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Objective: To correlate initial serum lactic acid and base deficit (BD) levels with early mortality in major thermal burns. Methods: This was a prospective descriptive study conducted over 6 months at Kenyatta National Hospital (KNH), Nairobi, Kenya. Ninety consecutive patients with major thermal burns exceeding 20% of total body surface area (TBSA), who met other inclusion criteria participated. Biographic and clinical data were collected using a structured questionnaire. Blood samples were drawn at admission for arterial blood gas analysis (ABGAs) to obtain serum lactic acid and BD levels. Patients were followed up for 7 days at KNH Burns Unit. Results: Studied patients had burns from 21% to 100% TBSA. Majority, 54(60%), had burns between 21% and 50% TBSA. 55(61.1%) patients died within 7 days after admission. 38(69.1%) of these deaths occured within the initial 48 h. Both mean serum lactic acid (P

This study critically investigates the social economic predictors of parental involvement in rural schools in Kenya and its implications on teaching and learning. Education is a major foundation for socioeconomic growth and the provision of quality education. However, teaching and learning are affected by various socioeconomic factors that this study seeks to investigate. Among the social economic predictors, family size, household income level and parents' level of education were found to significantly influence teaching and learning outcomes in Kenya's rural schools. Large families with small household income face challenges in paying school-related levies; acquire learning and teaching materials, book for extra learning activities and support co-curricular activities for their children. The article also presents the policy implications of the study, particularly on issues related to family size and household income level in parents' level of education in rural school settings. [ABSTRACT FROM AUTHOR]

Kenya must invest more in education to realize her vision 2030. The government commitment to Education for All's goal has been expressed through provision of basic education in pre-primary, primary and secondary school levels. To this end, the government introduced two kitties; Free Primary Education in 2003 and Subsidized Secondary Education in 2008 (where the government paid tuition fees for the students in secondary schools), but left parents to finance Early Childhood Development and Education. Since public centers were not well equipped, only the poor parents enrolled their children. The study was carried out in Nyahururu District in 2010, to assess the impacts of the two government kitties on public Early Childhood Development and Education centers in Kenya. To evaluate the impact of the kitties on the public Early Childhood Development and Education centers, private centers were also studied together. The study revealed that while the kitties led to rising enrolment in primary, secondary school and private Early Childhood Development and Education centers, enrolment declined in public centers. The two have lowered the quality of education in public Early Childhood Development and Education centers since parents were unwilling to raise finances enough to employ and motivate teachers, buy teaching/learning resources, school facilities and school feeding program. High enrolment after Free Primary Education also took up classrooms meant for Early Childhood Development and Education in public centers.

Tylosema fassoglense (TFG) is used as an antidiarrheal traditional medicine in Western Kenya. This study aimed to investigate the antidiarrheal activity of its aqueous extracts in-vivo and the putative mechanism (s) of action ex-vivo using Sprague-Dawley rats and New Zealand white rabbits respectively. The in-vivo antidiarrheal effects of the extract were evaluated in castor oil-induced diarrhea, the castor oil-induced enteropooling, and phenol red gastric motility tests. On the other hand, isolated rabbit’s jejunal segments were used to evaluate the spasmolytic effect of TFG on spontaneous contraction, in acetylcholine-induced contraction, in presence of 80mMK+, calcium chloride-induced contraction as well as in presence of the following antagonists: naloxone, methylene blue, L-NAME, prazosin, and propranolol in the ex-vivo studies. The data were express as Mean ± S.E.M and analyzed by one-way ANOVA and Tukey’s post hoc test in cases of significance which was set at p < 0.05. The extract was phytochemically characterized using Liquid chromatography Mass spectroscopy (LC-MS).The extract possessed significant inhibitory effect in the in-vivo experiments. The extract exhibited significant spasmolytic effect on both spontaneous contraction and in jejunal segment pre-contracted acetylcholine as well as in presence of 80mMK+ solution. It also attenuated the spasmogenic effect of various concentration of calcium chloride. The extract’s spasmolytic effect was, however, significantly attenuated in presence of several antagonists (methylene blue and L-NAME) but the adrenergic blockers (prazosin and propranolol) had no significant effect in the ex-vivo studies. LC-MS identified thirty compounds where Proathocyanidin (11.54%), Syringic acid (7.30%), and 4-Hydroxybenzoic acid (6.19%) had the highest percentage abundance. In conclusion, the results obtained in this study partially validate the traditional uses of the tubers of this plant species as an antidiarrheal. These antidiarrheal effects are probably mediated via modulation of nitrous oxide pathway, voltage gated calcium channels, and muscarinic receptors.

Although the introduction of rotavirus vaccines has substantially contributed to the reduction in rotavirus morbidity and mortality, concerns persist about the re-emergence of variant strains that might alter vaccine effectiveness in the long term. The G9 strains re-emerged in Africa during the mid-1990s and have more recently become predominant in some countries, such as Ghana and Zambia. In Rwanda, during the 2011 to 2015 routine surveillance period, G9P[8] persisted during both the pre- and post-vaccine periods. The pre-vaccination cohort was based on the surveillance period of 2011 to 2012, and the post-vaccination cohort was based on the period of 2013 to 2015, excluding 2014. The RotaTeq® vaccine that was first introduced in Rwanda in 2012 is genotypically heterologous to Viral Protein 7 (VP7) G9. This study elucidated the whole genome of Rwandan G9P[8] rotavirus strains pre- and post-RotaTeq® vaccine introduction. Fecal samples from Rwandan children under the age of five years (pre-vaccine n = 23; post-vaccine n = 7), conventionally genotyped and identified as G9P[8], were included. Whole-genome sequencing was then performed using the Illumina® MiSeq platform. Phylogenetic analysis and pair-wise sequence analysis were performed using MEGA6 software. Distinct clustering of three post-vaccination study strains was observed in all 11 gene segments, compared to the other Rwandan G9P[8] study strains. Specific amino acid differences were identified across the gene segments of these three 2015 post-vaccine strains. Important amino acid differences were identified at position N242S in the VP7 genome segment of the three post-vaccine G9 strains compared to the other G9 strains. This substitution occurs at a neutralization epitope site and may slightly affect protein interaction at that position. These findings indicate that the Rwandan G9P[8] strains revealed a distinct sub-clustering pattern among post-vaccination study strains circulating in Rwanda, with changes at neutralization epitopes, which may play a role in neutralization escape from vaccine candidates. This emphasizes the need for continuous whole-genome surveillance to better understand the evolution and epidemiology of the G9P[8] strains post-vaccination. [ABSTRACT FROM AUTHOR]

Objective To develop a novel measure to characterize human immunodeficiency virus (HIV) programme quality at health facilities in Kenya and explore its associations with patient--and facility-level characteristics. Methods We developed a composite indlcatorto measure quality of HIV care, comprising: assessment of eligibility for antiretroviral therapy (ART); initiation of ART; and retention on ART or in care, if ineligible for ART, for 12 months. We applied the comprehensive retention indicator to routinely collected clinical data from 13 331 patients enrolled In HIV care and treatment at 63 health facilities in the Eastern and Nyanza regions of Kenya from 1 January 2014 to 31 March 2016. We explored the association between facility--and patient-level characteristics and the primary outcome: appropriate staging and management of HIV, and retention in care over 12 months. Findings Of the enrolled patients, 8404 (63%) achieved comprehensive retention 12 months after enrolment in care. In univariate analyses, patients at facilities where nurses delivered HIV treatment services (including eligibility assessment, initiation and follow up of ART) had significantly higher comprehensive retention rates at 12 months. In multivariate analyses, after adjusting for both facility--and patient-level characteristics, patients at facilities where nurses initiated ART had significantly higher comprehensive retention in care at 12 months (relative risk, RR: 1.22; 95% confidence interval, CI: 1.00-1.48). Conclusion Nurse-led HIV services were significantly associated with quality of care, confirming the central role of nurses in the achievement of global health goals, and the need for further investment in nursing education, training and mentoring. Objectif Concevoir une nouvelle mesure pour caracteriser la qualite du programme VIH (virus de Hmmunodeficience humalne) dans des centres de sante au Kenya et analyser ses correlations avec les caracteristiques des patients et les caracteristiques des centres de sante. Methodes Pour mesurer la qualite des soins anti-VIH, nous avons concu un indicateur composite, qui englobe: Evaluation de l'eligibilite a une therapie antiretrovirale (TAR), le lancement de la TAR et le continuum de la TAR ou--pour les patients non eligibles a une TAR--le continuum de soins. Nous avons applique cet indicateur de continuum complet aux donnees cliniques habituellement consignees par les centres de sante; des donnees qui ont porte sur 13 331 patients pris en charge et traites pour une infection a VIH dans 63 centres de sante de la province orientaleet de la province de Nyanza au Kenya entre le 1er janvier 2014 et le 31 mars 2016. Nous avons analyse les correlations entre les caracteristigues des centres et des patients et le principal critere observe: le correct enchainement des etapes / la prise en charge appropriee de l'infection a VIH et le continuum de soins sur 12 mois. Resultats Le critere de continuum complet 12 mois apres la prise en charge a ete satisfait pour 8404 patients (63%). Dans nos analyses univariees, les taux de continuum complet a 12 mois ont ete sensiblement superieurs chez les patients pris en charge dans des centres ou les services de traitement contre le VIH ont ete menes par des infirmiers (charges notamment de Evaluation de l'eligibilite a une TAR ainsi que du lancement et du suivi des TAR). Dans nos analyses multivariees, apres ajustement en fonction des caracteristiques des centres et des patients, des taux sensiblement superieurs de continuum complet a 12 mois ont ete observes chez les patients pris en charge dans des centres ou les TAR ont ete lancees par des infirmiers (risque relatif: 1,22; intervalle de confiance de 95%: 1,00-1,48). Conclusion Les services anti-VIH menes par des infirmiers ont largement ete assocles a une bonne qualite des soins, ce qui confirme le role central des infirmiers dans l'atteinte des objectifs de sante mondiaux et la necessite d'investir davantage dans l'apprentissage, la formation et le tutorat des Infirmiers. Objetivo Desarrollar una medida novedosa para caracterizar la calidad del programa contra el virus de la inmunodeficiencia humana (VIH) en centros sanitarios de Kenya y explorar sus asociaciones con las caracteristicas a nivel de paciente y centro. Metodos Se desarrollo un indicador compuesto para medir la calidad de la atencion contra el VIH formado por: una evaluacion de la elegibilidad para el tratamiento antirretrovirico (TAR), la iniciacion del TAR y la retencion en el TAR o en la atencion, si no es posible recibir el TAR, durante 12 meses. Se aplico el Indicador de retencion completo a datos clinicos recopilados de forma rutinaria de 13 331 pacientes inscritos en la atencion y el tratamiento contra el VIH en 63 centros sanitarios en las provincias del Este y Nyanza, en Kenia, del 1 de enero de 2014 al 31 de marzo de 2016. Se analizo la asociacion entre las caracteristicas a nivel de pacientes y de centros y el resultado principal: una estadlficacion y gestion adecuadas del VIH, asi como una retencion de la atencion durante 12 meses. Resultados De los pacientes inscritos, 8 404 (63%) lograron una retencion completa al cabo de 12 meses de inscribirse en la atencion. En analisis univariables, los pacientes de los centros donde las enfermeras ofrecieron los servicios del tratamiento contra el VIH (incluida una evaluacion de la elegibilidad, la iniciacion y el seguimiento del TAR) registraron unas tasas de retencion completa mucho mas altas en 12 meses. En analisis multivariables, tras ajustar las caracteristicas a nivel de pacientes y de centros, los pacientes de los centros donde las enfermeras iniciaron el TAR registraron unas tasas de retencion completa mucho mas altas en 12 meses (riesgo relativo (RR): 1,22; intervalo de confianza (IC) del 95%: 1,00-1,48). Conclusion Los servicios contra el VIH dirigidos por enfermeras estaban significativamente asociados con la calidad de la atencion, lo que confirma el importante papel de las enfermeras a la hora de lograr objetivos de salud globales, asi como la necesidad de invertir mas en la educacion, formacion y orientacion de las enfermeras., Introduction The global response to the human immunodeficiency virus (HIV) epidemic has been remarkably successful. In low--and middle-income countries, the number of people living with HIV who have access to [...]

Kenya started providing secondary school education as part of her basic education in 2008 through subsidized secondary education in 2008, but was faced by two major challenges; secondary schools are fewer than primary schools, and secondary education is more costly than primary education. This has made many students especially those from poor families fail to access and complete their secondary education. The study was carried out to find out ways in which constituency development fund has promoted access and retention of secondary school students in Laikipia West district. The objectives of the study were to find out how many students access secondary education in the district, ways in which the fund promotes access to secondary education in the district, how the fund enhances retention rates of students in the district, procedure followed to propose, rank and finance projects initiated by the fund in the district, and the problems that face constituency development committee while utilizing the fund as an alternative method of financing secondary education in the district. The study was carried out using descriptive survey. The study was carried out on a population of 45 secondary school head teachers, 15 chiefs, district education office, constituency development committee's office and 4574 students who applied for Constituency Development Fund bursaries in 2008. Purposive sampling technique was used to select 813 students who benefited from bursaries by the fund in 2008. Data was collected using questionnaires, interviews and document analysis. Data was analyzed using descriptive statistics. Questionnaires were piloted in 5 schools and 15 bursary beneficiaries of 2008, one from each of the 15 locations in the district using test retest method. The study found out that the fund has promoted secondary education as witnessed by increased access to secondary education in the district through new and expanded school facilities like classrooms, science laboratories, and school water and electricity projects. It also enhanced retention rates of students in the district through bursaries and expanded facilities in young schools.