans and 12 C. gattii). The isolates were characterised using variousphenotypic tests including microscopic morphology, physiological and biochemicaltests (API 20 Caux), pigmentation on bird seed agar and reaction on canavanineglycine-bromthymolblue agar. European Committee on Anti-microbial SusceptibilityStandards (EUCAST) was used as the reference method for susceptibility testing.Results: Most C. neoformans isolates; clinical (61/66; 92.4%) and environmental (38/41;92.7%) were susceptible to FLC. The number of C. neoformans isolates inhibited atsusceptible dose dependent (SDD) range (16-32μg/ml) by FLC were clinical (4/66; 6.1%)and environmental (2/41; 4.9%). One C. neoformans isolate each; clinical (1/66; 1.5%)and environmental (1/41; 2.4%) was resistant to FLC. All C. gatti isolates from clinicaland environmental were fully susceptible to FLC. The percentage of C. neoformansisolates that were susceptible (S) (MIC ≤ 1.0 μg/ml) to AMP were; clinical(52/66; 90.2%)and environmental (37/41; 78.8%) while the rest were susceptible dose dependent(SDD) with MIC (2-8μg/ml). Reduced susceptibilities to 5FC was displayed in allclinical and environmental C. neoformans and C. gatii isolates; for instance resistanceto 5FC was reported in C. neoformans; clinical (8/66; 12.1%) and environmental (1/41;2.4 %). Among the C. gattii isolates there was also decreased susceptibility to 5FCwith Minimum Inhibition Concentration (MIC) range of between 0.5-32 μg/ml. Therewere no significant differences in susceptibility ranges among all the clinical andenvironmental isolates.Conclusion: This study demonstrated reduced susceptibilities among C. neoformansand C. gattii isolates to commonly used anti-fungal drugs

Willingness to pay for contagious bovine pleuropneumonia vaccination in Narok South District of Kenya

Contagious bovine pleuropneumonia (CBPP) is an economically important trans-boundary cattle disease which affects food security and livelihoods. A conjoint analysis–contingent valuation was carried out on 190 households in Narok South District of Kenya to measure willingness to pay (WTP) and demand for CBPP vaccine and vaccination as well as factors affecting WTP. The mean WTP was calculated at Kenya Shillings (KSh) 212.48 (USD 3.03) for vaccination using a vaccine with the characteristics that were preferred by the farmers (preferred vaccine and vaccination) and KSh −71.45 (USD −1.02) for the currently used vaccine and vaccination. The proportion of farmers willing to pay an amount greater than zero was 66.7% and 34.4% for the preferred and current vaccine and vaccination respectively. About one third (33.3%) of farmers would need to be compensated an average amount of KSh 1162.62 (USD 13.68) per animal to allow their cattle to be vaccinated against CBPP using the preferred vaccine and vaccination. About two-thirds (65.6%) of farmers would need to be compensated an average amount of KSh 853.72 (USD 12.20) per animal to allow their cattle to be vaccinated against CBPP using the current vaccine and vaccination. The total amount of compensation would be KSh 61.39 million (USD 0.88 million) for the preferred vaccine and vaccination and KSh 90.15 million (USD 1.29 million) for the current vaccine and vaccination. Demand curves drawn from individual WTP demonstrated that only 59% and 27% of cattle owners with a WTP greater than zero were willing to pay a benchmark cost of KSh 34.60 for the preferred and current vaccine respectively. WTP was negatively influenced by the attitude about household economic situation (p = 0.0078), presence of cross breeds in the herd (p < 0.0001) and years since CBPP had been experienced in the herd (p = 0.0375). It was positively influenced by education (p = 0.0251) and the practice of treating against CBPP (p = 0.0432). The benefit cost ratio (BCR) for CBPP vaccination was 2.9–6.1 depending on the vaccination programme. In conclusion, although a proportion of farmers was willing to pay, participation levels may be lower than those required to interrupt transmission of CBPP. Households with characteristics that influence WTP negatively need persuasion to participate in CBPP vaccination. It is economically worthwhile to vaccinate against CBPP. A benefit cost analysis (BCA) using aggregated WTP as benefits can be used as an alternative method to the traditional BCA which uses avoided production losses (new revenue) and costs saved as benefits

Isolation and characterisation of Cryptococcus neoformans and Cryptococcus gattii from environmental sources in Nairobi, Kenya

Objective: To establish the environmental reservoirs of Cryptococcus neoformans and Cryptococcus gattii in Nairobi, Kenya.Design: Prospective study.Setting: Kenya Medical Research Institute, Mycology laboratory, Nairobi, Kenya.Subjects: A total of 400 environmental samples from different sites were analysed including; avian droppings, tree swabs, soil contaminated with avian droppings and swabs from garbage damping sites. Samples were subjected to various phenotypic tests including microscopic morphology, physiological and biochemical tests, pigmentation on bird seed agar and reaction on Canavanine-Glycine-Bromothymol Blue agar.Results: Cryptococcus neoformans was isolated from 23/200 (11.5%) dropping samples and Cryptococcus gattii in 5/200 (2.5%) of the same samples. Cryptococcus gattii was isolated from 7/60 (11.7%) tree swabs and Cryptococcus neoformans in 5/60 (8.5%) of the same samples. From other sites there was no Cryptococcus gattii recovered with (5/50: 10%), (6/60: 10%), (2/30: 6.7%) Cryptococcus neoformans recovered from chicken cage, garbage damping site and soil respectively.Conclusion: Findings clearly showed a high presence of Cryptococcus neoformans and Cryptococcus gattii from several environmental sites in Nairobi, Kenya .This could probably explain the high incidence of cryptococcal meningitis in HIV/AIDS patients in Kenya

The Influence of Enterprise Resource Planning System on Organizational Performance: Case Study of Kenyan Engineering Consultancy Firms

A Research Project Report Submitted to the Chandaria School of Business in Partial Fulfillment of the Requirement for the Degree of Master of Science in Organizational Development (MOD)Empirical evidence suggest the ERP adoption facilitate organizational processes and activities including sales, billing, marketing, human resource management, quality control and production thus ensuring general performance. However, despite the adoption of ERP systems by Kenyan and Kenyan-based companies in the engineering consultancy industry of ERP system, little academic attention has gone to the assessment of the impacts of ERP adoption in the industry. The lack of academic attention on the effect of ERP on the performance of consultancy impedes scholarly understanding of the relationship between ERP adoption and the performance of engineering consultancy firm. The purpose of the study was to determine the influence of enterprise resource planning (ERP) system on organizational performance. The study sought to answer the following research questions, namely; what is the impact of ERP system on financial performance? What is the impact of the ERP system on organizational learning? What is the impact of the ERP system on internal processes? The study’s research methodology was as follows, it used a descriptive research design. This is design deemed essential and appropriate in describing the relationship between ERP and organizational performance. As such, a descriptive research design permitted the researcher to collect information regarding the ERP system and to describe how it affects the performance of engineering consultancy firms. The population for the study comprised of employees of engineering consultancy firms from which 41 individuals were sampled for participation in the study. It used the stratified random sampling to ensure that every individual in every level of selected engineering consultancy firms’ workforce was represented in the study. Structured questionnaires were used to collect the relevant data over a period of one week. The study results were presented using descriptive statistics while inferential statistics were also used for further analysis of data. The research used Statistical Package for Social Sciences (SPSS) program version 21 for data analysis. The study found that the majority of the respondents thought that ERP systems had a positive impact on the financial performance of the firm. The study found that the respondents thought ERP had a positive outcome for virtually all the aspect of financial performance including the firm’s profitability, the rate of ROI, competitive advantage, the operational costs and the firm’s market share. However, the study found that a few respondents were however not sure of the nature of ERPs impact on rate of ROI and the firm’s market share. The study also determined a greater number of respondents considered ERP to have a positive impact on the firm’s organizational learning processes. It established that decision-making process, business process, productivity, task performance, managerial control and customer satisfaction were all positively affected by the ERP systems in their firms. Nonetheless, a significant number of the respondents revealed that they were not sure of the impact of ERP on customer satisfaction. With regard to the impact of ERP on firms’ internal processes, the study again established that the majority of the respondents thought that the impact of ERP on the internal process was positive. The respondents indicated that ERP systems had a positive impact on the monitoring process, access to information, the process of HRM, internal communication and the accounting process. It concludes by contending that the impact of ERP on the financial performance of the engineering consultancy firms is mostly positive. This is mainly because the vital aspects or measures of financial performance are affected positively by ERP systems. It also argues that the process of organizational learning is a principal beneficiary of the ERP systems in a firm that adopts the system. The impact of ERP systems on the management of information within the firm has direct benefits in the facilitation of task performance, customer satisfaction, decision-making and managerial control. Furthermore, it reiterates that ERP systems, by their nature facilitate the internal process within the organization, which facilitates the efficient and timely performance of tasks. The systems are capable of facilitating information storage, access and transmittal in real time. The study recommends that the management of the engineering consultancy firms in Kenya as well as the firms in other industries in Kenya needs to appreciate the value of ERP systems on organizational performance and adopt the systems as part of their performance strategy. Similarly, as part of their performance strategy they must adopt ERP systems as a strategy of enhancing firm’s overall performance through ERP systems potential for the enhancement of business processes such as decision-making, productivity, task performance and managerial control. The researcher further recommends that firms should adopt ERP systems due to their potential to generate a positive impact on firms’ internal processes. For further research, the researcher recommends that there is need for further research to investigate why despite the relative positive impact that ERP systems have on the performance of the engineering consultancy firms in Kenya, few firms have adopted the systems