Influence of Media Reporting Guidelines on Children Reporting in Kenya: What Should Journalists Do?

Although media reporting guidelines protect children, very little is known about how these guidelines influence the practice of journalism. This study examined the influence of media reporting guidelines on children’s reporting in Kenya and tried to generate debate on what journalists do in such situations. All the 2,105 journalists in Nairobi County accredited by the Media Council of Kenya (MCK) constituted the target population. Based on practice theory, the study employed a descriptive research design. The researcher employed stratified random sampling and calculated the desired sample size using Taro Yamane’s formula. The study analysed 238 responses from an online questionnaire and found that most journalists had not fully interacted with the United Nations Children's Fund (UNICEF’s) guidelines for journalists reporting on children (40%). Also, it shows that many media organisations don’t have internal guidelines and 60% of the respondents had encountered cases of reporters and editors being sanctioned for violating existing media reporting guidelines in Kenya. In conclusion, the study argues that while these guidelines are good for children, they tend to complicate the work of media professionals because of the challenge of clearly defining stories that constitute public interest or those critical to the coverage of children. There is a need to continually organise refresher training to enhance knowledge and skills for journalists to determine children’s stories to be published and that are unlikely to attract public outcry

Presentation and management outcome of children with intussusception at Tenwek Hospital, Kenya

Background: Intussusception, a common cause of Intestinal obstruction in infants and young children, occurs when one segment of the bowel invaginates into a distal segment. While non-operative reduction has been well described, surgery remains the predominant mode of therapy in many developing countries due to delayed presentation. This study aimed to describe the presentation, management and outcome of children with intussusception at a single institution.Method: A retrospective review of patients aged 16 years and below with intussusception managed at Tenwek hospital from January 2009 through December 2014 was undertaken. Diagnosis was based on the presenting signs, symptoms, physical findings and plain upright or supine abdominal X-rays, and confirmed via ultrasonography, barium enema or at surgery.Results: A total of 45 cases (24 boys, 21 girls) of intussusception were noted, with a mean age of 2.6 years (range 1 month-15 years).  The mean duration between symptom onset and presentation was 4.4 days (range 1-14), and the classic triad (vomiting, bloody mucoid stools and abdominal pain/distension) was noted in 27 (60%) cases. Abdominal ultrasound was diagnostic in 7 of the 11 cases ordered, with the rest diagnosed clinically. Non-operative reduction was undertaken in 4 cases and successful in 3. Surgery was performed in 42 cases with bowel gangrene and perforation noted in 20 (47.6%) and 15 (35.7%) cases respectively.  The main types of intussusception were ileocolic (23, 51.1%), colocolonic (10, 22.2%) and ileoceacal (7, 15.6%). Five (11.1%) mortalities and 4 (8.8%) morbidities were noted at discharge, most commonly being surgical site infection in three cases.Conclusion: Intussusception, in this series, was primarily diagnosed clinically and managed surgically, with a majority of the patients having gangrenous or perforated bowel at laparotomy.Keywords: Intussusception, children, management, outcome, Keny

Predictors of quality of childcare centers in low-income settings: findings from a cross-sectional study in two Nairobi slums

Background: Rapid urbanization and increased women’s involvement in paid work have contributed to the upsurge of informal childcare centers, especially in low-income settings where quality is a major issue. However, there are limited data on the factors associated with the quality of childcare centers in informal settlements in Africa.Methods: We conducted a quantitative observation and questionnaire survey of 66 childcare centers to identify the factors associated with the quality of childcare services in two informal settlements (Korogocho and Viwandani) in Nairobi. The quality of the centers (outcome variable) was assessed using a locally developed tool. Data on center characteristics including type, size, location, length of operation, charges, and number of staff were collected. Center providers’ knowledge, attitude, and practices (KAP) in childcare were assessed through a questionnaire, focusing on nurturing care and business management. Data were described using means and standard deviation or frequencies and percentages. Associations between quality center score (outcome variable) and other variables were examined using multivariable linear regression to identify potential predictors of the quality of the center environment.Findings: A total of 129 childcare centers were identified and categorized as home-based (n = 45), center-based (n = 14), school-based (n = 61), and church-based (n = 9). The number of home-based centers was particularly high in Viwandani (n = 40; 52%). Only 9% of home-based centers reported any external support and 20% had any training on early childhood development. Of the 129 centers, 66 had complete detailed assessment of predictors of quality reported here. Unadjusted linear regressions revealed associations between quality of childcare center and center providers’ education level, type of center, support received, caregiver–child ratio, number of children in the center, and center providers’ KAP score (p < 0.05). However, in the multivariable regression, only higher levels of center provider KAP ( β = 0.51; 95% CI: 0.18, 0.84; p = 0.003) and center type ( β = 8.68; 95% CI: 2.32, 15.04; p = 0.008) were significantly associated with center quality score.Implication: Our results show that center providers’ knowledge and practices are a major driver of the quality of childcare centers in informal settlements in Nairobi. Interventions for improving the quality of childcare services in such settings should invest in equipping center providers with the necessary knowledge and skills through training and supportive supervision

Inter-domain Communication Mechanisms in an ABC Importer: A Molecular Dynamics Study of the MalFGK2E Complex

ATP-Binding Cassette transporters are ubiquitous membrane proteins that convert the energy from ATP-binding and hydrolysis into conformational changes of the transmembrane region to allow the translocation of substrates against their concentration gradient. Despite the large amount of structural and biochemical data available for this family, it is still not clear how the energy obtained from ATP hydrolysis in the ATPase domains is “transmitted” to the transmembrane domains. In this work, we focus our attention on the consequences of hydrolysis and inorganic phosphate exit in the maltose uptake system (MalFGK2E) from Escherichia coli. The prime goal is to identify and map the structural changes occurring during an ATP-hydrolytic cycle. For that, we use extensive molecular dynamics simulations to study three potential intermediate states (with 10 replicates each): an ATP-bound, an ADP plus inorganic phosphate-bound and an ADP-bound state. Our results show that the residues presenting major rearrangements are located in the A-loop, in the helical sub-domain, and in the “EAA motif” (especially in the “coupling helices” region). Additionally, in one of the simulations with ADP we were able to observe the opening of the NBD dimer accompanied by the dissociation of ADP from the ABC signature motif, but not from its corresponding P-loop motif. This work, together with several other MD studies, suggests a common communication mechanism both for importers and exporters, in which ATP-hydrolysis induces conformational changes in the helical sub-domain region, in turn transferred to the transmembrane domains via the “coupling helices”