21 research outputs found
Enhancing Maize Grain Yield in Acid Soils of Western Kenya Using Aluminium Tolerant Germplasm
Abstract: Maize (Zea mays L.) is one of the worldâs most important cereals and is a staple food for many people in developing
countries. However, in acid soils (pH < 5.5), its productivity is limited by aluminium (Al) toxicity, besides other factors. The
objectives of this study were to: develop Al tolerant maize inbred lines for a maize breeding program in Kenya, develop single cross
hybrids (SCHs) from some of the tolerant inbred lines and determine Al tolerance levels of the SCHs. One hundred and seventy five
inbreds and 49 SCHs were developed and screened in nutrient culture containing 0 or 222 ÎŒM using Relative Net Root Growth
(RNRG), hematoxylin staining (HS) and under Al saturated field conditions (44%-45.6%) at Sega and Chepkoilel. Seedling root
growth was inhibited in 95% of the inbreds. F1 hybrids obtained from inbreds varying in Al tolerance, exhibited tolerance equal to or
greater than that of the more tolerant parent indicating a positive transgressive inheritance to Al toxicity. Fifty eight percent of the F1
SCHs were heterotic for tolerance to Al toxicity. Al tolerance estimated by RNRG was well correlated to that of HS (r2 = 0.88, P <
0.005) but minimally correlated with the field estimates (r2 = 0.24-0.35), implying that RNRG can predict field selection under Al
toxic soils by between 24% and 35%. Plant breeders should therefore employ both approaches in selecting cultivars under Al stress.
This study has developed and identified Al tolerant inbreds and SCHs for use in the acid soils of Kenya and similar regions
Prevalence and missed cases of respiratory distress syndrome disease amongst neonatal deaths enrolled in the Kenya Child Health and Mortality Prevention Surveillance Network (CHAMPS) program between 2017 and 2021
Objectives: To describe RDS in neonatal deaths at the CHAMPS-Kenya site between 2017 and 2021.
Methods: We included 165 neonatal deaths whose their Causes of death (COD) were determined by a panel of experts using data from post-mortem conducted through minimally invasive tissue specimen testing, clinical records, and verbal autopsy.
Results: Twenty-six percent (43/165) of neonatal deaths were attributable to RDS. Most cases occurred in low birthweight and preterm neonates. From these cases, less than half of the hospitalizations were diagnosed with RDS before death, and essential diagnostic tests were not performed in most cases. Most cases received suboptimal levels of supplemental oxygen, and critical interventions like surfactant replacement therapy and mechanical ventilation were not adequately utilized when available.
Conclusion: The study highlights the urgent need for improved diagnosis and management of RDS, emphasizing the importance of increasing clinical suspicion and enhancing training in its clinical management to reduce mortality rates
Development of maize single cross hybrids for tolerance to low phosphorus
Low available phosphorus (P) is one of the major hindrances to maize (Zea mays L.) productivity in acid
soils. The objectives of this study were to: (1) develop P-efficient maize inbred lines, (2) develop single
cross hybrids from the P-efficient inbred lines, and (3) determine their response to P application in the
P-deficient acid soils of western Kenya. Ninety-eight inbred lines and 49 single crosses were developed
and screened at P-deficient (2.0 to 2.2 mg P/kg soil) soils of Sega and Bumala. Mean grain yield (GY) for
the hybrids was 75.3% higher with P-fertilizer than without P for the same hybrids. Thirty-three percent
(33%) of these hybrids were inefficient but responsive to P application, 27% were efficient and none
responsive, only 13% were efficient and responsive, while the rest were inefficient and non-responsive.
GY was positively correlated (r = 0.57**) with plant height (PH) and ear height (EH) (r = 0.60**) and PH
was correlated with EH (r = 0.86***). This study has developed and identified P-efficient maize
germplasm that can be utilized directly or in developing other hybrids for use in acid soils of western
Kenya and in other acid soils where P is limiting
Mobile phone-delivered reminders and incentives to improve childhood immunisation coverage and timeliness in Kenya (M-SIMU): a cluster randomised controlled trial
Background As mobile phone access continues to expand globally, opportunities exist to leverage these technologies to
support demand for immunisation services and improve vaccine coverage. We aimed to assess whether short message
service (SMS) reminders and monetary incentives can improve immunisation uptake in Kenya.
Methods In this cluster-randomised controlled trial, villages were randomly and evenly allocated to four groups:
control, SMS only, SMS plus a 75 Kenya Shilling (KES) incentive, and SMS plus 200 KES (85 KES = USD$1). Caregivers
were eligible if they had a child younger than 5 weeks who had not yet received a first dose of pentavalent vaccine.
Participants in the intervention groups received SMS reminders before scheduled pentavalent and measles
immunisation visits. Participants in incentive groups, additionally, received money if their child was timely
immunised (immunisation within 2 weeks of the due date). Caregivers and interviewers were not masked. The
proportion of fully immunised children (receiving BCG, three doses of polio vaccine, three doses of pentavalent
vaccine, and measles vaccine) by 12 months of age constituted the primary outcome and was analysed with logbinomial
regression and General Estimating Equations to account for correlation within clusters. This trial is
registered with ClinicalTrials.gov, number NCT01878435.
Findings Between Oct 14, 2013, and Oct 17, 2014, we enrolled 2018 caregivers and their infants from 152 villages into
the following four groups: control (n=489), SMS only (n=476), SMS plus 75 KES (n=562), and SMS plus 200 KES
(n=491). Overall, 1375 (86%) of 1600 children who were successfully followed up achieved the primary outcome, full
immunisation by 12 months of age (296 [82%] of 360 control participants, 332 [86%] of 388 SMS only participants,
383 [86%] of 446 SMS plus 75 KES participants, and 364 [90%] of 406 SMS plus 200 KES participants). Children in the
SMS plus 200 KES group were significantly more likely to achieve full immunisation at 12 months of age (relative risk
1·09, 95% CI 1·02â1·16, p=0·014) than children in the control group.
Interpretation In a setting with high baseline immunisation coverage levels, SMS reminders coupled with incentives
significantly improved immunisation coverage and timeliness. Given that global immunisation coverage levels have
stagnated around 85%, the use of incentives might be one option to reach the remaining 15%
Civil society leadership in the struggle for AIDS treatment in South Africa and Uganda
Includes abstract.Includes bibliographical references.This thesis is an attempt to theorise and operationalise empirically the notion of âcivil society leadershipâ in Sub-Saharan Africa. âAIDS leadership,â which is associated with the intergovernmental institutions charged with coordinating the global response to HIV/AIDS, is both under-theorised and highly context-specific. In this study I therefore opt for an inclusive framework that draws on a range of approaches, including the literature on âleadershipâ, institutions, social movements and the ânetworkâ perspective on civil society mobilisation. This framework is employed in rich and detailed empirical descriptions (âthick descriptionâ) of civil society mobilisation around AIDS, including contentious AIDS activism, in the key case studies of South Africa and Uganda. South Africa and Uganda are widely considered key examples of poor and good leadership (from national political leaders) respectively, while the Treatment Action Campaign (TAC) and The AIDS Support Organisation (TASO) are both seen as highly effective civil society movements. These descriptions emphasise âtransnational networks of influenceâ in which civil society leaders participated (and at times actively constructed) in order to mobilise both symbolic and material resources aimed at exerting influence at the transnational, national and local levels
Impact of mobile phone delivered reminders and unconditional incentives on measles-containing vaccine timeliness and coverage: a randomised controlled trial in western Kenya
Introduction Short message service (SMS) reminders coupled with a small monetary incentive conditioned on prompt vaccination have been shown to improve first-dose measles-containing vaccine (MCV1) uptake. We assessed whether SMS reminders and unconditional monetary incentivesâmore amenable to programmatic implementationâcan improve MCV1 uptake in Kenya.Methods Caregivers of eligible infants aged 6â8 months were enrolled into an individually randomised controlled trial and assigned to receive either: no intervention (control), two SMS reminders (SMS) sent 3 days, and 1 day before the scheduled MCV1 date, or SMS reminders coupled with a Kenya Shilling (KES) 150 incentive (SMS +150 KES) sent 3 days before the scheduled MCV1 date. Study staff conducted a household follow-up visit at age 12 months to ascertain vaccination status. Log-binomial regression was used to estimate the relative and absolute difference in MCV1 timely coverage (by age 10 months), the primary outcome.Results Between 6 December 2016 and 31 March 2017, 179 infants were enrolled into each of the three study arms. Follow-up visits were completed between 19 April 2017 and 8 October 2017 for control (n=170), SMS (n=157) and SMS + 150 KES (n=158) children. MCV1 timely coverage was 68% among control arm infants compared with 78% in each intervention arm. This represented a non-statistically significant increase in the SMS arm (adjusted relative risk 1.13; 95% CI 0.99 to 1.30; p=0.070; adjusted risk difference 9.2%; 95% CI: â0.6 to 19.0%; p=0.066), but a statistically significant increase in the SMS + 150 KES arm (1.16; 95% CI 1.01 to 1.32; p=0.035; 10.6%; 95% CI 0.8 to 20.3%; p=0.034).Conclusion These findings suggest that the effect of SMS reminders coupled with a small unconditional monetary incentive on MCV1 uptake is comparable to that of SMS reminders alone, limiting their utility. Further studies in the absence of unexpected supply-side constraints are needed.Trial registration number NCT0290464
Behavioral Interventions to increase uptake of HIV testing among the Key Populations in sub-Saharan Africa, a scoping review protocol
This is a scoping review to identify interventions that have been used to increase uptake of HIV testing among Key Populations including Men who have Sex with Men (MSM), People Who Inject Drugs (PWIDs) and Female Sex Workers (FSWs) in sub-Saharan Africa. This is important because as HIV incidence is declining, these groups report the highest incidence and hence remain the main HIV infection pathways. Targeting these high infection risk groups is important given the health service access challenges they are currently experiencing due to systematic discrimination and stigma
Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya : a mixed-methods survey
CITATION: Opiyo, R. O., et al. 2019. Factors associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis in national referral hospitals in Kenya : a mixed-methods survey. Renal Replacement Therapy, 5:41, doi:10.1186/s41100-019-0237-4.The original publication is available at https://rrtjournal.biomedcentral.comIntroduction: Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent
deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors
associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis.
Methods: A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at
the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a
QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on
hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of
adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected
using a structured, self-reported questionnaire using Open Data Kit âCollect softwareâ while qualitative data were
collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and
NVIV0 12 for qualitative data was conducted. The dependent variable, âadherence to diet prescriptionâ was analyzed as a
binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic
regression models respectively. Qualitative data were thematically analyzed.
Results: Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently
associated with adherence to diet prescriptions were âflexibility in the dietsâ (AOR 2.65, 95% CI 1.11â6.30, P
0.028), âdifficulties in following diet recommendationsâ (AOR 0.24, 95% CI 0.13â0.46, P < 001), and âadherence
to limiting fluid intakeâ (AOR 9.74, 95% CI 4.90â19.38, P < 0.001). Conclusions: For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions
and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones.
Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based
on the individual patientâs usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet
adherence messages should be integrated with fluid limitation messages. Further research on understanding patientsâ
adherence to fluid restriction is also suggested.Publisher's versio
Nodding syndrome in Ugandan childrenâclinical features, brain imaging and complications: a case series
Objectives Nodding syndrome is a devastating neurological disorder of uncertain aetiology affecting children in Africa. There is no diagnostic test, and risk factors and symptoms that would allow early diagnosis are poorly documented. This study aimed to describe the clinical, electrophysiological and brain imaging (MRI) features and complications of nodding syndrome in Ugandan children. Design Case series. Participants 22 children with nodding syndrome brought to Mulago National Referral Hospital for assessment. Outcome measures Clinical features, physical and functional disabilities, EEG and brain MRI findings and a staging system with a progressive development of symptoms and complications. Results The median age of symptom onset was 6 (range 4â10) years and median duration of symptoms was 8.5 (range 2â11) years. 16 of 22 families reported multiple affected children. Physical manifestations and complications included stunting, wasting, lip changes and gross physical deformities. The bone age was delayed by 2 (range 1â6) years. There was peripheral muscle wasting and progressive generalised wasting. Four children had nodding as the only seizure type; 18 in addition had myoclonic, absence and/or generalised tonicâclonic seizures developing 1â3â
years after the onset of illness. Psychiatric manifestations included wandering, aggression, depression and disordered perception. Cognitive assessment in three children demonstrated profound impairment. The EEG was abnormal in all, suggesting symptomatic generalised epilepsy in the majority. There were different degrees of cortical and cerebellar atrophy on brain MRI, but no hippocampal changes. Five stages with worsening physical, EEG and brain imaging features were identified: a prodrome, the development of head nodding and cognitive decline, other seizure types, multiple complications and severe disability. Conclusions Nodding syndrome is a neurological disorder that may be characterised as probably symptomatic generalised epilepsy. Clinical manifestations and complications develop in stages which might be useful in defining treatment and rehabilitation. Studies of risk factors, pathogenesis, management and outcome are urgently needed
Perceptions on Adherence to Dietary Prescriptions for Adults with Chronic Kidney Disease on Hemodialysis: A Qualitative Study
Diet is one of the modifiable lifestyle factors in management of kidney disease. We explored perceptions on adherence to dietary prescriptions for adults with chronic kidney disease on hemodialysis. This was a qualitative descriptive study. Participants were purposively selected at renal clinics/dialysis units at national referral hospitals in Kenya. Data were collected using in-depth interviews, note-taking and voice-recording. The data were managed and analyzed thematically in NVIV0-12 computer software. Study participants were 52 patients and 40 family caregivers (42 males and 50 females) aged 20 to 69 years. Six sub-themes emerged in this study: “perceived health benefits”; “ease in implementing prescribed diets”; “cost of prescribed renal diets”; “nutrition information and messages”; “transition to new diets” and “fear of complications/severity of disease”. Both patients and caregivers acknowledged the health benefits of adherence to diet prescriptions. However, there are mixed messages to the patients and caregivers who have challenges with management and acceptability of the prescriptions. Most of them make un-informed dietary decisions that lead to consumption of unhealthy foods with negative outcomes such as metabolic waste accumulation in the patients’ bodies negating the effects of dialysis and undermining the efforts of healthcare system in management of patients with chronic kidney disease