Effectiveness and Safety of 2-Hourly 20 MCG Oral Misoprostol Solution Compared to Standard Intravenous Oxytocin in Labour Induction Due to Pre-Labour Rupture of Membranes at Term: A Randomised Clinical Trial at Kenyatta National Hospital

Background: Pre-labour rupture of membranes (PROM) at term is a common event whose management varies from centre to centre. The practice at the Kenyatta National Hospital (KNH) for patients with PROM at term is to initiate delivery of the patient soon on admission with intravenous oxytocin, if there are no contraindications to vaginal delivery. However, in PROM at term, if the cervix is not ripe,vaginal administration of prostaglandin pessaries for cervical ripening is not possible when there is active draining of liquor, thus use of intravenous oxytocin may take a very long time or fail all together. Oral misoprostol at low doses has been found to be a safe and effective agent for labour induction in numerous studies carried out in the developed world, where there are better resources for monitoring of labour. None of the studies has been carried out in Kenya,a limited resource country. Therefore, there is a need to determine the effectiveness and safety of oral misoprostol solution at the KNH, a limited resource set up.Objective: To determine the effectiveness and safety of 2-hourly 20 mcg oral misoprostol solution compared to the standard intravenous oxytocinin labour induction in mothers with pre-labour rupture of membranes at term at the Kenyatta National Hospital.Design: An unblinded randomised clinical trial.Setting: Kenyatta National Hospital Labour Ward Unit.Participants: Eighty three pregnant women with pre-labour rupture of membranes at term without an indication for Caeserian section were consented and randomised for labour induction with either oral misoprostol at a dose of 20mcg 2-hourly up to a maximum of 4-doses, or with  intravenous oxytocin according to the WHO protocol.Main outcome measures: Induction to delivery interval; maternal  complications and early neonatal outcomes.Results: The overall induction success rates in the misoprostol arm was 81% versus 83% in the oxytocin arm (P=0.447). The mean induction to vaginal delivery interval in the misoprostol arm was 8.4 hours as compared to 9.45 hours in the oxytocin arm (P=0.116). The induction to active labour interval was similar in the two study arms. The mean induction to active labour in the misoprostol arm was 4.02 hours as versus 4.51 hours in the oxytocin arm (P=0.223 ). Two women who had failed induction with misoprostol were augmented with oxytocin and delivered vaginally. The Caesarean section rates were 19% in the misoprostol arm and 17% in the oxytocin arm (P=0.447), which was not statistically significant. The maternal outcomes were similar in the two study arms. Four women had tachysystole in the misoprostol arm, compared to three  in the oxytocin arm (P=0.253). In the misoprostol arm two women had hypertonus compared to three in the oxytocin arm (P=0.322).There was one case of hyperstimulation in the misoprostol arm and two in in the oxytocin arm. There were no differences in the foetal/ neonatal outcomes. No baby had an Apgar score of less than seven at one or five minutes. No baby was admitted to the New Born Unit in either of the two arms. There was no case of a still birth in either of the study arms. There was no significant difference in the passage of meconium between the two arms, 39% in the misoprostol arm and 35.7% in the oxytocin arm (P=0.755). The passage of meconium did not impact on the neonatal outcomes.Conclusion: Oral misoprostol solution 20mcg 2-hourly is as safe and effective as the standard intravenous oxytocin for labour induction in women presenting with prelabour rupture of membranes at term at the Kenyatta National Hospital

An Econometric Analysis Of Health Care Utilization In Kenya

Background: Increasing access to health care has been a policy concern for many governments, Kenya included. The Kenyan government introduced and implemented a number of initiatives in a bid to address the healthcare utilization challenge. These initiatives include 10/20 policy, exemptions for user fees for some specific health services (treatment of children less than five years, maternity services in dispensaries and health centers, Tuberculosis treatment in public health facilities), and increase in the number of health facilities and health workforce. These initiatives notwithstanding, healthcare utilization in Kenya remains a challenge. The Kenya Household Health Expenditure and Utilization Survey of 2007 found that 17 percent of those who needed health care services could not access the services from both government and private health facilities largely due to financial constraints. This paper employed econometric analysis to examine what could be constraining health care utilization in Kenya despite all the efforts employed. Methods: Using the 2007 Kenya Household Health Expenditures and Utilization Survey (KHHEUS) data (n = 8414), this paper investigates the factors that affect health care utilization in Kenya by estimating a count data negative binomial model. The model was also applied to public and private health facilities to better understand the specificities of poverty in these two facility types. Common estimation problems of endogeneity, heterogeneity, multicollinearity and heteroskedasticity are addressed. Findings: The econometric analysis reveals that out-of-pocket expenditures, waiting time, distance, household size, income, chronic illness area of residence and working status of the household head are significant factors affecting health care utilization in Kenya. While income and distance are significant factors affecting public health care utilization they are not significant in explaining healthcare utilization in private facilities. In addition, working status of the household head, insurance cover and education are significant in explaining private and not public health care utilization. A striking finding is the positive relationship between distance and health care utilization implying that people will travel long distances to obtain treatment. This is perhaps associated with expectations of higher quality of care at far away higher level facilities, especially in rural areas. Conclusion: The paper confirms the existing evidence of the negative effects of Out-of-Pocket (OOP) expenditures and other determinants of health care utilization. With a better understanding of why people use or do not use health services, health care organizations can seek to improve the quality of human life. The bypassing of health facilities for higher level far away facilities implies that it is not so much about availing health facilities, but the quality of the services offered in those facilities. The government should therefore assure quality to increase utilization of the lower level facilities, especially in the rural areas

Catastrophic Health Expenditures And Impoverishment In Kenya

Background: Out-of-pocket health expenditures leave households exposed to the risk of financial catastrophe and poverty whenever they entail significant dissaving or the sale of key household assets. Even relatively small expenditures on health can be financially disastrous for poor households and similarly, large health care expenditures can lead to financial catastrophe and bankruptcy for rich households. Objective: There is increasing evidence that out-of-pocket expenditures act as a financial barrier to accessing health care, and are a source of catastrophic expenditures and impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and impoverishment in Kenya. Methods: Using Kenya Household Health Expenditures and Utilization Survey data of 2007, the study uses both descriptive and econometric analysis to investigate the incidence and intensity of catastrophic health expenditures and impoverishment as well as the determinants of catastrophic health expenditures. To estimate the incidence and intensity of catastrophic expenditures and impoverishment, the study used both Wagstaff and van Doorslaer, (2002) and Xu et al. (2005) and applied various thresholds to demonstrate the sensitivity of catastrophic measures. For determinants of catastrophic health expenditures, a logit model was employed. Findings: Among those who utilized health care, 11.7 percent experienced catastrophic expenditures and 4 percent were impoverished by health care payments. In addition, approximately 2.5 million individuals were pushed into poverty as a result of paying for health care. The poor experienced the highest incidence of catastrophic expenditures. Conclusion: The paper recommends that the government should establish avenues for reducing the burden of out-of-pocket expenditures borne by households. This could be through a legal requirement for everyone to belong to a health insurance and targeting the poor, the elderly and chronically ill through the devolved system of the government and devolved funds

INFLUENCE OF TEACHER TRAINING ON USE OF MUSIC AS A MEDIUM OF TEACHING MATHEMATICS IN PRE PRIMARY SCHOOLS IN NAIROBI CITY COUNTY, KENYA

Music is a significant teaching strategy in early childhood education it improves development of young children’s self-confidence, self-esteem and their expression orally and mentally. Despite the fact that, use of music is a strategy that motivates and sustains children’s interest in the learning of mathematics, research studies in this area are scanty. The purpose of this study therefore was to find out influence of preschool teacher training on the use of music as a mode of teaching mathematics within Kasarani, Nairobi County. The study sought to determine the link between preschool teacher training and use of music in teaching mathematics. The descriptive survey research design was used to structure and guide the study. The study’s dependent variable was use of music as a medium of teaching mathematics while the independent variable was preschool teacher training in use of music in teaching mathematics. Random sampling was used to select 15 preschools out of the 30 targeted and purposive sampling used to select 15 head teachers out of 30 and 45 out of 90 preschool teachers. An observation guide and questionnaires were used to collect data for preschool teachers and head teachers. The study findings established a significant association between teacher training and use of music during mathematic instructions. The study concluded that preschool teachers in Kasarani Sub-County were using music to teach mathematics and that trained teachers used music to teach mathematics than their untrained counterparts. The study recommended the Kenya institute of curriculum development should come up with modules on step by step guidelines on how to teachers should integrate music during maths lessons.  Article visualizations

Power of song : an analysis on the power of music festivals or conserts as a tool for human rights education in Africa

Music has been an intrinsic part of not only my life but human life and the development of every people, society and culture throughout history. Music possesses the power to cross social, racial, cultural, economic and religious barriers and has the ability to truly touch people on a personal and emotional level which is why some even today fear the influence and impact of music. The process of trying to redeem humanitarian values can seem almost impossible in certain situations, however, human rights educators and researchers in social development have held that “change is successful when brought about at the micro-level.” Those in charge of organising human rights education (HRE) programmes need to take into account the social, political, cultural and economic contexts and the extent to which this education will have for social transformation. HRE in itself is primarily focused on building a human rights culture in communities and the programmes set up is evaluated on the basis of its realisation of this.In addition to building a human rights culture, HRE also leads to advocacy on those human rights issues. This is mostly as a result of societies where there is a struggle to embody and uphold human rights values. HRE would therefore need specific target groups and programmes following particular frameworks such as “fostering and enhancing leadership; coalition and alliance development; and personal empowerment” aimed at firstly healing of that community, its development and social transformation finally.Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2010.A dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Gilles Cistac of the Faculty of Law, Eduardo Mondlane University, Mozambique. 2010.http://www.chr.up.ac.za/Centre for Human RightsLL

Quantitative Analysis of Total Phenolic Content in Avocado (Persia Americana) Seeds in Eastern Province of Kenya

Phytochemical rich plants have played a significant role in diet based therapies to prevent and cure various ailments. The avocado (Persia Americana Mill,) fruits are much sought after for their high nutritional and sensory value. Avocado (Persia Americana) seeds were analysed for total phenolic content. This phenolic component is responsible for antioxidant activity. The amount of phenols was analysed using Folin-Ciocalteu method. The maximum phenolic content was found in the Fuerte seed extract (18.55 ± 2.8 mg/g) prepared at 50ºC. The phenolic content decreased by 10.3% at an extraction temperature of 50 °C to 70 °C and 32.1% at an extraction temperature of 50 °C to 100 °C for a duration of 30 minutes. Keywords: Avocado seeds, Persia Americana, Total phenolic

Responses of tropical maize landraces to damage by Chilo partellus stem borer

The potential to manage insect pests using host-plant resistance exists, but has not been exploited adequately. The objective of this study was to determine the resistance of 75 tropical maize landraces through artificial infestation with Chilo partellus Swinhoe. The trial was laid in alpha-lattice design and each seedling was infested with five neonates three weeks after planting, over two seasons in 2009 and 2010. The number of exit holes, tunnel length, ear diameter, ear length, plant height, stem diameter, stem lodging and grain yield were measured and a selection index computed. GUAT 1050 was the most resistant with an index of 0.56, while BRAZ 2179 was the most susceptible with an index of 1.66. Ear characteristics were negatively correlated with damage parameters. The principal component biplot suggested that exit holes, cumulative tunnel length, leaf damage, cob diameter, stem lodging, selection index, ear and plant height contributed 71.2% of the variation in resistance. The mean number of exit holes and tunnel length for resistant landraces and resistant hybrid checks were similar; at 5.5 and 2.48 cm, respectively. The identified resistant landraces (GUAT 1050, GUAT 280, GUAT 1093, GUAT 1082, GUAT 1014, CHIS 114, and GUAN 34) could be used to develop C. partellus stem borer-resistant maize genotypes.Key words: Chilo partellus, ear length, exit holes, stem borer resistance, tunnel length

An Investigation of the Antimicrobial Activity of Acmella caulirhiza

Background: Acmella caulirhiza is a plant that is used traditionally to treat several disorders such as mouth ulcers, sore throat, toothache and earache, among others. It is a small annual or perennial herb whose location is widespread worldwide. Objectives: The objective of the study was to determine whether the leaves, stem and the flowers extract of the plant possess antibacterial and antifungal activity and to find out which part of the plant is the most active, if any. Methodology: Acmella caulirhiza was collected from the wild in Kericho County. The flower heads, the leaves and the stems were dried separately, ground into a powder and extracted with chloroform. The plant extracts were tested for activity against Escherichia Coli, Staphylococcus aureus, Candida albicans and Bacillus pumilus. Results and Discussion: The plant extracts inhibited the growth of Escherichia Coli, Staphylococcus aureus and Bacillus pumilus. The activity was highest in the stems extracts. The extracts, however, did not have any anti-fungal activity when tested against Candida albicans. It was concluded from these results that the anti-bacterial activity may aid in the efficacy when the plant is used to treat mouth ulcers or sore throat. Key words: Acmella caulirhiza, anti-fungal activity, anti-bacterial activity, traditional medicin

HIV Protective Efficacy and Correlates of Tenofovir Blood Concentrations in a Clinical Trial of PrEP for HIV Prevention

Background: Antiretroviral pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy for which adherence is a known determinant of efficacy. Blood concentrations of PrEP medications are one objective marker of adherence. Methods: In a placebo-controlled PrEP efficacy trial of tenofovir disoproxil fumarate (TDF) and TDF with emtricitabine (FTC/TDF) among 4747 African women and men with an HIV-infected partner, we measured plasma tenofovir concentrations from participants in the active PrEP arms: 29 HIV seroconverters (cases) and 196 randomly selected controls who remained uninfected. Results: Among controls, 71% of visits had tenofovir concentrations >40 ng/mL, consistent with steady-state daily dosing, compared with 21% of cases at the visit HIV was first detected. Pill count data indicated that 96% of controls and 66% of cases had >80% adherence for these same visits. The estimated protective effect of PrEP against HIV, based on concentrations >40 ng/mL, was 88% (95% confidence interval: 60 to 96, P 40 ng/mL at month 1, 75% maintained this concentration at month 12. Only 5 of 29 seroconverters seemed to be consistently adherent to PrEP. Tenofovir concentrations >40 ng/mL were associated with older age and shorter time on study; concentrations ≤40 ng/mL occurred more commonly when participants reported no sex with their HIV-infected partner. Conclusions: Plasma concentrations of tenofovir consistent with daily dosing were highly predictive of protection from HIV acquisition. Most of those who took PrEP seemed to have high and consistent adherence

Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya

Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women. Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy. Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (Po0.001) and CIN2/3 among non-users of cART (P¼0.013). Combination antiretroviral therapies users (X2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users¼0.77, 95% confidence interval (CI): 0.61–0.96) and multiple infections (PR¼0.68, 95% CI: 0.53–0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age o35 years to 53.3% in X45 years. Conclusion: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies (X2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3