Acquisition of Materials and Performance of Road Construction Projects in Kenya: A Case of Nairobi County

This study sought to establish the influence of acquisition of materials on performance of road construction projects in Kenya: A case of Nairobi County. The objective of the study was to establish the extent to which acquisition of materials influences performance of road construction projects in Kenya. This study was anchored on the theory of controlling, theory of construction management, and stakeholder theory. The paradigm used was pragmatism and the research approach used was mixed methods. Cross sectional descriptive survey and correlational research design were used. The sample size was 74 senior engineers which comprised 30 senior engineers from consulting engineering firms and 44 senior engineers from construction companies; 74 managing directors which comprised 30 managing directors from consulting engineering firms and 44 managing directors from construction companies. A five point Likert type scale questionnaire was used to collect quantitative data while interview guides were used to collect qualitative data. The statistical tools of analysis that were used for descriptive data were frequencies, percentages, arithmetic mean and standard deviation while the statistical tools that were used for inferential statistics were Pearson’s Product Moment Correlation and Linear Regression. The Fisher (F) test was used to test the hypotheses. The results indicated that with R²=0.246, F(6,40)=2.173, p=0.066>0.05, H1 was rejected and it was concluded that acquisition of materials had no statistically significant influence on the performance of road construction projects. However, establishment of quantities of materials required had a statistically significant influence on the performance of road construction projects. The study recommends that organizations that deal with road construction should have appropriate policies on establishment of quantities of materials required

ENHANCING PERFORMANCE OF MANGO FARMING PROJECTS THROUGH PARTICIPATORY PROJECT MANAGMENT

Objective: This paper advocates for a paradigm shift from the traditional project management to a participatory approach throughout the management cycle, for increased performance of mango farming projects.   Theoretical Framework: Theories adopted: i. Project Management Theory: Highlights life cycle stages in uncovering new project insights. ii. Stakeholder Theory: Highlights the unity of stakeholders for enhanced involvement in projects. iii. Participation Ladder Theory: Enhances success through active participation. iv. Theory of Constraints: Confronts project challenges related to time, cost, and scope to achieve beneficial changes.   Method: The empirical study was carried out in Makueni County, Kenya. It used descriptive cross-sectional design and multistage rsampling on a population of 12,622, out of which a sample of 375 respondnets selected. Of these, 369 questionnaires were returned and analyzed. Additionally, it involved 15 key informants. Observation and an interview guides collected qualitative data. Descriptive and inferential tools, correlation, F-tests, regression and content analysis analyzed quantitative and qualitative data.   Results and Discussion: Results reflected item scores showing the composite mean of 3.2 and standard deviation of 3.0. Revealed is a significant positive correlation coefficient (r = 0.592), p-value (p = 0.000) of the relationship between two variables.   Research Implications: This study recommends adopting a participatory project cycle approach, supported by a feasible policy, to guide innovative mango farming practices to enhance the overall performance.   Originality/Value: The study contributes to literature by advocating project management cycle approach on performance of mango projects in today’s evolving project environment

Acute malnutrition recovery energy requirements based on mid-upper arm circumference: Secondary analysis of feeding program data from 5 countries, Combined Protocol for Acute Malnutrition Study (ComPAS) Stage 1.

BACKGROUND: Severe and moderate acute malnutrition (SAM and MAM) are currently treated with different food products in separate treatment programs. The development of a unified and simplified treatment protocol using a single food product aims to increase treatment program efficiency and effectiveness. This study, the first stage of the ComPAS trial, sought to assess rate of growth and energy requirements among children recovering from acute malnutrition in order to design a simplified, MUAC-based dosage protocol. METHODS: We obtained secondary data from patient cards of children aged 6-59 months recovering from SAM in outpatient therapeutic feeding programs (TFPs) and from MAM in supplementary feeding programs (SFPs) in five countries in Africa and Asia. We used local polynomial smoothing to assess changes in MUAC and proportional weight gain between clinic visits and assessed their normalized differences for a non-zero linear trend. We estimated energy needs to meet or exceed the growth observed in 95% of visits. RESULTS: This analysis used data from 5518 patients representing 33942 visits. Growth trends in MUAC and proportional weight gain were not significantly different, each lower at higher MUAC values: MUAC growth averaged 2mm/week at lower MUACs (100 to <110mm) and 1mm/week at higher MUACs (120mm to <125mm); and proportional weight gain declined from 3.9g/kg/day to 2.4g/kg/day across the same MUAC values. In 95% of visits by children with a MUAC 100mm to <125mm who were successfully treated, energy needs could be met or exceeded with 1,000 kilocalories a day. CONCLUSION: Two 92g sachets of Ready-to-Use Therapeutic Food (RUTF) (1,000kcal total) is proposed to meet the estimated total energy requirements of children with a MUAC 100mm to <115mm, and one 92g sachet of RUTF (500kcal) is proposed to meet half the energy requirements of children with a MUAC of 115 to <125mm. A simplified, combined protocol may enable a more holistic continuum of care, potentially contributing to increased coverage for children suffering from acute malnutrition

Epidémiologie moléculaire du rotavirus du groupe A associé aux gastroentérites chez les enfants de moins de 5 ans dans la ville de Yaoundé (Cameroun)

Le rotavirus est la première cause de gastroentérites grave chez les enfants de moins de 5 ans. La gravité et la mortalité de la maladie sont majorées dans les pays à revenus faibles d’Asie du sud et d’Afrique subsaharienne. Au Cameroun, la forte prévalence des rotaviroses, associées aux spécificités génotypiques locales du virus, soulignent l’importance de disposer de données épidémiologiques sur le virus. Cette étude visait à contribuer à une meilleure connaissance des principales souches de rotavirus responsables des gastroentérites chez les enfants de moins de 5 ans dans la ville de Yaoundé. Il s’agit d’une étude descriptive transversale d’une durée de 4 mois, dans 8 formations sanitaires de la ville de Yaoundé. Les échantillons de selles d’enfants de moins de 5 ans, hospitalisés pour gastroentérite ont été prélevés. La recherche du rotavirus s’est faite avec le kit ELISA Oxoid ProSpec TTM, et la détermination des génotypes du virus s’est faite par RT - PCR. Cent trente échantillons de selles d’enfants souffrant de gastroentérite ont été collectés. 66,1% de ces échantillons provenaient des hôpitaux FCB/CME, du CHE et de HDE. Le rotavirus a été isolé chez 30% des enfants, dont 40% avait entre 6 et 11 mois. Le CHE (6,9%) et l’HGY (0%) avaient respectivement la prévalence la plus élevée et la plus basse de la ville. Un nombre élevé de combinaisons génotypiques a été isolé, parmi lesquels prédominaient G1P[8] (31%) suivit de G3P[6] (28%) et de G4P[6] (13 %). Les génotypes mixtes G1P[6][8], G2P[6][8], et G1G3P[8] représentaient 22% des isolats. Un type G (3%) est resté indéterminé durant cette étude.© 2015 International Formulae Group. All rights reserved.Mots clés: Epidémiologie moléculaire, rotavirus, génotypes, gastroentérite, enfants, YaoundéEnglish Title:  Molecular epidemiology of group A rotavirus associated to gastroenteritis in children less than 5 years in Yaoundé (Cameroon)English AbstractRotavirus is the leading cause of severe gastroenteritis in children less than 5 years. Severity and mortality of this disease are majored in low-income countries of South - Asia and sub - Saharan Africa. In Cameroon, the high prevalence of rotaviruses associated to local genotypic specificities of virus enhances the importance of epidemiological database on the virus. This study aimed at contributing to a better knowledge of the main rotavirus strains responsible for gastroenteritis in children less than 5 years in Yaoundé. We carried out a descriptive and cross sectional study during 4 months, in 8 health centers in Yaoundé. Stool specimens were collected from children less than 5 years old, hospitalized for gastroenteritis. Rotavirus was detected with ELISA kit Oxoid ProSpecTTM, and genotypes determined by RT - PCR. One hundred and twenty seven stool specimens were collected during the study. FCB/CME, CHE, HDE provided 66.1% of specimens collected. Rotavirus was isolated in 30% of children, and 40% of these children were between 6 to 11 months old. The CHE (6. 9%) and the HGY (0%) had respectively the highest and the lowest prevalence of the town. A large number of genotype has been isolated and G1P[8] (31%) were predominant, followed by G3P[6] (28%) and G4P[6] (13%). Mixt genotypes G1P[6][8], G2P[6][8], and G1G3P[8] represented 22% of isolates. One G - type remained untypable.© 2015 International Formulae Group. All rights reserved.Keywords: Molecular epidemiology, rotavirus, genotypes, gastroenteritis, children, Yaound

Understanding the relationship between cerebellar structure and social abilities

Background The cerebellum contains more than 50% of all neurons in the brain and is involved in a broad range of cognitive functions, including social communication and social cognition. Inconsistent atypicalities in the cerebellum have been reported in individuals with autism compared to controls suggesting the limits of categorical case control comparisons. Alternatively, investigating how clinical dimensions are related to neuroanatomical features, in line with the Research Domain Criteria approach, might be more relevant. We hypothesized that the volume of the “cognitive” lobules of the cerebellum would be associated with social difficulties. Methods We analyzed structural MRI data from a large pediatric and transdiagnostic sample (Healthy Brain Network). We performed cerebellar parcellation with a well-validated automated segmentation pipeline (CERES). We studied how social communication abilities—assessed with the social component of the Social Responsiveness Scale (SRS)—were associated with the cerebellar structure, using linear mixed models and canonical correlation analysis. Results In 850 children and teenagers (mean age 10.8 ± 3 years; range 5–18 years), we found a significant association between the cerebellum, IQ and social communication performance in our canonical correlation model. Limitations Cerebellar parcellation relies on anatomical boundaries, which does not overlap with functional anatomy. The SRS was originally designed to identify social impairments associated with autism spectrum disorders. Conclusion Our results unravel a complex relationship between cerebellar structure, social performance and IQ and provide support for the involvement of the cerebellum in social and cognitive processes

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Changes in the Fungal Microbiome of Maize During Hermetic Storage in the United States and Kenya

Prior to harvest, maize kernels are invaded by a diverse population of fungal organisms that comprise the microbiome of the grain mass. Poor post-harvest practices and improper drying can lead to the growth of mycotoxigenic storage fungi and deterioration of grain quality. Hermetic storage bags are a low-cost technology for the preservation of grain during storage, which has seen significant adoption in many regions of Sub-Saharan Africa. This study explored the use of high-throughput DNA sequencing of the fungal Internal Transcribed Spacer 2 (ITS2) region for characterization of the fungal microbiome before and after 3 months of storage in hermetic and non-hermetic (woven) bags in the United States and Kenya. Analysis of 1,377,221 and 3,633,944 ITS2 sequences from the United States and Kenya, respectively, resulted in 251 and 164 operational taxonomic units (OTUs). Taxonomic assignment of these OTUs revealed 63 and 34 fungal genera in the US and Kenya samples, respectively, many of which were not detected by traditional plating methods. The most abundant genus was Fusarium, which was identified in all samples. Storage fungi were detected in the grain mass prior to the storage experiments and increased in relative abundance within the woven bags. The results also indicate that storage location had no effect on the fungal microbiome of grain stored in the United States, while storage bag type led to significant changes in fungal composition. The fungal microbiome of the Kenya grain also underwent significant changes in composition during storage and fungal diversity increased during storage regardless of bag type. Our results indicated that extraction of DNA from ground kernels is sufficient for identifying the fungi associated with the maize. The results also indicated that bag type was the most important factor influencing changes in fungal microbiome during storage. The results also support the recommended use of hermetic storage for reducing food safety risks, especially from mycotoxigenic fungi

Analgesics from Lonchocarpus eriocalyx Harms

Four lupane-type terpenoids, namely lupeol (1), friedelin (2), stigmasterol (3), and stigmasterol-3-O-glucoside (4) were isolated from the ethyl acetate extract of leaves of Lonchocarpus eriocalyx Harms. These compounds were obtained by extensive silica gel chromatography and their structures elucidated by 1D and 2D nuclear magnetic resonance (NMR) as well as comparison with literature data. The ethyl acetate, dichloromethane and methanol extracts (100 mg/Kg) had a pretreatment latency of 3.1±0.15, 3.0±0.01 and 3.5±0.12 at the zero minute. The post latency of 6.4±0.13 was observed for ethyl acetate at 30 minutes which confirmed its effectiveness to halt pain, while compounds 1 and 2had pretreatment latency of 3.1±0.12 and 3.2±0.12, respectively. The isolated compounds from this medicinal plant along with their analgesic activity have been reported for the first time.National Commission for Science, Technology and Innovation (NACOSTI) Kenya Medical Research Institute (KEMRI) Mr. Simon Matheng