Bronchoscopy for Removal of Aspirated Tracheobronchial Foreign Bodies at Kenyatta National Hospital, in Kenya

Background: This study was aimed at defining the presentation, morbidity and mortality following inhalation and subsequent removal of  tracheobronchial foreign body using a rigid bronchoscope.Methods: This was a retrospective, cross-sectional study undertaken in the Ear Nose and Throat-Head and Neck Surgery Unit of Kenyatta National Hospital. The study population consisted of patients with brochoscopically proven tracheobronchial foreign body. Case notes of 107 consecutive admissions with brochoscopically verified tracheobronchial foreign bodieswere analyzed for age, sex, time interval between inhalation and removal, duration of stay in hospital, complications and mortality.Results: The vast majority of patients were below 3 years of age and 63% of them presented within 3 days after onset of symptoms. The right bronchus was the most frequent destination of inhaled foreign bodies (50.5%) followed by the left bronchus (17.8%) and carina (14.2%) inthat order. The turnover of patients with inhaled foreign bodies was high with 86.9% being discharged within 6 days after surgery. The bronchoscopic procedure was uneventful in 76.6% of patients. Repeat bronchoscopy was performed in three patients with one undergoing eventual thoracotomy.Intraoperative cardiac arrest occurred in 5 cases (4.6%) with successful resuscitation in 2 and mortality in three (2.7%) % cases.Conclusion: Bronchoscopic removal of inhaled foreign bodies remains one of the riskiest otolaryngologic emergencies in Kenyatta National Hospital partly because of involvement of the life sustaining airway and partly because of lack of ideal equipment and adequate expertise. The need for hands on experience and close cooperation and familiarity between theanaesthesiologist and the bonchoscopist is emphasized

Impact of integrated fruit fly management strategy on food security among smallholder mango farmers in Kenya

Adoption of agricultural innovations is perceived as a key avenue for poverty reduction and improved food and nutritional security in developing countries. The International Centre for Insect Physiology and Ecology (icipe) has developed and implemented a set of Integrated Pest Management (IPM) strategies in several sub-Saharan African countries aimed at controlling mango infesting fruit flies (Bactrocera dorsalis). Although positive returns from the use of fruit fly IPM have already been documented, the impact of these technologies on food security is not well understood. This study evaluated the impact of the IPM strategy on food security with the help of a two-wave panel household survey data collected in Machakos County in Kenya. A difference-in-difference model was fitted to the data of a randomly selected sample of 600 mango growing households. A seven-day recall was used to elicit per capita calorie intake, while a 30-day recall was used to measure household dietary diversity. A before-and-after intervention and with-and-without (treatment and control) study design was utilized. The regression estimates indicate that fruit fly IPM use had a positive impact on per capita calorie intake but no significant effect on Household Dietary Diversity Index (HDDI) in comparison with the IPM non-users. This suggests that farmers using the fruit fly IPM technology benefit from income gains, and higher incomes improve the quantity of food consumed but not the diversity of the foods. This could be explained by a large share of the expenditure on food that was devoted to cereal staples such as maize, wheat, and rice as reported during the qualitative study. Other factors that had an effect on per capita calorie include the level of farm income, access to the extension services, wealth category and distance to agricultural input market and household size. This study recommends wider dissemination and upscaling of the fruit fly IPM strategy in mango producing regions to facilitate broader impacts on household-level food security

Managing food imports for food security in Qatar

Faced with food supply disruptions due in part to geopolitics and political instability in its traditional food source markets in the Kingdom of Saudi Arabia and the United Arab Emirates, Qatar—a wealthy, highly import-dependent open economy—plans to identify a set of alternative markets that can assure it of a stable food supply chain and food security. This study develops a set of preferences and import substitution elasticities for the country’s four most important food categories: meats, dairy, vegetables, and cereals. We used quarterly food import data from 2004 to 2017 and the Restricted Source-Differentiated Almost Ideal Demand System (RSDAIDS) to estimate import-substitution elasticities for meats, dairy, vegetables, and cereals imported by Qatar. Based on our findings, India, Australia, and the Netherlands emerged as Qatar’s most competitive sources of food, followed by Brazil, Jordan, and Argentina. Qatar can assure sustained demand for food imports from the aforementioned countries in order to address its food security

Gender Roles and Constraints in Beekeeping: A Case from Kitui County, Kenya

Beekeeping is a form of agriculture that involves management of wild or domesticated bee colonies for production of honey and wax. Generally, in Kenya, women perform most of the agricultural activities (GOK, 2005; Oduol et al., 2013). Even though they play a major role in these activities, they end up receiving a fraction of the income generated. In most of the African countries, beekeeping has often been a male-dominated enterprise (Nel & Illgner, 2004; Ogaba & Akongo, 2001; Shackleton, Paumgarten, Kassa, Husselman, & Zida, 2011). However, with intervention from rural development agencies, a change in this practice could occur..

Analysis of markets for African leafy vegetables within Nairobi ant its environs and implications for on-farm conservation of biodiversity

African Leafy Vegetables (ALVs) are important sources of essential macro and micro-nutrients. In addition they offer a source of livelihood when marketed, and also contribute to crop biodiversity. Despite these positive aspects, only a few ALVs are grown, marketed and consumed in Kenya. This study analyses the ALV market in Nairobi and the neighbouring areas, highlighting the factors that enable or inhibit its development. Furthermore, the study determined different factors influencing inter- and intra-specific on-farm biodiversity, with a focus on the role of ALV market development

P20-08. Glycosylation: an important factor in Env diversity

Supported by a CAVD Grant from the Bill and Melinda Gates Foundation

Returns to research and outreach for integrated pest management of western flower thrips infesting French bean and tomato in Kenya

Thrips, Frankliniella occidentalis (Pergande), is a major invasive pest that causes extensive yield losses in French bean and tomato in Kenya. Thrips management is based on the application of pesticides. In addition to increased environmental risks associated with pesticides, frequent use of these chemicals increases production costs and pesticide resistance. Furthermore, exports are restricted due to non-compliance to maximum residue levels in important consumer export markets, especially the European Union (EU). This study was conducted to estimate the potential benefits of the effectiveness of the icipe-developed strategy for control of western flower thrips before dissemination of the technology in Kenya, using the economic surplus model. We calculated the benefit–cost ratio, the Net Present Value (NPV) and the Internal Rate of Return (IRR) using Cost–Benefit Analysis (CBA). Assuming a maximum conservative adoption rate of 1% and a 10% discount rate for the base deterministic scenario, the NPV of the research was estimated at US$2.2 million, with an IRR of 23% and a BCR of 2.46. Sensitivity analyses indicated that the NPV, IRR and BCR increased at an increasing rate as adoption rates increased. However, as elasticities of supply and demand increased, the NPV, IRR and BCR increased at a decreasing rate. The findings demonstrate that farmers from developing countries can gain when they obtain access to suitable pest management innovations such as integrated pest management technologies. Consequently, investment in IPM technologies for suppression of western flower thrips should be enhanced

Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project.

Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context-mechanism-outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by 'bridging' communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a 'buzz' for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs' motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective