Assessment of Status, Challenges and Viability of Slum Tourism: Case Study of Kibera Slum in Nairobi, Kenya.

The status of slum tourism was carried out in Kibera slum in Nairobi. The study applied structured and semi- structured questionnaires which were administered to the target population from six villages randomly selected in Kibera slum in Nairobi, Kenya. The Snowball sampling method was used to select respondents in these villages. Observing residents’ life style and taking photographs were identified as major tourist activities in Kibera slum while improvement of security and involvement of residents in tourism activities were identified as key ways for promoting slum tourism. The data was analyzed using the Statistical Package for Social Sciences (SPSS). Poor understanding of slum tourism concept and lack of involvement of residents was identified as the major challenge while lack of policy was the other challenge. The data was analyzed using the Statistical Package for Social Sciences (SPSS). Poor understanding of slum tourism concept and lack of involvement of residents was the major challenge while lack of policy was the other challenge. It was identified that there was need for the Government to develop a comprehensive slum tourism policy which would guide on ways of conducting slum tours so that it can benefit both the government and the Resident communities in these slums. The Ministry of Tourism needs to sensitize the slum residents on how they can take advantage of their living conditions to establish Community Based tourism businesses Key words: Slum, Tourism, Status, Challenges, Benefit

Endometrial tuberculosis compounding polycystic ovary syndrome in a subfertile woman: a case report

Background: Asymptomatic female genital tuberculosis can impair tubal and endometrial function and later present as subfertility. A majority of the patients with genital tuberculosis in endemic regions present with subfertility and the delay in presentation, coupled with the potential the disease has in mimicking other gynecological conditions, renders it elusive. In addition to the challenge of diagnosing genital tuberculosis, fertility outcomes after treatment are not impressive. This is particularly so in the background of another confounding subfertility factor to which interventional efforts may initially be directed, at the expense of undiagnosed genital tuberculosis. We therefore present a case of subfertility due to endometrial tuberculosis, but confounded by other subfertility factors notably polycystic ovary syndrome. To the best of our knowledge this case report is the first of its kind in the literature. Case presentation: This is a case report of a 42-year-old woman of African descent who presented to our fertility clinic with a 10-year history of primary subfertility and amenorrhea of 6 years duration. She was a nurse in a medical ward and had no prior history of tuberculosis. She had undergone a diagnostic laparoscopy 8 years prior which demonstrated dense pelvic adhesions and an impression of tubal factor subfertility was made. At presentation, her gonadal hormone profile and pelvic ultrasound were consistent with polycystic ovary syndrome. A negative response to a progesterone challenge test prompted a hysteroscopic evaluation which revealed endometrial atrophy. Endometrial biopsies confirmed histological features consistent with tuberculosis. Normal endometrial function was not restored despite adequate treatment and her options were limited to surrogacy or adoption. Conclusions: Genital tuberculosis is elusive in presentation and clinicians should consider it in patients with amenorrhea and/or tubal disease from tuberculosis-endemic regions. Due to the attendant high cost of fertility treatment and associated poor fertility outcomes, it is prudent to explore options to diagnose it early. A routine endometrial biopsy in a patient with subfertility in a tuberculosis-endemic area would be pragmatic. An alternative algorithm in management would be risk stratification prior to endometrial biopsy

Variation of Input Impedance with Feeding Position in Probe and inset-Fed Microstrip Patch Antenna

Proper impedance matching of a microstrip patch antenna to the feed line is paramount for efficient radiation. However, impedance matching in such a system is not easy and consequently most systems suffer from return losses. The variation of the input impedance of a probe-fed and inset-fed rectangular microstrip patch antennas along the longitudinal and transverse lengths is investigated on probe-fed and microstrip-fed antenna operating at 2.4GHz and 2.0GHz respectively. FEKO simulation software is used to evaluate and characterize the behaviour of the input resistance for varying values of feeding position. It is observed that the transverse variation in the input resistance is very minimal. The conclusion drawn here is that a cosine squared and shifted cosine squared function can be used to exactly locate the feed point in a probe and inset fed antennas respectively for an impedance matched antenna system.   Keywords: Longitudinal feeding position, FEKO, probe feeding, inset feeding, input impedance, return loss

Detection and Quantification of Oestrogenic Endocrine Disruptors in Water in Mwanza Gulf in the Lake Victoria Basin, Tanzania

The aim of this study was to detect the presence and quantify the total oestrogens (estriol (E1), estradiol (E2), and estrone (E3)) in Lake Victoria water with a view of assessing their contribution to the health status of fish. A total of 27 water samples; three from each of the nine sampling sites were collected in Mwanza gulf in the city in May 2012. Solvent extraction procedures were used to obtain extracts of pollutants that were further analysed using the competitive Enzyme- Linked Immunosorbent Assay (ELISA) technique to detect and quantify the total oestrogens. Overall, the concentration of total oestrogens was low and ranged from 10 – 200 pg/L. Concentrations of these chemicals decreased along the gradient, being highest (107±81.4 pg/L) in rivers before entering into the lake and lowest (19±5.4 pg/L) in water samples collected in the lake at about 100 meters from inshore (intermediate sampling points). Levels of total oestrogens were significantly different between categories of water sources (P = 0.009). Two most polluted rivers were Butimba and Nyakurunduma with concentrations at 150 pg/L and 200 pg/L respectively. Dumping of wastes in rivers without treatment was the most likely source of the pollutants. Findings from this study have revealed the existence of oestrogens with endocrine disrupting properties at different concentrations, and that rivers are the main sources of oestrogenic endocrine disruptors in Lake Victoria water near Mwanza City.Keywords: ELISA, endocrine disruptors, oestrogens, pollutio

A comparison of serum biochemical changes in two breeds of sheep (Red Masai and Dorper) experimentally infected with Fasciola Gigantica

Twelve Red Masai and 12 Dorper sheep aged between 6 and 9 months, were acquired from a flukefree area and sheep of each breed divided into two equal groups of six. Each animal in one group of each breed was experimentally infected with 400 viable metacercariae of Fasciola gigantica. The other groups acted as uninfected controls. Blood samples were taken at weekly intervals for the determination of serum bilirubin, albumin, and gamma glutamyl transferase levels. Following the establishment of infection, albumin levels declined in both breeds of infected animals without any significant difference between the two breeds. However, serum bilirubin and gamma glutamyl transferase (GGT) in the infected animals were elevated significantly more in the Dorper than in the Red Masai sheep. Based on these findings, it would appear that Dorper sheep are more susceptible to the infection than Red Masai sheep.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Danish International Development Agency (DANIDA).mn201

Stakeholder perceptions on patient-centered care at primary health care level in rural eastern Uganda: A qualitative inquiry

Background: Patient-centered care (PCC) offers opportunities for African health systems to improve quality of care. Nonetheless, PCC continually faces implementation challenges. In 2015, Uganda introduced PCC as a concept in their national quality improvement guidelines. In order to investigate whether and how this is implemented in practice, this study aims to identify relevant stakeholders’ views on the current quality of primary health care services and their understanding of PCC. This is an important step in understanding how the concept of PCC can be implemented in a resource constrained, sub-Saharan context like Uganda. Methods: This qualitative study was conducted in Uganda at national, district and facility level, with a focus on three public and three private health centres. Data collection consisted of in-depth interviews (n = 49); focus group discussions (n = 7); and feedback meetings (n = 14) across the four main categories of stakeholders identified: patients/communities, health workers, policy makers and academia. Interviews and discussions explored stakeholder perceptions on the interpersonal aspects of quality primary health care and meanings attached to the concept of PCC. A content analysis of Ugandan policy documents mentioning PCC was also conducted. Thematic content analysis was conducted using NVivo 11 to organize and analyze the data. Findings and conclusion: While Ugandan stakeholder groups have varying perceptions of PCC, they agree on the following: the need to involve patients in making decisions about their health, the key role of healthcare workers in that endeavor, and the importance of context in designing and implementing solutions. For that purpose, three avenues are recommended: Firstly, fora that include a wide range of stakeholders may offer a powerful opportunity to gain an inclusive vision on PCC in Uganda. Secondly, efforts need to be made to ensure that improved communication and information sharing–important components of PCC–translate to actual shared decision making. Lastly, the Ugandan health system needs to strengthen its engagement of the transformation from a community health worker system to a more comprehensive community health system. Cross-cutting the entire analysis, is the need to address, in a culturally-sensitive way, the many structural barriers in designing and implementing PCC policies. This is essential in ensuring the sustainable and effective implementation of PCC approaches in low- and middle-income contexts

Beacon of hope: Evaluation of the Kenya Girl Guides Association HIV/AIDS program for school children

This Horizons report presents findings from an evaluation of the Kenya Girl Guides Participatory Peer Education Program for HIV and AIDS Prevention. The objective of the program was to train Girl Guide patrol leaders as peer educators, who in turn would communicate key information and concepts about such topics as HIV prevention, relationships, and self-esteem to other Girl Guides, and ultimately to their school peers. The results demonstrate that peer education conducted by Girl Guides is a feasible strategy for imparting HIV and AIDS education to school-going youth; however, such a program would need to be branded, strengthened, and appropriately resourced to attain positive results that extend beyond the Girl Guides to include their peers. The results also demonstrate that school girls in this study are operating in an environment where their male counterparts are more than seven times as likely to be sexually experienced, and may be exerting considerable pressure to have sex even on the strongest of girls. HIV risk-reduction programs directed at school girls may be more successful if they also address the risk behavior of school boys

Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type:a cross-sectional patient survey

BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues

On the coloniality of “new” mega‐infrastructure projects in east Africa

This article responds to a preference for short‐term history in research on the infrastructure turn by engaging with the longue durée of East Africa’s latest infrastructure scramble. It traces the history of LAPSSET in Kenya and the Central Corridor in Tanzania, revealing the coloniality of new and improved transport infrastructure along both corridors. This exercise demonstrates how the spatial visions and territorial plans of colonial administrators get built in to new infrastructure and materialise in ways that serve the interests of global capital rather than peasant and indigenous peoples being promised more modern, prosperous futures. The article concludes by suggesting that a focus on the longue durée also reveals uneven patterns of mobility and immobility set in motion during the colonial scramble for Africa and reinforced after independence. These “colonial moorings” are significant as they shape political reactions to new mega‐infrastructure projects today and constrain the emancipatory potential of infrastructure‐led development

Mixed methods study protocol for combining stakeholder-led rapid evaluation with near real-time continuous registry data to facilitate evaluations of quality of care in intensive care units [version 1; peer review: awaiting peer review]

BACKGROUND: Improved access to healthcare in low- and middle-income countries (LMICs) has not equated to improved health outcomes. Absence or unsustained quality of care is partly to blame. Improving outcomes in intensive care units (ICUs) requires delivery of complex interventions by multiple specialties working in concert, and the simultaneous prevention of avoidable harms associated with the illness and the treatment interventions. Therefore, successful design and implementation of improvement interventions requires understanding of the behavioural, organisational, and external factors that determine care delivery and the likelihood of achieving sustained improvement. We aim to identify care processes that contribute to suboptimal clinical outcomes in ICUs located in LMICs and to establish barriers and enablers for improving the care processes. METHODS: Using rapid evaluation methods, we will use four data collection methods: 1) registry embedded indicators to assess quality of care processes and their associated outcomes; 2) process mapping to provide a preliminary framework to understand gaps between current and desired care practices; 3) structured observations of processes of interest identified from the process mapping and; 4) focus group discussions with stakeholders to identify barriers and enablers influencing the gap between current and desired care practices. We will also collect self-assessments of readiness for quality improvement. Data collection and analysis will be performed in parallel and through an iterative process across eight countries: Kenya, India, Malaysia, Nepal, Pakistan, South Africa, Uganda and Vietnam. CONCLUSIONS: The results of our study will provide essential information on where and how care processes can be improved to facilitate better quality of care to critically ill patients in LMICs; thus, reduce preventable mortality and morbidity in ICUs. Furthermore, understanding the rapid evaluation methods that will be used for this study will allow other researchers and healthcare professionals to carry out similar research in ICUs and other health services