Export Market Linkage via Gentleman's Agreement: Evidence from French Bean Marketing in Kenya

"Gentleman's agreements" involving handshakes or promissory market access possibilities through brokers and middlemen have enabled most small farmers in Kenya to export an extensive array of fruits and vegetables. However, despite rapid expansion into these forms of market linkages, there has been a dearth of empirical information regarding the factors that such marketers consider when linking small farmers to the market. This paper uses data from a 2001 French bean farmers survey conducted in Mwea Tebere Central Kenya to evaluate household and infrastructural factors determining informal linkages for French bean marketing. Logit estimates show that irrigation equipment is a prerequisite for linkage, farm localities further from central crop collection centres and close proximity of farms to source of irrigation waters, and poor accessibility of large farms preferred by brokers in linking small farmers. The results lend credence to the importance of brokers and middlemen as an emerging institution in linking small farmers to export markets in rural regions that have poor infrastructures e.g. roads.verbal agreement, logit, French beans exports, small farmers, linkage, brokers and middlemen, International Relations/Trade,

The Culture of Drug Abuse and Substance Use as a determinant of Health Outcomes among Students in Kenya public Universities

The culture of drug abuse and substance use among university students has become a global concern, considering the continued consumption of these illegal drugs and substances. Despite this understanding and worrying state of affairs, limited evidence on the health outcomes and how to curb the menace. It is on this basis that our paper applies an emic perspective in understanding the trends, dynamics and socio-health outcomes of drug abuse and substance use among university students. It is on this basis that our paper applies an emic perspective in understanding the trends, dynamics and socio-health outcomes of drug abuse and substance use among university students. The study employed a descriptive research design and was anchored on the social comparison theory. Data was collected through KoBo Collect tool and administered to 250 second year and third year university students. Ten (10) interviews were conducted with university students’ leaders. The data was analysed qualitatively and quantitatively. The study found out that drug and substance use culture at university is a norm to students. From the multiple responses, the respondents indicated that their parents ensured that they had the resources they needed to study and live comfortably at 84.6% and 78.9% respectively, but without putting into consideration effective strategies for monitoring their children’s activities while on campus. Most (76.3%) of the respondents indicated that drug abuse had effects to individuals, 64.0% to the society and (44.7%). The study recommends the need to adopt interventions aimed at promoting student’s well-being in the university setting, while protecting them from accessing illegal drugs and substances that are harmful to their health and wellbeing. It is also paramount to involve local structures, such as the Nyumba Kumi initiative to track the sources of illegal drugs and substances to students on campus and in the neighbourhoods, to ensure their prevention and control.&nbsp

The Malawi Diffusion and Ideational Change Project 2004-06

In this paper, we evaluate the quality of survey data collected by the Malawi Diffusion and Ideational Change Project by investigating four potential sources of bias: sample representativeness, interviewer effects, response unreliability and sample attrition. We discuss the results of our analysis and implications of our findings for the collection of data in similar contexts.AIDS/HIV, data quality, interviewer effects, representativeness, response reliability, sample attrition, Sub-Saharan Africa

Cash & Compassion: The Somali Diaspora's Role in Relief, Development & Peacebuilding

This research report, commissioned by UNDP Somalia, is based on work done in six diaspora hubs (Dubai, London, Minneapolis, Nairobi, Oslo, and Toronto) as well as in Somaliland, Puntland and South/Central Somalia. It examines the involvement of Somalis in the diaspora in dynamics in their country of origin, including collective and social remittances. Volume 1 contains the full report. Volume 2 contains the research guides, terms of reference and other annexes

Subjective expectations in the context of HIV/AIDS in Malawi

In this paper we present a newly developed interactive elicitation methodology for collecting probalistic in expectations in a developing country context with low levels of literacy and numeracy, and we evaluate the feasibility and success of this method for a wide range of outcomes in rural Malawi. We find that respondents' answers about their subjective expectations take into account basic properties of probabilities, and vary meaningfully with observable characteristics and past experience. From a substantive point of view, the elicited expectation's indicate that individuals are generally aware of differential risks. For example, individuals with lower incomes and less land rightly feel at greater risk of financial distress than people with higher socioeconomic status (SES), and people who are divorced or widowed rightly feel at greater risk of being infected with HIV than currently married individuals. Meanwhile many expectations - including the probability of being currently infected with HIV - are well-calibrated compared to actual probabilities, but mortality expectations are substantially overestimated compared to life table estimates. This overestimation maylead individuals to underestimate the benefits of adopting HIV risk-reduction strategies. The skewed distribution, of expectations about condom use also suggests that a small group of innovators are the forerunners in the adoption of condoms within marriage for HIV prevention. © 2009 Adeline Delavande & Hans-Peter Kohler

Performance of Quantitative Buffy Coat, QBC Fluorescence and Staining Technologies™ Test, and SD Bioline™ Malaria Rapid Test in Malaria Diagnosis in Western Kenya

Malaria remains the most important parasitic disease in sub-Saharan Africa as a cause of morbidity and mortality.  Effective management of malaria relies on prompt and accurate diagnosis to guide treatment.  The World Health Organization (WHO) recommends that all suspected malaria cases be tested before initiation of treatment, thus diagnosis of malaria requires parasitological confirmation of malaria parasites in the blood of suspected patients.  This cross-sectional study conducted at the Ahero County Hospital, Kisumu, Kenya, evaluated the performance of quantitative buffy coat (QBC) (QBC Fluorescence and Staining Technologies™(QBC F.A.S.T.™)-improved QBC system and SD Bioline™ malaria rapid tests) against 'gold standard' (Giemsa blood stained slides microscopy) for the detection of Plasmodium species in children<five years old (n=385)in a malaria holo-endemic area of western Kenya.  Real-time PCR was performed on discrepant samples across the tests and the gold standard (microscopy).Sensitivity of QBC, QBC F.A.S.T.™ and SD Bioline™ malaria rapid tests were 90% (95% CI: 85-94), 77% (95% CI: 71-83) and 91% (95% CI: 86-94), respectively, while specificity was 30% (95% CI: 24-37), 83% (95% CI: 77-88) and 67% (95% CI: 60-73), respectively.  The positive predictive values (PPV) were 58% (95% CI: 52-63), 83% (95% CI: 77-88) and 74% (95% CI: 63-80), respectively, while the negative predictive values (NPV) were 74% (95% CI: 63-84), 78% (95% CI: 71-83) and 87% (95% CI: 81-92), respectively.Although the standard QBC malaria test and the SD Bioline™ malaria rapid diagnostic test (RDT) showed better sensitivity relative to the improved QBC F.A.S.T.™ test, the latter had a better specificity.  The performance of these tests remains modest against microscopy. Keywords: Malaria, Quantitative buffy coat, QBC F.A.S.T.™, SD Bioline

Sample-ready multiplex qPCR assay for detection of malaria

BACKGROUND: Microscopy and antigen detecting rapid diagnostic tests are the diagnostic tests of choice in management of clinical malaria. However, due to their limitations, the need to utilize more sensitive methods such as real-time PCR (qPCR) is evident as more studies are now utilizing molecular methods in detection of malaria. Some of the challenges that continue to limit the widespread utilization of qPCR include lack of assay standardization, assay variability, risk of contamination, and the need for cold-chain. Lyophilization of molecular assays can overcome some of these limitations and potentially enable widespread qPCR utilization. METHODS: A recently published multiplex malaria qPCR assay was lyophilized by freezing drying into Sample-Ready™ format (MMSR). MMSR assay contained all the required reagents for qPCR including primers and probes, requiring only the addition of water and sample to perform qPCR. The performance of the MMSR assay was compared to the non-freeze dried, “wet” assay. Stability studies were done by maintaining the MMSR assays at four different ambient temperatures of 4°C, room temperature (RT), 37°C and 42°C over a period of 42 days, tested at seven-day intervals. Plasmodium falciparum and Plasmodium vivax DNAs were used for analysis of the MMSR assay either as single or mixed parasites, at two different concentrations. The C(T) values and the standard deviations (SD) were used in the analysis of the assay performance. RESULTS: The limit of detection for the MMSR assay was 0.244 parasites/μL for Plasmodium spp. (PLU) and P. falciparum (FAL) assay targets compared to “wet” assay which was 0.39 and 3.13 parasites/μL for PLU and FAL assay targets, respectively. The MMSR assay performed with high efficiencies similar to those of the “wet” assay and was stable at 37°C for 42 days, with estimated shelf-life of 5 months. When used to analyse field clinical samples, MMSR assay performed with 100% sensitivity and specificity compared to the “wet” assay. CONCLUSION: The MMSR assay has the same robust performance characteristics as the “wet” assay and is highly stable. Availability of MMSR assay allows flexibility and provides an option in choosing assay for malaria diagnostics depending on the application, needs and budget

Misclassification of Plasmodium infections by conventional microscopy and the impact of remedial training on the proficiency of laboratory technicians in species identification.

BACKGROUND: Malaria diagnosis is largely dependent on the demonstration of parasites in stained blood films by conventional microscopy. Accurate identification of the infecting Plasmodium species relies on detailed examination of parasite morphological characteristics, such as size, shape, pigment granules, besides the size and shape of the parasitized red blood cells and presence of cell inclusions. This work explores misclassifications of four Plasmodium species by conventional microscopy relative to the proficiency of microscopists and morphological characteristics of the parasites on Giemsa-stained blood films. CASE DESCRIPTION: Ten-day malaria microscopy remedial courses on parasite detection, species identification and parasite counting were conducted for public health and research laboratory personnel. Proficiency in species identification was assessed at the start (pre) and the end (post) of each course using known blood films of Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale and Plasmodium vivax infections with densities ranging from 1,000 to 30,000 parasites/μL. Outcomes were categorized as false negative, positive without speciation, P. falciparum, P. malariae, P. ovale, P. vivax and mixed infections. DISCUSSION AND EVALUATION: Reported findings are based on 1,878 P. falciparum, 483 P. malariae, 581 P. ovale and 438 P. vivax cumulative results collated from 2008 to 2010 remedial courses. Pre-training false negative and positive misclassifications without speciation were significantly lower on P. falciparum infections compared to non-falciparum infections (p < 0.0001). Post-training misclassifications decreased significantly compared to pre- training misclassifications which in turn led to significant improvements in the identification of the four species. However, P. falciparum infections were highly misclassified as mixed infections, P. ovale misclassified as P. vivax and P. vivax similarly misclassified as P. ovale (p < 0.05). CONCLUSION: These findings suggest that the misclassification of malaria species could be a common occurrence especially where non-falciparum infections are involved due to lack of requisite skills in microscopic diagnosis and variations in morphological characteristics within and between Plasmodium species. Remedial training might improve reliability of conventional light microscopy with respect to differentiation of Plasmodium infections

Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya

<p>Abstract</p> <p>Background</p> <p>Malaria microscopy, while the gold standard for malaria diagnosis, has limitations. Efficacy estimates in drug and vaccine malaria trials are very sensitive to small errors in microscopy endpoints. This fact led to the establishment of a Malaria Diagnostics Centre of Excellence in Kisumu, Kenya. The primary objective was to ensure valid clinical trial and diagnostic test evaluations. Key secondary objectives were technology transfer to host countries, establishment of partnerships, and training of clinical microscopists.</p> <p>Case description</p> <p>A twelve-day "long" and a four-day "short" training course consisting of supervised laboratory practicals, lectures, group discussions, demonstrations, and take home assignments were developed. Well characterized slides were developed and training materials iteratively improved. Objective pre- and post-course evaluations consisted of 30 slides (19 negative, 11 positive) with a density range of 50–660 parasites/μl, a written examination (65 questions), a photographic image examination (30 images of artifacts and species specific characteristics), and a parasite counting examination.</p> <p>Discussion and Evaluation</p> <p>To date, 209 microscopists have participated from 11 countries. Seventy-seven experienced microscopists participated in the "long" courses, including 47 research microscopists. Sensitivity improved by a mean of 14% (CI 9–19%) from 77% baseline (CI 73–81 %), while specificity improved by a mean of 17% (CI 11–23%) from 76% (CI 70–82%) baseline. Twenty-three microscopists who had been selected for a four-day refresher course showed continued improvement with a mean final sensitivity of 95% (CI 91–98%) and specificity of 97% (CI 95–100%). Only 9% of those taking the pre-test in the "long" course achieved a 90% sensitivity and 95% specificity, which increased to 61% of those completing the "short" course. All measures of performance improved substantially across each of the five organization types and in each course offered.</p> <p>Conclusion</p> <p>The data clearly illustrated that false positive and negative malaria smears are a serious problem, even with research microscopists. Training dramatically improved performance. Quality microscopy can be provided by the Centre of Excellence concept. This concept can be extended to other diagnostics of public health importance, and comprehensive disease control strategies.</p