Are dormancy management and physiological age the achilles' heel of aeroponic minituber production in seed potato value chains in SSA?

Scarcity of good quality seed is major obstacle to expanded potato (Solanum tuberosum L.) production in sub-saharan Africa (SSA). Constraints in availability and supply of seed potato are partly attributable to challenges in production of pre-basic which is an intermediary step necessary in production of seed tubers in the seed potato value chain. Aeroponic minutuber production is a relatively recent technology that has the potential to break the seed potato bottleneck in many SSA countries due to several advantages that it holds especially those related to high multiplication rates; typically (1:50-100) that arise from sequential harvesting. There are, however, a number of potential challenges which, if not addressed, can contribute to non attainment of the projected increases in seed availability and not only mess up the 3 generation (3G) revolution strategy of boosting seed tuber production in SSA but also jeopardize the adoption of the technology. Besides problems associated with failure of electricity supply and management of nutrition, the Achilles‘ heel of aeroponic minituber production is probably the large variation in physiological age of resulting tubers due to sequential harvesting that takes place over several months during the production cycle. In the absence of cold storage facilities which are few and beyond the reach of many pre-basic seed potato growers in many SSA countries, harvested minitubers can either be at dormant, apical dominance, multiple sprouting or senile stage when they are required for planting with significant impacts on subsequent yields. This paper discusses the problems associated with physiological age in seed tuber systems based on aeroponic minitubers and proposes some approaches that may overcome these challenges to ensure that the promise of aeroponic minituber production is realized. The proposed approaches include the strategic application of dormancy inhibiting and dormancy promoting substances at various stages of aeroponic minituber production combined with the use of low cost storage systems such as the diffused light storage technology depending on the dormancy period of the variety (ies) being grown

Molecular epidemiology of Klebsiella pneumoniae invasive infections over a decade at Kilifi County Hospital in Kenya.

Multidrug resistant (MDR) Klebsiella pneumoniae is a common cause of nosocomial infections worldwide. Recent years have seen an explosion of resistance to extended-spectrum ?-lactamases (ESBLs) and emergence of carbapenem resistance. Here, we examine 198 invasive K. pneumoniae isolates collected from over a decade in Kilifi County Hospital (KCH) in Kenya. We observe a significant increase in MDR K. pneumoniae isolates, particularly to third generation cephalosporins conferred by ESBLs. Using whole-genome sequences, we describe the population structure and the distribution of antimicrobial resistance genes within it. More than half of the isolates examined in this study were ESBL-positive, encoding CTX-M-15, SHV-2, SHV-12 and SHV-27, and 79% were MDR conferring resistance to at least three antimicrobial classes. Although no isolates in our dataset were found to be resistant to carbapenems we did find a plasmid with the genetic architecture of a known New Delhi metallo-?-lactamase-1 (NDM)-carrying plasmid in 25 isolates. In the absence of carbapenem use in KCH and because of the instability of the NDM-1 gene in the plasmid, the NDM-1 gene has been lost in these isolates. Our data suggests that isolates that encode NDM-1 could be present in the population; should carbapenems be introduced as treatment in public hospitals in Kenya, resistance is likely to ensue rapidly

Prevalence and determinants of human papillomavirus infection and cervical lesions in HIV-positive women in Kenya

Background: We assessed the association of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) with various characteristics, CD4 count and use of combination antiretroviral therapy (cART) among HIV-positive women. Methods: Cross-sectional study of 498 HIV-positive women who underwent HPV PCR-based testing, cytology, and systematic cervical biopsy. Results: In all, 68.7% of women were HPV-positive, 52.6% had high-risk (hr) HPV, and 40.2% multiple type infections. High-risk human papillomavirus-positivity did not vary significantly by age but it was negatively associated with education level. The most frequent types in 113 CIN2/3 were HPV16 (26.5%), HPV35 (19.5%), and HPV58 (12.4%). CD4 count was negatively associated with prevalence of hrHPV (Po0.001) and CIN2/3 among non-users of cART (P¼0.013). Combination antiretroviral therapies users (X2 year) had lower hrHPV prevalence (prevalence ratio (PR) vs non-users¼0.77, 95% confidence interval (CI): 0.61–0.96) and multiple infections (PR¼0.68, 95% CI: 0.53–0.88), but not fewer CIN2/3. The positive predictive value of hrHPV-positivity for CIN2/3 increased from 28.9% at age o35 years to 53.3% in X45 years. Conclusion: The burden of hrHPV and CIN2/3 was high and it was related to immunosuppression level. Combination antiretroviral therapies (X2 year) use had a favourable effect on hrHPV prevalence but cART in our population may have been started too late to prevent CIN2/3

Evaluation of Pneumococcal Load in Blood by Polymerase Chain Reaction for the Diagnosis of Pneumococcal Pneumonia in Young Children in the PERCH Study.

BACKGROUND.: Detection of pneumococcus by lytA polymerase chain reaction (PCR) in blood had poor diagnostic accuracy for diagnosing pneumococcal pneumonia in children in 9 African and Asian sites. We assessed the value of blood lytA quantification in diagnosing pneumococcal pneumonia. METHODS.: The Pneumonia Etiology Research for Child Health (PERCH) case-control study tested whole blood by PCR for pneumococcus in children aged 1-59 months hospitalized with signs of pneumonia and in age-frequency matched community controls. The distribution of load among PCR-positive participants was compared between microbiologically confirmed pneumococcal pneumonia (MCPP) cases, cases confirmed for nonpneumococcal pathogens, nonconfirmed cases, and controls. Receiver operating characteristic analyses determined the "optimal threshold" that distinguished MCPP cases from controls. RESULTS.: Load was available for 290 of 291 cases with pneumococcal PCR detected in blood and 273 of 273 controls. Load was higher in MCPP cases than controls (median, 4.0 × 103 vs 0.19 × 103 copies/mL), but overlapped substantially (range, 0.16-989.9 × 103 copies/mL and 0.01-551.9 × 103 copies/mL, respectively). The proportion with high load (≥2.2 log10 copies/mL) was 62.5% among MCPP cases, 4.3% among nonconfirmed cases, 9.3% among cases confirmed for a nonpneumococcal pathogen, and 3.1% among controls. Pneumococcal load in blood was not associated with respiratory tract illness in controls (P = .32). High blood pneumococcal load was associated with alveolar consolidation on chest radiograph in nonconfirmed cases, and with high (>6.9 log10 copies/mL) nasopharyngeal/oropharyngeal load and C-reactive protein ≥40 mg/L (both P < .01) in nonconfirmed cases but not controls. CONCLUSIONS.: Quantitative pneumococcal PCR in blood has limited diagnostic utility for identifying pneumococcal pneumonia in individual children, but may be informative in epidemiological studies

Standardization of Laboratory Methods for the PERCH Study.

The Pneumonia Etiology Research for Child Health study was conducted across 7 diverse research sites and relied on standardized clinical and laboratory methods for the accurate and meaningful interpretation of pneumonia etiology data. Blood, respiratory specimens, and urine were collected from children aged 1-59 months hospitalized with severe or very severe pneumonia and community controls of the same age without severe pneumonia and were tested with an extensive array of laboratory diagnostic tests. A standardized testing algorithm and standard operating procedures were applied across all study sites. Site laboratories received uniform training, equipment, and reagents for core testing methods. Standardization was further assured by routine teleconferences, in-person meetings, site monitoring visits, and internal and external quality assurance testing. Targeted confirmatory testing and testing by specialized assays were done at a central reference laboratory

Assessment of Patient Satisfaction with Nursing Care at a Large Public Referral Hospital in Kenya

Patient satisfaction with nursing care is known to predict patient outcomes. Nursing care offered by the largest single technical group in any hospital, is known to often determine the overall quality of care offered. This study hence examined the extent to which patients at a Referral hospital in Western Kenya are satisfied with the nursing care they receive. A cross sectional exit survey of discharged patients using a self-administered patient questionnaire was used. 274 patients participated, of which 65.6% were female. 94.1% had formal education with 59.1% reporting that this was their maiden visit to the hospital. Overall, 87% of patients felt satisfied with nursing care received. Most (81.8%) of the patients interviewed felt they had been promptly attended to, with a further 71.6% rating the nurses as competent and knowledgeable in their clinical care. The ward in which the patient had been admitted and the number of days a patient had spent in hospital were found to be significantly associated with reporting of overall satisfaction with nursing care (p=0.037 &amp; 0.03 respectively). Since nursing care is determinant of patient outcomes during hospitalization, clinical care administrators should often emphasize on the Nurses’ technical competence and interpersonal relationships throughout patient care. Prompt quality nursing care should be prioritized to match with patient expectations in each hospital units and ensure patient satisfaction through reduction of length of stay in hospital. Key words: Assessment, patient satisfaction, nursing car

Detection of Pneumococcal DNA in Blood by Polymerase Chain Reaction for Diagnosing Pneumococcal Pneumonia in Young Children From Low- and Middle-Income Countries.

BACKGROUND.: We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries. METHODS.: We tested blood by PCR for the pneumococcal autolysin gene in children aged 1-59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization-defined severe or very severe pneumonia or were age-frequency-matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls. RESULTS.: In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%-11.5% among cases and 5.3%-10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus. DISCUSSION.: The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases