Timing and Determinants of Tuberculosis Treatment Interruption in Nairobi County, Kenya

Tuberculosis (TB) treatment is a key pillar in the management and control of TB. Service delivery within the treatment facilities plays an important role in ensuring treatment adherence by TB patients. A prospective cohort study involving 25 health facilities, 25 facility in-charge officers and 291 patients diagnosed as new sputum smear positive (SM+) between December 2014 and July 2015 was undertaken. The aim of the study was to estimate the median time to treatment interruption, associated factors and overall predictors of non-adherence to TB treatment. A total of 19 (6.5%) treatment interruptions were observed. The median time to default was 56 [95% CI, 36-105] days. Treatment in a non-public facility [AOR=0.210, 95% CI (0.046-0.952)] and facilities perceived to have adequate number of health care workers to offer Directly Observed Therapy (DOT) [AOR=0.195, 95% CI (0.068-0.56)] showed a lower odds of treatment interruption whereas attainment of secondary level education [AOR=5.28, 95% CI (1.18-23.59)] indicated a higher odds of treatment interruption. Non-clinical aspects of health care service delivery influence patient adherence to TB treatment. Health seeking behavior of groups considered to be high risk for treatment interruption should be incorporated into the design and delivery of TB treatment

Moderating Effect of Competitive Intensity on the Relationship between Customer Orientation and Performance of Hotels in Kenya

Customer orientation should permeate the overall activities of a firm in a competitive environment as it is considered to be an essential element for enhanced performance. The main objective of this study was to empirically test the moderating effect of competitive intensity on the relationship between customer orientation and performance of hotels in Kenya. Resource-Based View (RBV) theory grounded the study. The study employed explanatory research design and sampled 330 respondents from a target population of about 630 managers in 210 hotels, listed under Kenya Association of Hotelkeepers and Caterers (KAHC). Respondents were selected using cluster sampling combined with simple random. Primary data was collected using a structured questionnaire. Data was analyzed using Statistical Package for Social Sciences (SPSS 22.0). Stepwise regression was used to test the research hypotheses. The results revealed that customer orientation is directly associated with hotel performance and has a significant effect on the relationship. The study further revealed that competitive intensity has a moderating effect on the relationship between customer orientation and hotel performance. It therefore reasonable to conclude that customer orientation is an important determinant of performance. The study recommends that hotels must view customer relationship as an asset, consider customer retention as a priority and be committed to meeting customers’ needs and expectations. Such measures will offer hotels better understanding of customers in a competitive business environment which will eventually lead to enhanced performance. Keywords: Customer Orientation, Competitive Intensity, Performance, Hotels, Keny

Prevalence of Group a Rotavirus before and after Vaccine Introduction in Mukuru Informal Settlement in Kenya

Background: Rotavirus vaccines have been shown to be a lifesaving and cost-effective public health intervention in Africa and have resulted in reduced rotavirus mortality. In Kenya, rotavirus diarrhea causes 19% of hospitalizations and 16% of clinic visits among children <5 years of age and causes 4471 deaths and 8,781 hospitalizations per year. Nationally, rotavirus disease costs the health care system $10.8 million annually. It is estimated that routine vaccination with a 2-dose rotavirus vaccination series would avert approximately 2,467 deaths (55%), 5,724 hospitalizations (65%), 852, 589 clinic visits (59%) and would save 58 disability-adjusted life-years (DALYs) per 1000 children annually. In July 2014, Kenya introduced rotavirus vaccine into its routine expanded programme  immunisation, with two doses given at 6 and 10ths week of age.WHO recommend having  surveillance studies before and after vaccine as baseline data and monitoring the possible effect after vaccine introductions. The aim of this study was to determine the prevalence of rotavirus in pre- and post-vaccine stool samples collected from children under five years, attending two selected clinics in Mukuru informal settlement in Nairobi, Kenya. Methods: Archived samples collected during a Salmonella surveillance study (SSC No. 2074) conducted between July 2013 and July 2015 were used for this study. A total of 270 samples (150 pre-vaccine and 120 post-vaccine) were tested for rotavirus using ELISA Prospect kit (Oxoid Ltd UK) and data analyzed using SPSS version 20. Results: Rotavirus prevalence was 10% (15/150) and 5% (6/120) in pre-vaccine and post-vaccine samples respectively. There was significant difference in prevalence pre and post vaccine samples for children less than 12 months (P=0.014), 13-24 months (P=0.002) and over 49 months (P=0.01). However, there was no difference in prevalence for age categories 25-36 and 37- 48 months. Conclusion: This study showed a reduction in prevalence of Group A rotavirus in Mukuru selected clinics one year after vaccine introduction into National immunization program in Kenya. Rotavirus prevalence differed significantly for cases less than 12 months, 13-24 months and over 49 months pre and post vaccine introduction. However, there was no difference in prevalence for age category 25-36 and 37- 48 months thus the vaccine proved to have a significant protection in the most vulnerable group of children. Keywords: Rotavirus, Kenya, vaccine, pre-vaccine, post-vaccine, prevalence, Kenya

Factors influencing smallholder farmers’ inputs use in major bean production corridors in Kenya

This study analysed socio-economic determinants for inputs use in major bean corridors in Kenya. It comprised 417 respondents sampled from four major bean corridors. A structured questionnaire was used in data collection. Probit model was used to assess determinants of input use among the bean-farming households. From the results, 74% of respondents were male with a mean age of 48.6 years. The probability of using agricultural inputs increased with education level and income from crop sales. Fertilizer was mainly used in Bomet (73%) and Narok (74%) counties. Eighty-five percent planted recycled seeds. Education level and Income from crops positively influenced inputs use. It was concluded that education level, incomes from sale of crops, livestock and livestock products, and farm income influenced use of inputs. As a recommendation, Capacity building on merits of input use and promotion of public-private partnerships to strengthen input supply system would enhance increased input use by smallholder farmers.Keywords: Bean, inputs, determinants, Keny

Consumer intentions to buy nutrient-rich precooked bean snacks: does sensory evaluation matter?

Precooked bean products have the potential of bridging the common bean demand and consumption gap in Kenya. However, sensory evaluation of novel precooked processed products has been inadequate in determining acceptability. This study assessed the sensory evaluation of precooked bean snacks by 269 rural consumers in Machakos County of Kenya. Descriptive results indicated that less than one-quarter (22%) of the consumers were aware of the precooked bean products. The low awareness is a disconnect from the expectations that farming households were probably going to be aware of processed bean products because of their participation in bean value chain. Sensory evaluation showed that 75% of the consumers evaluated the freshness of the bean snacks positively, with about 90% and 63% of them positively assessing the taste of the precooked bean snacks branded Keroma Delicious and Keroma Fruity, respectively. The taste evaluation of Keroma Fruity brand significantly differed depending on age and level of education of the consumer. Similarly, the taste of Keroma Delicious brand also significantly differed by age and educational attainment of consumers. Furthermore, while consumers liked the taste parameters of the products, less than half of them liked the beany flavour of the two products. Results from the binary logit regression model indicated that freshness, sourness, and flavour positively and significantly predicted the probability of future purchases of Keroma Fruity bean snack brands. Consumer intentions to buy Keroma Delicious brand were positively predicted by flavour and marginally by sweetness. To accelerate the consumption of precooked bean products, product development and marketing strategies should recognise the role of sensory attributes in driving acceptability of the bean snacks, deploy processing technologies that retain and enhance sensory attributes, create awareness of the products, and segment the market from a gender lens in order to satisfy the diverse consumer needs and preferences

Immunological profiles in HIV positive patients following Haart initiation in Kigali, Rwanda

Background: Interleukin-10, IL-2 and IFN -γ are some of the crucial cytokines associated with HIV infection and pathogenesis. While IL-2 and IFN-γ play critical roles in host resistance to infection, IL-10 inhibits the synthesis IFN-γ, IL-2 at mRNA and protein level; exacerbating damage to immune system.Objective: To determine the levels of, changes in and correlation between CD4 count, viral load, IL-10, IL-2 and IFN-γ before HAART and at six months of HAART among HIV positive patients in Kigali; with a view to understand cytokine networks particularly in relation to HAART ; and to see whether they can be used as alternative markers of the disease progression.Design: Longitudinal study.Setting: Kagugu, Kimironko, Biryogo, Gitega Health Centres and Centre Medico-Social Cornum; all located in Kigali.Subjects: Thirty three (33) HAART initiation eligible HIV positive patients including 13 women and 20 men.Results: A drop in viral load (though only a small number of patients achieved an undetectable viraemia); a recovery of CD4+ cells, a decrease in IL-10 (though it remained high for many patients especially those with unchanged viraemia); and an increase in IL-2 and IFN-γ indicated a successful HAART . A negative correlation between CD4 count and viral load and between CD4 count and IL-10 (but r <-0.5) was observed. IL-10 correlated positively and strongly with viremia (r > 0.5 at both time points: p-values <0.05). There was no significant correlation between CD4 count, IL-2 and IFN-γ.Conclusion: Results demonstrated the down-regulatory effect of IL-10 on Th1 cytokines and that a shift from Th1 to Th2 cytokine is associated with HIV disease progression. A successful HAART results in CD4+ cells recovery, drop in viraemia and IL-10 with up-regulation of Th1 cytokines. Also, findings show potential usefulness of IL-10 as a marker of HIV disease progression

Bacterial contamination of Kale (Brassica oleracea acephala) along the supply chain in Nairobi and its environment

Objective: To assess the microbiological safety of kale (Brassica oleracea Acephala) produced from farms and those sold at the markets with special focus on coliforms, E.coli and Salmonella.Design: A cross sectional study.Setting: Peri-Urban farms (in Athi River, Ngong and Wangige), wet markets (in Kawangware, Kangemi and Githurai), supermarkets and high-end specialty store both within Nairobi city.Results: Mean coliform count on vegetables from farms were 2.6x105 ±5.0x105 cfu/g while those from the wet markets were 4.6x106 ±9.1x106 cfu/g, supermarkets, 2.6x106 ±2.7x106 and high-end specialty store 4.7x105 ±8.9x105. Coliform numbers obtained on kales from the wet markets and supermarkets were significantly higher (p<0.05) compared to those from farms, while kale samples purchased from high- end specialtystore had similar levels of coliform loads as those from the farms. E. coli prevalence in the wet markets, supermarkets and high-end specialty store were: 40, 20 and 20%, respectively. Salmonella was detected on 4.5 and 6.3% of samples collected from the farms in Wangige and wet market in Kawangware, respectively. Fecal coliforms in water used on farms (for irrigation) and in the markets (for washing the vegetables) exceeded levels recommended by World Health Organization (WHO) of 103 organisms per 100 milliliter while Salmonella was detected in 12.5% of washing water samples collected from Kangemi market.Conclusion: Poor cultivation practices and poor handling of vegetables along the supply chain could increase the risk of pathogen contamination thus puting the health of the public at risk, therefore good agricultural and handling practices should be observed

A cost-benefit analysis of farmer based seed production for common bean in Kenya

Community based informal seed production has recently gained popularity as an alternative to the formal seed sector of disseminating new crop varieties including the common bean. This is because farmer produced seed is readily available and is more affordable by most farmers than certified seed. This study examined the profitability of farmer based common bean seed production in Kenya. The study used data collected from farmers and one seed company participating in seed multiplication. The principal finding was that farmer based common bean seed production was a profitable enterprise and was less sensitive to price fluctuations. Compared to certified common bean seed production, net profit margins were five times higher for certified common bean seed than for farmer based common bean seed production. With the current varieties, profitability depends on access to irrigation and good agronomy.Une production formelle de semences communautaires a r\ue9cemment gagn\ue9 la popularit\ue9 comme une alternative au secteur formel de semence de dissemination de nouvelles vari\ue9t\ue9s des cultures dont le haricot commun. Ceci se justifie par le fait que la semence produite par les fermiers est disponible et est plus abordable par la plupart de fermiers que la semence certifi\ue9e. Cette \ue9tude a examin\ue9 la profitabilit\ue9 de la production de semence par les fermiers au Kenya. Les donn\ue9es utilis\ue9es \ue9taient celles collect\ue9es chez les fermiers et dans une compagnie de multiplication de semence. Le principal r\ue9sultat \ue9tait que la production communautaire de semence de haricot commun \ue9tait une enterprise profitable et \ue9tait moins sensitive aux fluctuations des prix. En comparaison \ue0 la production certifi\ue9e de semence de haricot commun, les profits nets marginaux \ue9taient cinq fois plus \ue9lev\ue9s pour la semence du haricot commun certifi\ue9e que pour la production de m\ueame semence par les fermiers. Avec de vari\ue9t\ue9s actuelles, la profitabilit\ue9 d\ue9pends de l\u2019acc\ue8s \ue0 l\u2019irrigation et une bonne agronomie

Impact of two rounds of praziquantel mass drug administration on Schistosoma mansoni infection prevalence and intensity: a comparison between community wide treatment and school based treatment in western Kenya

AbstractThis study compared the effectiveness of the community-wide treatment and school-based treatment approaches in the control of Schistosoma mansoni infections in villages with ⩾25% prevalence in western Kenya. Stool samples from first year students, 9–12year olds and adults (20–55years) were analyzed by the Kato–Katz technique for S. mansoni eggs. After two rounds of treatment, S. mansoni prevalence and intensity levels significantly declined in both treatment approaches. Prevalence comparisons between the two approaches did not show any significant differences following treatment. However, infection intensity levels in the 9–12year old school-attending pupils were significantly higher in the community-wide treatment arm than in the school-based treatment arm. Nevertheless, significant reductions in S. mansoni infection prevalence and intensity levels were achieved among school-age children regardless of the treatment approach used