Late Effects of Therapy, Stigmatization and Social Reintegration following Childhood Cancer Survival in Kenya: A Case Report

Childhood cancer survival is increasing in low- and middle-income countries like Kenya, which comes with a new healthcare challenge: late effects and quality-of-life of survivors. A case was studied to depict a Kenyan Hodgkin lymphoma survivor, illustrating some of the childhood cancer survivors' difficulties in Kenya. Late effects of therapy, stigmatization and social reintegration were explored. The investigators reviewed medical records and used semi-structured interviews and stigma assessments using the Social Impact Scale. The survivor developed severe pulmonary hypertension during treatment with ABVD and salvage protocols. Three years after treatment, the patient experienced chemotherapy-induced late effects (chronic heart disease) that hindered personal care, social activities and job opportunities and required follow-up. Stigmatization by the community burdened his family life and marital prospects. This case report is one of the first that testifies of combined medical and psychosocial challenges that childhood cancer survivors may face in sub-Saharan Africa and underlines the need for a holistic approach

Energy absorption characteristics of nano-composite conical structures.

The effect of the filler material on the energy absorption capabilities of polyamide 6 composite structures is studied in details in the present paper. The axial dynamic and quasi-static collapse of conical structures was conducted using a high energy drop tower, as well as Instron 5500R electro-mechanical testing machine. The impact event was recorded using a high-speed camera and the fracture surface was investigated using scanning electron microscopy (SEM). The obtained results indicate an important influence of filler material on the energy absorption capabilities of the polymer composites. A significant increase in specific energy absorption (SEA) is observed in polyamide 6 (PA6) reinforced with nano-silica particles (SiO2) and glass-spheres (GS), whereas addition of montmorillonite (MMT) did not change the SEA parameter

Factors Influencing Preferences and Adoption of Improved Groundnut Varieties among Farmers in Tanzania

Access and use of seed of improved varieties of groundnut among farmers can improve farmers’ livelihoods and contribute to the potential of crop production in Tanzania. This paper analyzes factors underpinning the adoption of improved groundnut varieties among farmers to pave the way for upscaling quality seed used for increased production and commodity business in farming communities. A four-stage stratified sampling was used to collect data from 300 groundnut farmers in seven agro-ecological zones through individual interviews. Secondary data were collected from the literature and the Tanzania Agricultural Research Institute at Naliendele centre (TARI–Naliendele). Descriptive statistics and Probit regression model were used for data analysis. The empirical results showed that Johari 1985, Pendo 1998, Naliendele 2009, Mnanje 2009, Mangaka 2009 and Nachi 2015, are the main six improved groundnut varieties used by farmers, with Pendo 1998 having the highest adoption rate (17.1%). In the grain market, four varieties, namely Pendo 1998, Mnanje 2009, Nachi 2015 and Johari 1985, were observed to be highly preferred by grain off-takers. Furthermore, among the adopted improved varieties, Nachi 2015, is observed to be the most consistent high yielding variety, ranging from 1100 kg/ha to 1500 kg/ha in all agro-ecological zones. A farmer’s decision to adopt new varieties is affected by age and gender, farmer group membership, availability of improved seed and seed cost. Overall, male farmers are more likely to adopt improved varieties of groundnut than female farmers. The implications of these findings are also discussed, in particular in the area of policy support

Effect of fibre configurations on mechanical properties of flax/tannin composites.

Flax reinforced tannin-based composites have a potential to be used in vehicle applications due to the environmental advantages and good mechanical properties. In this paper, the effects of fibre configuration on mechanical properties of flax/tannin composites were investigated for nonwoven and woven fabric lay-up angles (UD, [0°, 90°]2 and [0°, +45°, 90°, -45°]2). The tannin/flax composites were prepared by compression moulding. The manufactured specimens were then characterized for quasi-static tensile properties, dynamic mechanical properties and low-energy impact performance. Failure mechanism was further investigated using microscopy and demonstrated the need for further adhesion improvements. The study shows that the UD fabric reinforced composite performs better in tensile strength and modulus whereas [0°, +45°, 90°, -45°]2 composite provides the best impact energy absorption performance

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment. Study participants were parents of childhood cancer patients diagnosed between August 2013 and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9–1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days; P < .001). Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media

Determinants of antibody persistence across doses and continents after single-dose rVSV-ZEBOV vaccination for Ebola virus disease: an observational cohort study.

BACKGROUND: The recombinant vesicular stomatitis virus (rVSV) vaccine expressing the Zaire Ebola virus (ZEBOV) glycoprotein is efficacious in the weeks following single-dose injection, but duration of immunity is unknown. We aimed to assess antibody persistence at 1 and 2 years in volunteers who received single-dose rVSV-ZEBOV in three previous trials. METHODS: In this observational cohort study, we prospectively followed-up participants from the African and European phase 1 rVSV-ZEBOV trials, who were vaccinated once in 2014-15 with 300 000 (low dose) or 10-50 million (high dose) plaque-forming units (pfu) of rVSV-ZEBOV vaccine to assess ZEBOV glycoprotein (IgG) antibody persistence. The primary outcome was ZEBOV glycoprotein-specific IgG geometric mean concentrations (GMCs) measured yearly by ELISA compared with 1 month (ie, 28 days) after immunisation. We report GMCs up to 2 years (Geneva, Switzerland, including neutralising antibodies up to 6 months) and 1 year (Lambaréné, Gabon; Kilifi, Kenya) after vaccination and factors associated with higher antibody persistence beyond 6 months, according to multivariable analyses. Trials and the observational study were registered at ClinicalTrials.gov (Geneva: NCT02287480 and NCT02933931; Kilifi: NCT02296983) and the Pan-African Clinical Trials Registry (Lambaréné PACTR201411000919191). FINDINGS: Of 217 vaccinees from the original studies (102 from the Geneva study, 75 from the Lambaréné study, and 40 from the Kilifi study), 197 returned and provided samples at 1 year (95 from the Geneva study, 63 from the Lambaréné, and 39 from the Kilifi study) and 90 at 2 years (all from the Geneva study). In the Geneva group, 44 (100%) of 44 participants who had been given a high dose (ie, 10-50 million pfu) of vaccine and who were seropositive at day 28 remained seropositive at 2 years, whereas 33 (89%) of 37 who had been given the low dose (ie, 300 000 pfu) remained seropositive for 2 years (p=0·042). In participants who had received a high dose, ZEBOV glycoprotein IgG GMCs decreased significantly between their peak (at 1-3 months) and month 6 after vaccination in Geneva (p0·05). Neutralising antibodies seem to be less durable, with seropositivity dropping from 64-71% at 28 days to 27-31% at 6 months in participants from the Geneva study. INTERPRETATION: Antibody responses to single-dose rVSV-ZEBOV vaccination are sustained across dose ranges and settings, a key criterion in countries where booster vaccinations would be impractical. FUNDING: The Wellcome Trust and Innovative Medicines Initiative 2 Joint Undertaking