Progress in blood transfusion services in Kenya from the 1980’s: A review

Background: Provision of safe and adequate supplies of blood is dependent on a well organised blood transfusion service with dedicated well-trained manpower and resources for the service.Objective: To provide an overview of the evolution of blood transfusion services in Kenya, from the 1980s to date.Data sources: Various Government of Kenya publications and websites on blood transfusion related issues. Publications and websites of stakeholders including donors and other partners as well. Personal experience - the author has been in national blood transfusion administration for over five years.Data selection: Data related to blood transfusion in Kenya on websites and publication were scrutinised.Data extraction: All selected articles were read.Data synthesis: All the collected data together with the author’s experience were used for this publication.Conclusion: As part of the effort by the Ministry of Health to reform the health sector, there was need to reorganise departments and divisions within the Ministry. The reorganisation of the blood transfusion service was one such consideration and it was hoped that following this change, there would be better, safer and more efficient provision of blood for transfusion service snation wide. This article documents the evolution of blood transfusion services from the early 1980s to date

P14.01 An example of too much too soon? A review of caesarean sections performed in the first stage of labour in Kenya

Objective: Caesarean Section (CS) has potential short and long-term complications and is associated with excess maternal death. Decisions to perform (CS) are frequently made by inexperienced and unsupported non-specialist doctors, sometimes resulting in inappropriate decision-making and surgery. Our study assesses decision-making for CS in the first stage of labour in Kenya. Method: A panel of one UK and six Kenyan expert obstetricians reviewed clinical data extracted from 87 case-notes, that were randomly selected from a series obtained from seven referral hospitals in five Kenyan counties over six months in 2020. Following a preliminary review of the data and email discussion, an online panel was convened to discuss outstanding cases where consensus was yet to be reached. Agreement was reached by the panel in all but 5 cases. Results: In 41.3% cases, CS was considered appropriate, including 8% where CS was performed too late. The decision to delivery interval exceeded 2 h in 58.6% cases, including 16 cases of non-reassuring fetal status. In 10.3% it was considered that due to delay, further reassessment should have occurred. In 9.1% the CS was done too soon. There was insufficient information available to make a full assessment in 21.8% of cases. In 11.5% the CS was inappropriate. Conclusion: This review demonstrates that unnecessary caesarean sections are being performed, while some with appropriate indications are subject to delays. There is need for improved support for decision-making, coupled with improved record-keeping, improved quality of fetal monitoring during labour and more timely surgery when necessary

Reimagining invasions; the social and cultural impacts of Prosopis on pastoralists in Southern Afar

Abstract Whilst the environmental impacts of biological invasions are clearly conceptualised and there is growing evidence on the economic benefits and costs, the social and cultural dimensions remain poorly understood. This paper presents the perceptions of pastoralist communities in southern Afar, Ethiopian lowlands, on one invasive species, Prosopis juliflora. The socio-cultural impacts are assessed, and the manner in which they interact with other drivers of vulnerability, including political marginalisation, sedentarisation and conflict, is explored. The research studied 10 communities and undertook semi-structured interviews and focus group discussions with pastoralists and agro-pastoralists. These results were supported by interviews with community leaders and key informants. The benefits and costs were analysed using the asset-based framework of the Sustainable Livelihoods Framework and the subject-focused approach of Wellbeing in Development. The results demonstrate that the costs of invasive species are felt across all of the livelihood capital bases (financial, natural, physical, human and social) highlighted within the framework and that the impacts cross multiple assets, such as reducing access through blocking roads. The concept of Wellbeing in Development provides a lens to examine neglected impacts, like conflict, community standing, political marginalisation and cultural impoverishment, and a freedom of definition and vocabulary to allow the participants to define their own epistemologies. The research highlights that impacts spread across assets, transcend objective and subjective classification, but also that impacts interact with other drivers of vulnerability. Pastoralists report deepened and broadened conflict, complicated relationships with the state and increased sedentarisation within invaded areas. The paper demonstrates that biological invasions have complex social and cultural implications beyond the environmental and economic costs which are commonly presented. Through synthesising methodologies and tools which capture local knowledge and perceptions, these implications and relationships are conceptualised

Surfing the spectrum - what is on the horizon?

Diagnostic imaging techniques have evolved with technological advancements - but how far? The objective of this article was to explore the electromagnetic spectrum to find imaging techniques which may deliver diagnostic information of equal, or improved, standing to conventional radiographs and to explore any developments within radiography which may yield improved diagnostic data. A comprehensive literature search was performed using Medline, Web of Knowledge, Science Direct and PubMed Databases. Boolean Operators were used and key-terms included (not exclusively): terahertz, X-ray, ultraviolet, visible, infra-red, magnetic resonance, dental, diagnostic, caries and periodontal. Radiographic techniques are primarily used for diagnostic imaging in dentistry, and continued developments in X-ray imaging include: phase contrast, darkfield and spectral imaging. Other modalities have potential application, for example, terahertz, laser doppler and optical techniques, but require further development. In particular, infra-red imaging has regenerated interest with caries detection in vitro, due to improved quality and accessibility of cameras. Non-ionising imaging techniques, for example, infra-red, are becoming more commensurate with traditional radiographic techniques for caries detection. Nevertheless, X-rays continue to be the leading diagnostic image for dentists, with improved diagnostic potential for lower radiation dose becoming a reality

Approaches to advancing blood safety through haemovigilance: A review

Background: Blood transfusion is always associated with some level of risk. Haemovigilance is a risk monitoring system integral to the practice of transfusion medicine whose ultimate purpose is to improve the quality and safety of transfusion therapy. Objective: To examine the contribution of haemovigilance to blood safety, including the approaches that some countries have taken to institute haemovigilance, and explore routes through which countries without such systems can achieve them. Data sources: The internet and journals on the topic of haemovigilance and development of haemovigilance systems in the English language. Data selection: Reputable journals on the topic of haemovigilance were examined for abstracts and papers. Abstracts based on known credible and distinguished sources were selected. Data extraction: Information on haemovigilance and the processes of developing haemovigilance in various countries was reviewed. Data synthesis: The information from selected papers and abstracts was used for writing this paper. Conclusion: Varying processes for haemovigilance have been adopted by different countries. The more advanced systems have national/regional coordinating mechanisms. Availability of haemovigilance data has given transfusion services a clear understanding of problems associated with transfusion that need to be solved so as to improve transfusion safety. Although countries in sub-Saharan Africa have made considerable progress in enhancing blood safety in the recent past, nationally coordinated haemovigilance systems are lacking. Focus on haemovigilance systems is considered the next frontier to be conquered in enhancing blood safety in the region

Effect of natural antioxidants on protein and lipid oxidation in fish (Siganus sutor) processed in a locally fabricated hybrid windmill-solar tunnel dryer.

The aim was to evaluate the drying characteristics, quality, safety, carbon footprint and physico-chemical properties of fresh and antioxidant-treated dried Siganus sutor fish fillets. An innovative hybrid windmill-solar tunnel dryer was designed and fabricated in Kenya to harness solar and wind energy, day and night and in damp weather conditions. The moisture content for both salted and unsalted Siganid fish reduced exponentially to 19.9 % over a 3-day drying period. The quality and yield of Siganid fish fillets after delayed icing for 0, 2 and 4 h that was determined using the Quality Index Method, was linearly related to storage time. Biochemical evaluation of solar dried fish, stored for up to 75 days, showed lowest levels of Peroxide Value (PV), Thiobarbituric Acid Reactive Substances (TBARS), Volatile -Total Basic Nitrogen (TVB-N), trimethylamine, pH and moisture in vacuum packaging, followed by polythene packs and highest levels in samples with no packaging. Microbial plate counts were significantly reduced after solar tunnel drying of the Siganids. Fish fillets were treated with synthetic antioxidant BHA (control) and extracts from water hyacinth, seaweeds and turmeric as sources of natural antioxidants. The efficacy of antioxidants to reduce lipid oxidation products PV and TBARS was in the order BHA>tumeric>seaweed>water hyacinth and significant (p<0.05). Small deformation rheology of stored (up to 90 days) solar dried fish fillets treated with natural antioxidants had lower G’ values compared to the control, reflecting desirable texture qualities. The thermodynamic properties (denaturation temperature (Tm) and heat enthalpy change (∆H) altered significantly only after 60 days storage. The carbon footprint was low because of low labour input, non-motorized fishing vessels and renewable energy-wind and solar used for drying. A descriptive generic Hazard Analysis Critical Control Point tool for solar dried fish was obtained for the first time. The above findings can enhance the processing and preservation of fish and influence fish quality and fisheries policies