Determining the Dynamics of HIV Voluntary Counselling and Testing Uptake among the Rural and Urban Communities of Nakuru District, Kenya

Globally, it is estimated that over 40 million people are living with HIV/AIDS with 67% of these coming from Sub Sahara Africa. While the epidemic has been receiving increasing attention towards and more emphasis placed on access to care and treatment, these efforts are bound to become unsustainable due to a high rate of new infections. In 2007, for every HIV patient who was put on drugs six others became infected with the virus. Voluntary testing and counselling (VCT) has been suggested as the most effective intervention that could reverse this rate of infection. Its utilization in Africa and many parts of the world has however, been at an all time low. In Kenya where populations of over 1.4 million people are living with the HIV/AID virus, less than 20% of the total population knows their status. The aim of this study is, therefore, to establish and document the dynamics of VCT uptake in Nakuru district of Kenya with a view to suggesting measures to increase this uptake. The main objectives of the study were to identify factors that influence VCT uptake and determine the levels of knowledge and prevailing attitudes on HIV testing. The role that gender plays in VCT utilization was also explored. This was a cross sectional study in which a mixed research method methodology employing quantitative and qualitative data collection methods was used. Quantitative data was collected using a structured questionnaire while qualitative data was collected using focus group discussions and key informant interviews. The target population was residents of Nakuru aged 16-60. 480 distributed completed the structured questionnaire out which 422 were completed and returned. Six focus group discussions and five key informant interviews were carried out. The research found that the awareness regarding HIV and VCT among the community members is relatively high. However, there are still a significant proportion of people who hold misconceptions about the disease and the testing service. This may partially explain why people opted not to take the test for the virus. Further, a majority of the people wanted to take up the test but both social and health system barriers such as gender inequality, the cost of taking the service, service operational hours, accessibility; misconceptions about the disease are barriers to the utilization of the service. The study recommends the adoption of more pro-active model of testing which could include mobile and home-based testing to help remove most of these barriers and therefore lead to an increased uptake. Moreover promotional activities targeting couples, providing the service beyond the current normal working hours weekdays and weekends, strengthening the general public health facility to help win back the trust of the service consumer and provision of youth-friendly voluntary counselling and testing for HIV (VCT) service are recommended

Determining the Dynamics of HIV Voluntary Counselling and Testing Uptake among the Rural and Urban Communities of Nakuru District, Kenya

Globally, it is estimated that over 40 million people are living with HIV/AIDS with 67% of these coming from Sub Sahara Africa. While the epidemic has been receiving increasing attention towards and more emphasis placed on access to care and treatment, these efforts are bound to become unsustainable due to a high rate of new infections. In 2007, for every HIV patient who was put on drugs six others became infected with the virus. Voluntary testing and counselling (VCT) has been suggested as the most effective intervention that could reverse this rate of infection. Its utilization in Africa and many parts of the world has however, been at an all time low. In Kenya where populations of over 1.4 million people are living with the HIV/AID virus, less than 20% of the total population knows their status. The aim of this study is, therefore, to establish and document the dynamics of VCT uptake in Nakuru district of Kenya with a view to suggesting measures to increase this uptake. The main objectives of the study were to identify factors that influence VCT uptake and determine the levels of knowledge and prevailing attitudes on HIV testing. The role that gender plays in VCT utilization was also explored. This was a cross sectional study in which a mixed research method methodology employing quantitative and qualitative data collection methods was used. Quantitative data was collected using a structured questionnaire while qualitative data was collected using focus group discussions and key informant interviews. The target population was residents of Nakuru aged 16-60. 480 distributed completed the structured questionnaire out which 422 were completed and returned. Six focus group discussions and five key informant interviews were carried out. The research found that the awareness regarding HIV and VCT among the community members is relatively high. However, there are still a significant proportion of people who hold misconceptions about the disease and the testing service. This may partially explain why people opted not to take the test for the virus. Further, a majority of the people wanted to take up the test but both social and health system barriers such as gender inequality, the cost of taking the service, service operational hours, accessibility; misconceptions about the disease are barriers to the utilization of the service. The study recommends the adoption of more pro-active model of testing which could include mobile and home-based testing to help remove most of these barriers and therefore lead to an increased uptake. Moreover promotional activities targeting couples, providing the service beyond the current normal working hours weekdays and weekends, strengthening the general public health facility to help win back the trust of the service consumer and provision of youth-friendly voluntary counselling and testing for HIV (VCT) service are recommended

Differentiation of Schistosoma haematobium from related schistosomes by PCR amplifying an inter-repeat sequence.

Schistosoma haematobium infects nearly 150 million people, primarily in Africa, and is transmitted by select species of local bulinid snails. These snails can host other related trematode species as well, so that effective detection and monitoring of snails infected with S. haematobium requires a successful differentiation between S. haematobium and any closely related schistosome species. To enable differential detection of S. haematobium DNA by simple polymerase chain reaction (PCR), we designed and tested primer pairs from numerous newly identified Schistosoma DNA repeat sequences. However, all pairs tested were found unsuitable for this purpose. Differentiation of S. haematobium from S. bovis, S. mattheei, S. curassoni, and S. intercalatum (but not from S. margrebowiei) was ultimately accomplished by PCR using one primer from a newly identified repeat, Sh110, and a second primer from a known schistosomal splice-leader sequence. For evaluation of residual S. haematobium transmission after control interventions, this differentiation tool will enable accurate monitoring of infected snails in areas where S. haematobium is sympatric with the most prevalent other schistosome species

Cross-sectional study of the burden of vector-borne and soil-transmitted polyparasitism in rural communities of Coast Province, Kenya.

BACKGROUND: In coastal Kenya, infection of human populations by a variety of parasites often results in co-infection or poly-parasitism. These parasitic infections, separately and in conjunction, are a major cause of chronic clinical and sub-clinical human disease and exert a long-term toll on economic welfare of affected populations. Risk factors for these infections are often shared and overlap in space, resulting in interrelated patterns of transmission that need to be considered at different spatial scales. Integration of novel quantitative tools and qualitative approaches is needed to analyze transmission dynamics and design effective interventions. METHODOLOGY: Our study was focused on detecting spatial and demographic patterns of single- and co-infection in six villages in coastal Kenya. Individual and household level data were acquired using cross-sectional, socio-economic, and entomological surveys. Generalized additive models (GAMs and GAMMs) were applied to determine risk factors for infection and co-infections. Spatial analysis techniques were used to detect local clusters of single and multiple infections. PRINCIPAL FINDINGS: Of the 5,713 tested individuals, more than 50% were infected with at least one parasite and nearly 20% showed co-infections. Infections with Schistosoma haematobium (26.0%) and hookworm (21.4%) were most common, as was co-infection by both (6.3%). Single and co-infections shared similar environmental and socio-demographic risk factors. The prevalence of single and multiple infections was heterogeneous among and within communities. Clusters of single and co-infections were detected in each village, often spatially overlapped, and were associated with lower SES and household crowding. CONCLUSION: Parasitic infections and co-infections are widespread in coastal Kenya, and their distributions are heterogeneous across landscapes, but inter-related. We highlighted how shared risk factors are associated with high prevalence of single infections and can result in spatial clustering of co-infections. Spatial heterogeneity and synergistic risk factors for polyparasitism need to be considered when designing surveillance and intervention strategies

Assessing water availability under pastoral livestock systems in drought-prone Isiolo District, Kenya

Water availability / Water demand / Surface water / Groundwater / Wells / Salinity / Livestock / Grazing / Land use / Water supply / Drainage / GIS / Databases / Cost recovery

Efficacy of fungicide mixtures for the management of Phytophthora infestans (US-1) on potato

Fungicide application strategies (timing, frequency, rates and mixtures) are important for the control and resistance management of potato late blight caused by Phytophthora infestans. The efficacy of fungicide mixtures consisting of fenamidone + mancozeb and propamocarb HCL + mancozeb at various rates and in spray regimes containing metalaxyl and mancozeb was evaluated for late blight control (US-1) at four locations in Kenya. Propamocarb HCL + mancozeb significantly (P < 0.05) reduced foliar blight compared with mancozeb and the untreated control under moderate to severe disease pressure. Disease severity was significantly lower following application of propamocarb HCL + mancozeb at a rate of 4L ha-1 than at rates of 2L and 3L ha-1 in 1999 and 2000, but it was not significantly lower following applications at a rate of 3L ha-1 in 2000 and 2001. There were no significant differences in mean final late blight score among the three rates of 0.9, 1.0 and 1.1 kg ha-1 of fenamidone + mancozeb. All fungicide mixtures and application sequences significantly reduced the area under the disease progress curve and final late blight scores as compared with the unprotected control. Total and marketable tuber yield significantly (P < 0.05) increased in all fungicide-treated plots.Les stratégies d’application de fongicides (calendrier, fréquence, taux et mélanges) sont importantes pour la gestion et la lutte au mildiou de la pomme de terre, une maladie causée par le Phytophthora infestans. L’efficacité de mélanges fongicides composés de fénamidone + mancozèbe et de propamocarbe HCL + mancozèbe à différents taux et différents régimes d’arrosage comprenant du métalaxyl et du mancozèbe a été évaluée en ce qui a trait à la lutte au mildiou (US-1) dans quatre sites au Keyna. Le mélange composé de propamocarbe HCL + mancozèbe a réduit le mildiou de façon significative (P < 0.05) comparativement au mancozèbe utilisé seul et au témoin lorsque la maladie était de modérée à sévère. La maladie était significativement moins sévère après l’application de 4L ha-1 du mélange composé de propamocarbe HCL + mancozèbe qu’après une application à des taux de 2L et 3L ha-1 en 1999 et 2000, mais elle n’était pas significativement moins sévère après des applications de 3L ha-1 en 2000 et 2001. Il n’y avait pas de différence significative dans le taux final moyen du mildiou entre les trois applications de 0,9, 1,0 et 1,1 kg ha-1 de fénamidone + mancozèbe. Tous les mélanges fongicides et les séquences d’application ont réduit de façon significative la surface sous la courbe de la progression de la maladie et les taux finaux de mildiou comparativement au témoin non protégé. Le rendement total et le rendement de valeur marchande des tubercules ont augmenté de façon significative (P < 0.05) dans toutes les parcelles traitées avec des fongicides

Measuring fitness of Kenyan children with polyparasitic infections using the 20-meter shuttle run test as a morbidity metric.

BACKGROUND: To date, there has been no standardized approach to the assessment of aerobic fitness among children who harbor parasites. In quantifying the disability associated with individual or multiple chronic infections, accurate measures of physical fitness are important metrics. This is because exercise intolerance, as seen with anemia and many other chronic disorders, reflects the body's inability to maintain adequate oxygen supply (VO(2) max) to the motor tissues, which is frequently linked to reduced quality-of-life in terms of physical and job performance. The objective of our study was to examine the associations between polyparasitism, anemia, and reduced fitness in a high risk Kenyan population using novel implementation of the 20-meter shuttle run test (20mSRT), a well-standardized, low-technology physical fitness test. METHODOLOGY/PRINCIPAL FINDINGS: Four villages in coastal Kenya were surveyed during 2009-2010. Children 5-18 years were tested for infection with Schistosoma haematobium (Sh), malaria, filaria, and geohelminth infections by standard methods. After anthropometric and hemoglobin testing, fitness was assessed with the 20 mSRT. The 20 mSRT proved easy to perform, requiring only minimal staff training. Parasitology revealed high prevalence of single and multiple parasitic infections in all villages, with Sh being the most common (25-62%). Anemia prevalence was 45-58%. Using multiply-adjusted linear modeling that accounted for household clustering, decreased aerobic capacity was significantly associated with anemia, stunting, and wasting, with some gender differences. CONCLUSIONS/SIGNIFICANCE: The 20 mSRT, which has excellent correlation with VO(2), is a highly feasible fitness test for low-resource settings. Our results indicate impaired fitness is common in areas endemic for parasites, where, at least in part, low fitness scores are likely to result from anemia and stunting associated with chronic infection. The 20 mSRT should be used as a common metric to quantify physical fitness and compare sub-clinical disability across many different disorders and community settings

Complexity metrics for measuring the understandability and maintainability of Business Process Models using Goal-Question-Metric (GQM)

Business Process Models (BPMs), often modeling language such as UML activity between the created using stakeholders in the can provide us a diagrams, Event- Driven Process Chains Markup Language (EPML) and Yet Another Workflow Language (YAWL), serve as a base for communication that adequate software development process. In order to fulfill this purpose, they should be easy to understand and easy to maintain. For this reason, it is useful to have measures information about understandability and maintainability of the BPM. Although there are hundreds of software complexity measures that have been described and published by many researchers over the last few decades, measuring the complexity of business process models is a rather new area of research with only a small number of contributions. In this paper, we provide a comprehensive report on how existing complexity metrics of software were adapted in order to analyze the current business process models complexity. We also proposed a Goal- Question-Metric (GQM) framework for measuring the understandability and maintainability of BPMs