Expanding Access to Malaria Diagnosis through Retail Shops in Western Kenya: What Do Shop Workers Think?

Background. The common symptoms of malaria reduce the specificity of clinical diagnosis. Presumptive treatment is conventional but can lead to overdiagnosis of malaria, delay of appropriate treatment, overprescription of antimalarials, and drug resistance. Routine use of diagnostic tests can address many of these concerns. Though treatment is often procured from retailers, there is low availability of rapid diagnostic tests for malaria (MRDTs), a simple, inexpensive, and accurate diagnostic solution. We know little about the challenges to expanding access to diagnostics through these outlets. Methods. To understand the perceptions of the benefits and challenges to selling rapid diagnostic tests for malaria, we conducted focus group discussions with antimalarial retailers who serve the residents of the Webuye Health and Demographic Surveillance Site in western Kenya. Results. Medicine retailers perceived MRDTs to be beneficial to their customers and businesses but also included cost, fear of the tests, risks of self-treatment, and regulatory concerns among the challenges to using and selling MRDTs. Conclusion. MRDTs represent a viable approach to increase access to malaria diagnostic testing. Medicine retailers are eager for MRDTs to be made available to them. However, certain challenges remain to implementation in retail outlets and should be addressed in advance

Geographically-weighted regression of knowledge and behaviour determinants to anti-malarial recommending and dispensing practice among medicine retailers in western Kenya: capacitating targeted interventions

Background Most patients with malaria seek treatment first in retail drug shops. Myriad studies have examined retailer behaviours and characteristics to understand the determinants to these behaviours. Geospatial methods are helpful in discovering if geographic location plays a role in the relationship between determinants and outcomes. This study aimed to discover if spatial autocorrelation exists in the relationship between determinants and retailer behaviours, and to provide specific geographic locations and target behaviours for tailoring future interventions. Methods Retailer behaviours and characteristics captured from a survey deployed to medicine retailers in the Webuye Demographic and Health Surveillance Site were analysed using geographic weighted regression to create prediction models for three separate outcomes: recommending the first-line anti-malarial therapy to adults, recommending the first-line anti-malarial therapy to children, and selling that therapy more than other anti-malarials. The estimated regression coefficients for each determinant, as well as the pseudo R2 values for each final model, were then mapped to assess spatial variability and local areas of best model fit. Results The relationships explored were found to be non-stationary, indicating that spatial heterogeneity exist in the data. The association between having a pharmacy-related health training and recommending the first-line anti-malarial treatment to adults was strongest around the peri-urban centre: comparing those with training in pharmacy to those without training (ORæ=æ5.75, pæ=æ0.021). The association between knowing the first-line anti-malarial and recommending it to children was strongest in the north of the study area compared to those who did not know the MOH-recommended anti-malarial (ORæ=æ2.34, pæ=æ0.070). This is also the area with the strongest association between attending a malaria workshop and selling the MOH-recommended anti-malarial more than other anti-malarials, compared to retailers who did not attend a workshop (ORæ=æ2.38, pæ=æ0.055). Conclusion Evidence suggests that spatial heterogeneity exists in these data, indicating that the relationship between determinants and behaviours varies across space. This is valuable information for intervention design, allowing efforts to focus on those factors that have the strongest relationship with their targeted behaviour within that geographic space, increasing programme efficiency and cost-effectiveness

Improvement of resistance to fusarium root rot through gene pyramiding and validation of SSR PVBR87 marker in common bean

Fusarium root rot caused by Fusarium solani f. sp. phaseoli is among the most serious diseases of the common bean in Uganda causing total crop loss in susceptible cultivars. Studies have indicated that 2-9 genes located at different loci govern resistance to Fusarium root rot among different resistance sources. Accumulation of several of these genes from the different sources into a single genetic background has been proposed to result in an increased level of resistance to Fusarium root rot, and more effective transfer of this resistance into consumer-preferred cultivars. Use of molecular markers together with phenotypic selection could speed up breeding progress for Fusarium root rot resistance. A simple sequence repeat (SSR) PVBR87 marker linked to Fusarium root rot resistance quantitative trait loci (QTL) was identified in a previous study but its use in identifying resistant genotypes outside the original two mapping populations has not been determined. This study estimated the number of pyramided Fusarium root rot resistance genes from four sources of resistance, their interaction and effectiveness in improving Fusarium root rot resistance levels. The study also validated the association of the SSR PVBR87 marker with resistance to Fusarium root rot in an additional population. The study was conducted at the International Centre for Tropical Agriculture (CIAT) based at the National Agricultural Research Laboratories – Kawanda, Uganda. Four Fusarium root rot resistant (R) inbred lines: MLB-48-89A (48), MLB-49-89A (49), G2333 (G2) and G685 (G6), and two susceptible (S) lines: K20 and Kanyebwa (Kan) were used in the study. A double cross (DC) was developed from the four resistant parents. The DC F1 and each resistant parent were crossed to the two susceptible cultivars to form five-parent crosses and single crosses, respectively. Parental, F1 and F2 populations were subjected to Fusarium solani f. sp. phasoeli isolate-3. Twenty one days xi after planting, symptom severity was assessed on a scale of 1-9 (varied at 1,2,3,4,5,6,7,8,9). Plants of each cross were grouped into resistant (score 1-4) and susceptible (score 5-9). F2 plants of K20 x G2 and 49 x Kan were screened with SSR PVBR87 marker. The estimated number of genes and gene interactions were determined using X2 goodness-of-fit test (P = 0.05) and means were compared by “Students t-test” (P = 0.05). The association of SSR PVBR87 marker to Fusarium root rot resistance was determined using X2 test of independence and single marker regression analysis (P = 0.05). Two to three genes segregated in the R x R single crosses and at least four genes segregated in the double cross population indicating three of the four resistant parents differed from each other by at least one gene and two of the four parents have at least one gene in common. Genetic effects among the crosses included additive and dominance effects and epistatic interactions. Five-parent crosses performed better than the single crosses, demonstrating the potential of using combined resistance in improving resistance to Fusarium root rot in susceptible bean cultivars. The SSR PVBR87 marker showed significant association to Fusarium root rot resistance in both K20 x G2 and Kan x 49 indicating its stability in different genetic background but still requires further validation in different environments and in additional genetic backgrounds to determine its use for marker-assisted breeding for improving resistance to Fusarium root rot. The genes responsible for the higher levels of Fusarium root rot resistance in the pyramids are not specifically known. It is necessary that these resistance genes be tagged with molecular markers. Tagging of the genes with molecular markers would provide knowledge of their genomic locations, the nature of their interactions and also facilitate the transfer of these genes or alleles, through molecular marker-assisted gene introgression, into other agronomically superior, but Fusarium root rot susceptible cultivars. Since no selection for Fusarium root rot resistance or any other desirable agronomic traits was practiced in this study, there is need to select between and within families from among the five-parent cross populations and the single crosses for resistance to Fusarium root rot. However, the predominance of non-additive gene effects for Fusarium root rot resistance, especially in the five-parent crosses suggests that selection for resistance would be more effective at advanced generations of selfing. The bean parents used in constructing the five-parent cross populations are of diverse seed character, growth habit, maturity period, and have varied response to several abiotic and biotic constraints. There is also need to select for these traits in the populations developed in this study as these traits eventually affect acceptability of any potential new variety. The amounts of phenotypic variation explained by the SSR PVBR87 in two populations were low; hence, there is still need to further validate the marker in additional populations and in several environments to determine its efficacy for marker-assisted breeding for Fusarium root rot resistance

Webuye health and demographic surveillance systems baseline survey of soil-transmitted helmints and intestinal protozoa among children up to five years

Background. The intestinal parasitic infections (IPIs) are globally endemic, and they constitute the greatest cause of illness and disease worldwide. Transmission of IPIs occurs as a result of inadequate sanitation, inaccessibility to potable water, and poor living conditions. Objectives. To determine a baseline prevalence of IPIs among children of five years and below at Webuye Health and Demographic Surveillance (HDSS) area in western Kenya. Methods. Cross-sectional survey was used to collect data. Direct saline and formal-ether-sedimentation techniques were used to process the specimens. Descriptive and inferential statistics such as Chi-square statistics were used to analyze the data. Results. A prevalence of 52.3% (417/797) was obtained with the male child slightly more infected than the female (53.5% versus 51%), but this was not significant (χ2=0.482, P>0.05). Giardia lamblia and Entamoeba histolytica were the most common pathogenic IPIs with a prevalence of 26.1% (208/797) and 11.2% (89/797), respectively. Soil-transmitted helminths (STHs) were less common with a prevalence of 4.8% (38/797), 3.8% (30/797), and 0.13% (1/797) for Ascaris lumbricoides, hookworms, and Trichuris trichiura, respectively. Conclusions. Giardia lamblia and E. histolytica were the most prevalent pathogenic intestinal protozoa, while STHs were less common. Community-based health promotion techniques are recommended for controlling these parasites

Study of inheritance and identification of molecular markers for seed protein content in pigeonpea (Cajanus cajan (L.) Millsp.).

Doctor of Philosophy in Plant Breeding. University of KwaZulu-Natal, Pietermaritzburg 2017.Abstract available in PDF file

Prevalence of metastatic disease in newly diagnosed breast cancer patients as seen on contrast enhanced computed tomography of the chest, abdomen and pelvis at the Aga Khan University Hospital, Nairobi.

Introduction: Breast cancer patients have traditionally been screened for occult metastases with abdominal ultrasound, chest radiography and bone scan although the use of modern tests with greateraccuracy such as computed tomography (CT), 2-[fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) and Magnetic resonance (MR) imaging is on the increase. The use of contrast enhanced CT (CECT) in the staging of patients with newly diagnosed breast cancer has increased greatly in clinical practice in view of it being widely available and relatively cheapwhen compared to other modalities such as MRI and PET imaging. The clinical utility of routine staging CECT is yet to be fully defined as there is no agreement between protocols on what clinical stage, size of tumour or extent of lymph node involvement that should trigger the use of advanced imaging such as staging CECT or even MRI/PET at time of breast cancer diagnosis. Objective: This study was done to determine the prevalence of distant metastasis as seen on staging CECT done at time of diagnosis in patients with new diagnosis breast cancer. Study design: Cross sectional study with data gathered retrospectively. Methods: Results of CECT examinations done for staging of patients with new diagnosis breast cancer were reviewed retrospectively to determine the prevalence of metastatic disease at time of diagnosis. CECT examinations done between January 2014 andJanuary 2017 at Aga Khan University Hospital in Nairobi (AKUH, N) were used in this study. Additional data were gathered from patient files and pathology records. Results: The overall prevalence of distant metastasis was 14.8 % in the 183 patients recruited in this study. Using tumour size and nodal status staging (AJCC 7thEdition), 38 patients were classified as stage I (21%), 89 patients were classified as stage II (49%) and 56 patients (30%) were classified as stage III. Following the results of CECT,noneof the 38 patients at stage I were upstaged while6 of the 89 patients (7%) and 21 of the 56 (37.5%) at stage II andIII respectively were upstaged to stage IV breast cancer. Conclusions: The overall prevalence of distant metastasis was 14.8 % in the 183 patients recruited in this study. The general practice of using staging CECT to screen for metastasis in patients with newly diagnosed breast cancer was useful in patients with locally advanced breast cancer (stage III) and not useful in those with stage I disease. 7% of patients were upstaged from stage II breast cancer to stage IV disease following staging CECT therefore staging CECT may be considered in these patients. In view of this, larger studies are recommended to establish which patients in stage II breast cancer may benefit from staging CECT examinations

The relationship between urban land conflicts and inequity: the case of Nairobi.

This thesis sets out to deepen our understanding of the linkages between urban dynamics that influence access, use and ownership of land in developing countries. This is because land scarcity, increased competition for land and inequitable allocation of land in African cities and the mediation of power, politics, ethnicity and corruption, coupled with inequitable access to land, often contribute to conflicts over land. The thesis explores this reality through the case of Nairobi. Two arguments premise this thesis; one argument posits that urban land conflicts persisting in Africa are largely resulting from land commodification which is not in conformity with existing African land relations. The second argument is that the persistence of urban inequity well beyond colonialism into the present time has produced reinforced inequity in access to and ownership, thereby producing patronage, ethnic and corrupt approaches to land management and allocation processes. These have invariably led land conflicts. As such the study sought to answer one major question that could help establish the links between land scarcity, ethnicity, corruption and conflicts. The question is: what is the relationship between land conflicts and inequity? The thesis aimed to explain the linkage between land commodification processes and inequity, exploring the nature, causes, extent, dimensions and dynamics of land conflicts. It further sought to explore the linkage of the existing institutional arrangements to urban land conflicts. It anticipated the drawing of conclusions on the linkages between land conflicts, land management, commodification, ethnicity, corruption and political patronage and how these linkages contribute to inequity and, subsequently, land conflicts. The study applied a qualitative case study approach, exploring the relationships between land conflicts and inequity. Four in depth case studies, Tassia, Embakasi Jua Klai, Pipeline and Mathare North, were conducted in Nairobi. The study drew on a combination of theories, including ethnic manipulation, structure and agency, institutional analysis, uneven development, grounded theories and group interest. These helped in the analysis and informed the data collection approaches. In addition, they assisted in the development of appropriate explanations of the dynamics between factors such as ethnicity, corruption, and the market, among others. In drawing conclusions, they were useful in unraveling the relationships between land conflicts and the various mediating factors. The results from this study include the establishment of the fact that urban land conflicts result from social, political and economic factors. The factors are mediated by several factors that are institutional, ethnic and patronage-based. The thesis reveals the linkage between ethnicity and corruption, and the simultaneous relationships between power, corruption, institutions and ethnicity. For the Nairobi case, the study brings to the fore the central role of ethnicity in resource conflicts. It also reveals the dynamic nature of land conflicts, thereby suggesting that land issues are social, economic and political. Addressing land conflicts conclusively requires a careful political process that must also be embedded in the legal systems of the particular country. The study concludes by proposing areas for further study, including ethnicity and land ownership in Kenya’s urban areas; corruption, politics and landlordism in Nairobi; land markets and conflicts in urban areas; the development of appropriate models for urban land management, and the links between land tenure and conflicts over land in urban area

Impact of integrating digitalization and financialisation in agriculture among smallholder farmers in Nyanza, Kenya

The advent of digitalization in Kenya, promoted by the government, has led to significant advancement in Kenya's agricultural sector through the introduction of various digital technologies targeted at helping smallholder farmers. Among these innovations are the agricultural digital platforms built around network effect and consolidating various solutions into a single interface. These platforms utilize simple mobile phone technology that is easily accessible for smallholder farmers and are designed with a promise to make smallholder agriculture productive. The prevailing narrative suggests that smallholder farmers are poor and to alleviate them from poverty, it is essential to provide agricultural financial support for purchasing agricultural inputs necessary to improve their production. However, while these digital platforms have the potential to enhance productivity by providing financial assistance, they may also create dependencies and undermine the autonomy of smallholder farmers due to conditions often attached. For instance, the credit loans provided to the smallholder farmers being linked to the agricultural inputs at designated agro dealer shops limiting farmers choices. Moreover, they also have the potential of creating inequalities regarding who owns and benefits from the data generated by these digital platforms. It is therefore important not to idealize these digital platforms as purely positive developments without acknowledging the potential drawbacks. This paper explores the impact of integrating digitalization in agriculture and financialization amongst smallholder farmers using two case studies of One Acre Fund and Apollo agricultural digital platforms in Nyanza County, Kenya. By employing a political economy perspective grounded in critical agrarian studies, it examines how data is collected and utilized in these digital platforms while considering who stands to gain from it amidst various stakeholders involved, with a particular focus on smallholder farmers as the primary target in the ecosystem

The role of Escherichia coli in the etiology of piglet diarrhea in selected pig producing districts of central Uganda

Background: Pig production in Uganda is highly constrained by rampant piglet mortalities with diarrhea being a key feature. The present study was conducted to determine possible involvement of Escherichia coli (E. coli) as agents of diarrhea in piglets and elucidate the factors for their spread and virulence, towards development of mitigation strategies in the smallholder pig value chains in Uganda. Methodology: This was a cross-sectional study carried out from January to August 2020 on pre- and post-weaned piglets from households in Kayunga and Mityana districts of Central Uganda, selected by snowballing method to redundancy. Data about herd management and risk factors for colibacillosis were collected from selected farmers in the two districts. A total of 179 faecal samples were collected from randomly selected neonatal and pre-weaning piglets for bacteriological isolation of Escherichia coli. Virulence (enterotoxin and fimbrial) genes from the isolates were detected by multiplex polymerase chain reaction (PCR) assay. Results: From the 179 faecal samples, a total of 158 (88.3%) E. coli isolates were obtained. Virulence gene markers were detected in 18.4% (29/158) of the isolates. Among the investigated genes encoding for enterotoxin production, STb was the most prevalent (16/158, 10.13%), followed by STa (12/158, 7.59%), while gene for LT was not detected. The gene coding for F4 adhesin was the only one detected while F18 adhesin was not detected from the isolates. On multiple logistic regression analysis, only tertiary educational level (OR=0.141; 95% CI=0.30-0.666; p=0.013) and infrequent use of antibiotics (OR=0.231, 95% CI=0.062-0.859; p=0.029) among the farmers, were the two factors significantly protective of the piglets from diarrhoea. Conclusion: This study reports a high prevalence of enterotoxin gene markers among E. coli isolates in piglets and revealed the potential role of these bacteria in the aetiology of piglet diarrhoea and mortalities in Uganda. Additionally, this study identified risk factors that can be useful in formulating treatment and control strategies of infection caused by these bacteria. Further studies are needed to identify more adhesins these E. coli isolates employ for intestinal colonization, a step that will help inform vaccine development.   French title: Le rôle d'Escherichia coli dans l'étiologie de la diarrhée des porcelets dans certains districts producteurs de porcs du centre de l'Ouganda   Contexte: La production porcine en Ouganda est fortement limitée par la mortalité généralisée des porcelets, la diarrhée étant une caractéristique clé. La présente étude a été menée pour déterminer l'implication possible Escherichia coli piglet diarrhea in Uganda  d'Escherichia coli (E. coli) en tant qu'agents de diarrhée chez les porcelets et élucider les facteurs de leur propagation et de leur virulence, vers le développement de stratégies d'atténuation dans les chaînes de valeur des petits producteurs de porcs en Ouganda. Méthodologie: Il s'agit d'une étude transversale réalisée de janvier à août 2020 sur des porcelets pré- et post-sevrés issus de ménages des districts de Kayunga et Mityana du centre de l'Ouganda, sélectionnés par la méthode boule de neige jusqu'à la redondance. Les données sur la gestion du troupeau et les facteurs de risque de colibacillose ont été recueillies auprès d'éleveurs sélectionnés dans les deux districts. Au total, 179 échantillons de matières fécales ont été prélevés sur des porcelets néonatals et en pré-sevrage sélectionnés au hasard pour l'isolement bactériologique d'Escherichia coli. Les gènes de virulence (entérotoxine et fimbrial) des isolats ont été détectés par une amplification en chaîne par polymérase (PCR) multiplex. Résultats: À partir des 179 échantillons de matières fécales, un total de 158 (88,3%) isolats d'E. coli ont été obtenus. Des marqueurs du gène de virulence ont été détectés dans 18,4% (29/158) des isolats. Parmi les gènes étudiés codant pour la production d'entérotoxines, STb était le plus répandu (16/158, 10,13%), suivi de STa (12/158, 7,59%), tandis que le gène de la LT n'a pas été détecté. Le gène codant pour l'adhésine F4 était le seul détecté alors que l'adhésine F18 n'a pas été détectée dans les isolats. Sur l'analyse de régression logistique multiple, seul le niveau d'enseignement supérieur (OR=0,141; IC à 95%=0,30-0,666; p=0,013) et l'utilisation peu fréquente d'antibiotiques (OR=0,231, IC à 95 %=0,062-0,859; p=0,029) parmi les éleveurs, étaient les deux facteurs de protection significative des porcelets contre la diarrhée. Conclusion: Cette étude rapporte une prévalence élevée de marqueurs génétiques d'entérotoxines parmi les isolats d'E. coli chez les porcelets et a révélé le rôle potentiel de ces bactéries dans l'étiologie de la diarrhée et de la mortalité des porcelets en Ouganda. De plus, cette étude a identifié des facteurs de risque qui peuvent être utiles dans la formulation de stratégies de traitement et de contrôle de l'infection causée par ces bactéries. D'autres études sont nécessaires pour identifier plus d'adhésines que ces isolats d'E. coli utilisent pour la colonisation intestinale, une étape qui aidera à éclairer le développement de vaccins

Pengaruh Dimensi-Dimensi Pembentuk Merek Perusahaan Pemberi-Kerja terhadap Niat Melamar Pekerjaan dengan Reputasi Perusahaan sebagai Peubah Pemediasi

Tujuan penelitian ini adalah untuk mengetahui pengaruh dimensi-dimensi pembentuk merek perusahaan pemberi-kerja (employer brand)terhadap niat melamar pekerjaan, dengan reputasi perusahaan sebagai peubahpemediasi. Untuk pengujian hipotesis penelitian ini menggunakan Partial Least Square (PLS). Teknik pengambilan sampel menggunakan sampel probabilitas dengan metode acak sederhana dengan jumlah sampel sebanyak 105 responden. Hasil penelitian menunjukkan dimensi nilai ekonomi dan nilai aplikasi berpengaruh signifikan terhadap reputasi perusahaan, sedangkan nilai inovasi, nilai pengembangan dan nilai sosial tidak berpengaruh signifikan terhadap reputasi perusahaan. Penelitian ini juga menunjukkan reputasi perusahaan memengaruhi niat melamar pekerjaan secara signifikan.Kata kunci: employer branding, reputasi perusahaan, niat melamar pekerjaan