Roles of DNA Molecules in Identification of Unclaimed or Missing Dead Bodies Presumed Death in Western Kenya Utilizing Comparison Standards

Medico-legal form bench-mark of health determinants and provide integrated services towards criminal justice support in health. Globally, over 44 million cases of unclaimed bodies or missing dead persons (UCBOMDPs) occur annually 88% of these cases are in Sub Saharan Africa. In Kenya and western Kenya rate of UCBOMDPs from road traffic accidents accounts 30% and 10% respectively 80% of these UCBOMDPs are associated with limited access to affordable quality comparison tests for identifications attributed to the increased prevalence of health and occupational hazards in population health. The current investigations aimed at identifying UCBOMDPs from public mortuaries by quantifying demographic data and determining DNA finger print and chemical tests (electrophoresis) using comparison standards. In Exploratory and cross sectional 235 respondents were investigated through purposive and saturated sampling using Finger print forms structured questionnaires focus group discussions (FGDs) observations and key informant interviews (KII) guides to collect data. Analyzed statistical inferences and contents analysis to saturation, results showed, 94% of mortuary service providers in tier 4 were primary and secondary education drop outs of males on contract jobs with limited access to quality services in mortuary science contrarily to females and males counterparts from tiers 5 and 6 mortuary facilities on permanent and trained. Rate of gross infection in public mortuaries and congestion had significant OD (2.2, 0.44). Prevalence of male being admitted as UCBOMDPs was significant due to being family bread winners OD (8.3, 0.12), RR (0.33), 95% CI (1.23, 1.02), significance were associated with male deliberately leaving IDs in houses due to identity. Utilization of Dactylography was significant than electrophoresis method, P value (0.67), OD (4.8, 1.3) due to high costs, procedures, DNA quantifying reagents and next of kin sampling for comparisons. Need for quality service advocacy in Department of Forensic Pathology to develop subsidized functional DNA chemical structures

Factors influencing anti-retroviral drug adherence in HIV infected children attending Kericho District Hospital, Kenya

Objective: To identify factors influencing anti-retroviral (ARV) drug adherence by HIV infected children aged 3 to 14 years attending Kericho District Hospital (KDH), Kenya.Design: A cross-sectional studySetting: Kericho District Hospital, KenyaSubjects: Two hundred and thirty ( 230) HIV infected children aged 3 to 14 years under caregivers who had been on ARV treatment for at least three months before study as verified by clinicians.Results: A total of 230 children aged between 3 and 14 years (mean age was 8.5 years ±3.2SD) were enrolled. Caregivers were aged between 16 and 90 years (mean age 34.6 years ± 10.4 SD). Majority, 178 (77.4%), of the caregivers were female and 137 (59.6%) were biological parents. ARV drug adherence levels, based on various methods of assessment, were sub-optimum, varied from 56.1% based on time of taking drugs, 49.1% based on pharmacy drug refills, 45.7% based on clinic appointments to 27.0% by pill counts.The key factors associated with adherence based on time of taking drugs were: caregiver being away from home (p=0.0010), caregiver forgetting to give drugs to the child (p=0.020), lack of disclosure of the child’s HIV infection status (p=0.0080) and side effects experienced by the child (p=0.0120), lack of knowledge on treatment (p=0.0030) and stigma (p=0.0470). Based on clinic appointments, the factors included caregiver being away from home (p=0.004), lack of disclosure of the child’s HIV infection (p=0.0000), side effects experienced by the child (p= 0.0030), stigma (p=0.0070) and transport cost (p=0.0240).Conclusion: The most important adherence factors among children were: caregiver being away from home, caregiver forgetting, lack of disclosure, child experiencing side effects, lack of knowledge and skills in managing the disease, stigma and transport costs to hospital

Effectiveness of Transformative Instructional Model on Acquisition of Selected Vocational skills among the Vulnerable Youth in Nakuru County, Kenya

Educators and community trainers have identified the critical role that practical vocational skills can play in the development of broad-based capabilities among the youth. However, the question is whether instructional methods used for practical skills are sufficient to prepare trainees with potentials that reflect and model content productively. This paper presents findings of a study conducted to determine the effectiveness of structured group learning model (SGLM) in acquisition of vocational skills in handicrafts among the vulnerable youth in Nakuru County. The study used quasi experimental design. The Population of the study was 200 identified vulnerable youths in the County. A sample size of 60 members was purposively selected for the study, 30 youth were used as experimental group and the other 30 as control group. Experimental group was trained using (SGLM) methods and a control group was trained through traditional methods. The research instruments were validated and pilot tested, the reliability analysis yielded an index of 0.89 which was sufficient for the study. Data was collected using a guided questionnaire and observation checklist after the training. Pearson chi square was used to test the association between SGLM and acquisition of vocational skills at a significant level of 0.05. The results revealed that there is an association between SGLM and acquisition of some facets of vocational craft skills but not in skill on developing patterns, specifications, branding and packaging of finished products. The Model could be an alternative training strategy for vulnerable youth as it empowers the youth with necessary skills for productive livelihood

Fatal Injuries in the Slums of Nairobi and their Risk Factors: Results from a Matched Case-Control Study

Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality

Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa.

OBJECTIVE: Systematic review and meta-analysis of published studies of alcohol use among young people (age 15-24 years) in eastern Africa to estimate prevalence of alcohol use and determine the extent of use of standardised screening questionnaires in alcohol studies. METHODS: Five databases (MEDLINE, EMBASE, Global Health, Africa-wide, and PsycINFO) were searched for publications until 30th June 2013. Results were summarised using the guidelines on preferred reporting items for systematic reviews and meta-analyses (PRISMA) and on quality assessment using the modified quality assessment tool for systematic reviews of observational studies (QATSO). Heterogeneity was assessed using the I(2) statistic (DerSimonian-Laird). RESULTS: We identified 2785 potentially relevant studies, of which 56 were eligible for inclusion. Only two studies (4%) used the standardised Alcohol Use Disorder Identification Test (AUDIT) questionnaire, and six studies (13%) used the Cut down, Annoyed, Guilt, Eye opener (CAGE) questionnaire. The reported median prevalence of alcohol use was ever-use 52% [interquartile range (IQR): 20-58%], use in the last month 28% (IQR: 17-37%), use in the last year 26% (IQR: 22-32%), and problem drinking as defined by CAGE or AUDIT 15% (IQR: 3-36%). We observed high heterogeneity between studies, with the highest prevalence of ever use of alcohol among university students (82%; 95%CI: 79-85%) and female sex workers (66%; 95%CI: 58-74%). Current use was most prevalent among male sex workers (69%; 95%CI: 63-75%). CONCLUSIONS: Reported alcohol use and problem drinking were common among diverse groups of young people in eastern Africa, indicating the urgent need for alcohol-focused interventions in this population. Few studies have used standardised alcohol screening questionnaires. Epidemiological research to investigate alcohol-focused interventions in young people should aim to apply such questionnaires that should be validated for use in this population

Induction of microRNAs, mir-155, mir-222, mir-424 and mir-503, promotes monocytic differentiation through combinatorial regulation

Acute myeloid leukemia (AML) involves a block in terminal differentiation of the myeloid lineage and uncontrolled proliferation of a progenitor state. Using phorbol myristate acetate (PMA), it is possible to overcome this block in THP-1 cells (an M5-AML containing the MLL-MLLT3 fusion), resulting in differentiation to an adherent monocytic phenotype. As part of FANTOM4, we used microarrays to identify 23 microRNAs that are regulated by PMA. We identify four PMA-induced micro- RNAs (mir-155, mir-222, mir-424 and mir-503) that when overexpressed cause cell-cycle arrest and partial differentiation and when used in combination induce additional changes not seen by any individual microRNA. We further characterize these prodifferentiative microRNAs and show that mir-155 and mir-222 induce G2 arrest and apoptosis, respectively. We find mir-424 and mir-503 are derived from a polycistronic precursor mir-424-503 that is under repression by the MLL-MLLT3 leukemogenic fusion. Both of these microRNAs directly target cell-cycle regulators and induce G1 cell-cycle arrest when overexpressed in THP-1. We also find that the pro-differentiative mir-424 and mir-503 downregulate the anti-differentiative mir-9 by targeting a site in its primary transcript. Our study highlights the combinatorial effects of multiple microRNAs within cellular systems.Comment: 45 pages 5 figure

Citywide Trauma Experience in Mwanza, Tanzania: A Need for Urgent Intervention.

Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001). Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region

Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead.

Lifestyle factors are responsible for a considerable portion of cancer incidence worldwide, but credible estimates from the World Health Organization and the International Agency for Research on Cancer (IARC) suggest that the fraction of cancers attributable to toxic environmental exposures is between 7% and 19%. To explore the hypothesis that low-dose exposures to mixtures of chemicals in the environment may be combining to contribute to environmental carcinogenesis, we reviewed 11 hallmark phenotypes of cancer, multiple priority target sites for disruption in each area and prototypical chemical disruptors for all targets, this included dose-response characterizations, evidence of low-dose effects and cross-hallmark effects for all targets and chemicals. In total, 85 examples of chemicals were reviewed for actions on key pathways/mechanisms related to carcinogenesis. Only 15% (13/85) were found to have evidence of a dose-response threshold, whereas 59% (50/85) exerted low-dose effects. No dose-response information was found for the remaining 26% (22/85). Our analysis suggests that the cumulative effects of individual (non-carcinogenic) chemicals acting on different pathways, and a variety of related systems, organs, tissues and cells could plausibly conspire to produce carcinogenic synergies. Additional basic research on carcinogenesis and research focused on low-dose effects of chemical mixtures needs to be rigorously pursued before the merits of this hypothesis can be further advanced. However, the structure of the World Health Organization International Programme on Chemical Safety 'Mode of Action' framework should be revisited as it has inherent weaknesses that are not fully aligned with our current understanding of cancer biology