Spatial Inequality in Times of Urban Transition: Complex Land Markets in Uganda and Somaliland: Overarching Synthesis Report

This report synthesises the analysis of research on “Spatial Inequalities in Times of Urban Transitions” that was executed from December 2017 to September 2019 in 4 cities in Uganda and Somaliland. Based on a systemic view of land markets and integrated with a political settlement analysis it is meant to help in understanding and eventually overcoming constraints to the ways that land markets can contribute to spatial justice. The report draws on an understanding of political settlements as a way of understanding how varieties of clientelism through informal interfaces manifest themselves in cities and how the materialities and resources of cities shape and afford possibilities for clientelism (Goodfellow, 2017)

Spatial Inequality in Times of Urban Transition: Complex Land Markets in Uganda and Somaliland: Public Facing Report

This report synthesizes the main issues, findings and recommendations from the analysis of our research on Spatial Inequalities of Urban Transitions, executed between Dec. 2017 and Sept. 2019. Based on a systemic view of land markets and integrated with a political settlement analysis, this report helps in understanding and eventually overcoming constraints to the ways that land markets can contribute to spatial justice. The report can identify some of the ways in which land markets relate to spatial justice. The aim of the report is to suggest forms of support to assist policy development and policy interventions that can enable East African cities to offer greater opportunities to poor and marginalised urban groups. It presents findings on overarching issues in each city from all the research components and associated policy recommendations

Comparison of alternative evidence summary and presentation formats in clinical guideline development: a mixed-method study.

BACKGROUND: Best formats for summarising and presenting evidence for use in clinical guideline development remain less well defined. We aimed to assess the effectiveness of different evidence summary formats to address this gap. METHODS: Healthcare professionals attending a one-week Kenyan, national guideline development workshop were randomly allocated to receive evidence packaged in three different formats: systematic reviews (SRs) alone, systematic reviews with summary-of-findings tables, and 'graded-entry' formats (a 'front-end' summary and a contextually framed narrative report plus the SR). The influence of format on the proportion of correct responses to key clinical questions, the primary outcome, was assessed using a written test. The secondary outcome was a composite endpoint, measured on a 5-point scale, of the clarity of presentation and ease of locating the quality of evidence for critical neonatal outcomes. Interviews conducted within two months following completion of trial data collection explored panel members' views on the evidence summary formats and experiences with appraisal and use of research information. RESULTS: 65 (93%) of 70 participants completed questions on the prespecified outcome measures. There were no differences between groups in the odds of correct responses to key clinical questions. 'Graded-entry' formats were associated with a higher mean composite score for clarity and accessibility of information about the quality of evidence for critical neonatal outcomes compared to systematic reviews alone (adjusted mean difference 0.52, 95% CI 0.06 to 0.99). There was no difference in the mean composite score between SR with SoF tables and SR alone. Findings from interviews with 16 panelists indicated that short narrative evidence reports were preferred for the improved clarity of information presentation and ease of use. CONCLUSIONS: Our findings suggest that 'graded-entry' evidence summary formats may improve clarity and accessibility of research evidence in clinical guideline development. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN05154264

TERRORIST BOMBING AT THE US EMBASSY IN NAIROBI

Background: On 7th August 1998, a terrorist bomb destroyed the American Embassyin Nairobi, killing and injuring thousands of people.Objectives: To describe the media component of the (larger) mental health response.To evaluate the impact of the intervention.Design: Descriptive cross sectional studySetting: Nairobi, three months after the explosion.Subjects: Residents of Nairobi and outlying areas, exposed to the bomb blast and whoreceived Radio and TV coverage about the explosion.Interventions: Radio and TV broadcasts, starting hours after the explosion andcontinuing for two weeks thereafter.Results: Of a sample of 400 respondents interviewed, 172 reported they were affectedby the bomb blast, either directly or through friends and relatives. T.V., and radiohad the highest reach, (89% and 85%) respectively. 70% felt the programmes gavevictims hope and 90% felt the programmes should continue, as they were helpful tothe needy.Conclusion: The media is a controversial, sometimes overused and at times underusedresource in Disaster Management. Judicious use of the media was shown to be helpfulin this study. Literature supports media interventions in disaster. Doctors working indisaster areas need to understand the media and to prepare for its use as it complimentsother interventions

Geology, geochemistry, and stratigraphy of the Lemudong'o formation, Kenya Rift Valley

The Lemudong’o Formation is defined here as part of a late Miocene to Late Pleistocene sequence of stratified lavas, air-fall and waterlain tuffs, lacustrine, alluvial, and fluvial sediments, and paleosols, that crop out over an approximately 25*50 km area on the western margin of the southern Kenyan Rift Valley, approximately 100 km west of Nairobi. The study area is deeply incised by three major permanent river systems that expose sediments of three late Neogene lake basins. The Lemudong’o Formation comprises deposits of the second paleolake basin, which formed during the late Miocene. Stratigraphic sections in several localities are described and correlated in this report, the Lemudong’o Formation is defined, and a basin sedimentary history and environmental reconstruction is proposed. The Lemudong’o Formation has three main phases of sedimentation with a total thickness of 135 m. Phase 1 is represented by predominantly lacustrine and lake-margin siltstones, mudstones,and sandstones. Phase 2 comprises paleosols in the basin center, and fluvial and alluvial sediments on the eastern basin margin. Phase 3 comprises mainly waterlain tuffs and silts, capped by a welded tuff. Phase 2 may reflect a more arid climate, or a lower basin-overflow elevation. Four tuffs in upper phase-1 mudstones in Lemudong’o Gorge are dated to 6.12 – 6.08 Ma. The main fossil-bearing horizons at Lemudong’o Gorge Locality 1 lie between, and immediately above, the dated tuffs. Fossils are associated with beach and/or deltaic sands and fine gravels, and silty and sandy claystones representative of an intermittently flooded lake margin.Stanley H. Ambrose, Christopher M. Nyamai, Eliud M. Mathu and Martin A. J. William

Adoption of recommended practices and basic technologies in a low-income setting.

OBJECTIVE: In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent. DESIGN AND SETTING: We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002-2012). MAIN OUTCOME MEASURES: Basic resource availability, use of diagnostics and uptake of recommended practices. RESULTS: There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines. CONCLUSIONS: Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions

Adoption of recommended practices and basic technologies in a low-income setting

Objective: In global health considerable attention is focused on the search for innovations; however, reports tracking their adoption in routine hospital settings from low-income countries are absent. Design and setting: We used data collected on a consistent panel of indicators during four separate cross-sectional, hospital surveys in Kenya to track changes over a period of 11 years (2002-2012). Main outcome measures: Basic resource availability, use of diagnostics and uptake of recommended practices. Results: There appeared little change in availability of a panel of 28 basic resources (median 71% in 2002 to 82% in 2012) although availability of specific feeds for severe malnutrition and vitamin K improved. Use of blood glucose and HIV testing increased but remained inappropriately low throughout. Commonly (malaria) and uncommonly (lumbar puncture) performed diagnostic tests frequently failed to inform practice while pulse oximetry, a simple and cheap technology, was rarely available even in 2012. However, increasing adherence to prescribing guidance occurred during a period from 2006 to 2012 in which efforts were made to disseminate guidelines. Conclusions: Findings suggest changes in clinical practices possibly linked to dissemination of guidelines at reasonable scale. However, full availability of basic resources was not attained and major gaps likely exist between the potential and actual impacts of simple diagnostics and technologies representing problems with availability, adoption and successful utilisation. These findings are relevant to debates on scaling up in low-income settings and to those developing novel therapeutic or diagnostic interventions