The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP. It will now be determined how HPV testing fits into cervical cancer screening programs in Kenya and Uganda, how aflatoxin influences immunological control of HIV, how HPV alters certain genes involved in the growth of tumours in HIV-infected women. Although there have been challenges in performing this research, with time, this work should help to reduce the burden of cervical cancer and other cancers related to HIV infection in people living in sub-Saharan Africa, as well as optimized processes to better facilitate research as well as patient autonomy and safety. • KEY MESSAGES • The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer. • Collaborations have been established between researchers in North America and East African countries for these studies. • Studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on HPV detection, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for cervical dysplasia by either cryotherapy or LEEP.
The demand for particleboard has been increasing over the years. Currently, most particleboards are produced from wood which may not be sustainable in the long term. Therefore, there is need of exploring alternative materials such as making particleboards from waste materials. This study investigated the mechanical properties of particleboard consisting of waste leather shavings and waste papers blended together by unsaturated polyester. A single-layered particleboards were manufactured using compression method. Different resin contents (60%, 70%, 80%, and 90%) and leather/paper ratios (100:0, 25:75, 50:50, 75:25) were used to determine the effects on the mechanical properties (internal bond, bending strength, compression, and impact strength) of fabricated boards. From the results of this study, it was found that leather shavings and waste papers can be used as alternative raw materials for particleboard production and that mechanical properties were depended on the resin content and the blend ratio. Also, mechanical properties were reduced with resin content increment, except for impact strength, and improved by high paper blend ratio. It could be concluded that the produced particle panels could be used for indoor application or interior equipping. Additionally, it is recommended that further studies can be done on morphological analysis to establish the bonding between the particles and matrix.
Objectives To examine how drug shop clients’ expenditures are affected by subsidies for malaria diagnostic testing and for malaria treatment, and also to examine how expenditures vary by clients’ malaria test result and by the number of medications they purchased. Design Secondary cross-sectional analysis of survey responses from a randomised controlled trial. Setting The study was conducted in twelve private drug shops in Western Kenya. Participants We surveyed 836 clients who visited the drug shops between March 2018 and October 2019 for a malaria-like illness. This included children >1 year of age if they were physically present and accompanied by a parent or legal guardian. Interventions Subsidies for malaria diagnostic testing and for malaria treatment (conditional on a positive malaria test result). Primary and secondary outcome measures Expenditures at the drug shop in Kenya shillings (Ksh). Results Clients who were randomised to a 50% subsidy for malaria rapid diagnostic tests (RDTs) spent approximately Ksh23 less than those who were randomised to no RDT subsidy (95% CI (−34.6 to −10.7), p=0.002), which corresponds approximately to the value of the subsidy (Ksh20). However, clients randomised to receive free treatment (artemisinin combination therapies (ACTs)) if they tested positive for malaria had similar spending levels as those randomised to a 67% ACT subsidy conditional on a positive test. Expenditures were also similar by test result, however, those who tested positive for malaria bought more medications than those who tested negative for malaria while spending approximately Ksh15 less per medication (95% CI (−34.7 to 3.6), p=0.102). Conclusions Our results suggest that subsidies for diagnostic health products may result in larger household savings than subsidies on curative health products. A better understanding of how people adjust their behaviours and expenditures in response to subsidies could improve the design and implementation of subsidies for health products. Trial registration number NCT03810014 .
The chemical pollution crisis severely threatens human and environmental health globally. To tackle this challenge the establishment of an overarching international science–policy body has recently been suggested. We strongly support this initiative based on the awareness that humanity has already likely left the safe operating space within planetary boundaries for novel entities including chemical pollution. Immediate action is essential and needs to be informed by sound scientific knowledge and data compiled and critically evaluated by an overarching science–policy interface body. Major challenges for such a body are (i) to foster global knowledge production on exposure, impacts and governance going beyond data-rich regions (e.g., Europe and North America), (ii) to cover the entirety of hazardous chemicals, mixtures and wastes, (iii) to follow a one-health perspective considering the risks posed by chemicals and waste on ecosystem and human health, and (iv) to strive for solution-oriented assessments based on systems thinking. Based on multiple evidence on urgent action on a global scale, we call scientists and practitioners to mobilize their scientific networks and to intensify science–policy interaction with national governments to support the negotiations on the establishment of an intergovernmental body based on scientific knowledge explaining the anticipated benefit for human and environmental health.
Objective Adolescents and youth constitute a significant proportion of the population in developing nations. Conventional survey methods risk missing adolescents/youth because their family planning/contraception (FP/C) behavior is hidden. Respondent-driven sampling (RDS), a modified chain-referral recruitment sampling approach, was used to reach unmarried adolescents/youth aged 15–24 in Nairobi, Kenya to measure key FP/C indicators. Seeds were selected and issued with three coupons which they used to invite their peers, male or female, to participate in the study. Referred participants were also given coupons to invite others till sample size was achieved. We report on key implementation parameters following standard RDS reporting recommendations. Results A total of 1674 coupons were issued to generate a sample size of 1354. Coupon return rate was 82.7%. Study participants self-administered most survey questions and missing data was low. Differential enrolment by gender was seen with 56.0% of females recruiting females while 44.0% of males recruited males. In about two months, it was possible to reach the desired sample size using RDS methodology. Implementation challenges included presentation of expired coupons, recruitment of ineligible participants and difficulty recruiting seeds and recruits from affluent neighborhoods. Challenges were consistent with RDS implementation in other settings and populations. RDS can complement standard surveillance/survey approaches, particularly for mobile populations like adolescents/youth.
Households in urban informal settlements of Kisumu City use multiple fuels for their cooking and heating. Despite this reality, previous national inventories of fuel choices in these settlements were based on the most preferred fuel rather than the whole fuel composite used by the households. This paper, therefore, examines the fuel combinations that households in informal settlements of Kisumu City use and how their socio-economic characteristics influence their choice of these combinations. The paper is premised on the energy stacking theory. The study sampled 419 households from informal settlements of Kisumu City. Multinomial logistic regression is used to establish correlation between household characteristics and fuel combination choices. The findings show that majority of households in urban informal settlements of Kisumu City use multiple fuels for cooking, with charcoal and liquefied petroleum gas being the most commonly stacked fuels. Education does not have a strong correlation with fuel choices; whereas household size reliably predicts the choice of individual fuels. Household income significantly predicts the adoption of fuel stacks that have liquefied petroleum gas and charcoal. While increase in household income has a positive correlation with adoption of modern fuels, it does not lead to households dropping primitive and transitional fuels from their stacks. The study asserts that the energy stacking theory is a suitable basis for assessing the relationship between household-based socioeconomic determinants and fuel combination choices among residents of SSA cities. The reality of fuel stacking in urban informal settlements requires policies geared towards increasing access to modern household fuel technologies while incentivizing adoption of fuel-efficient biomass stoves.
IntroductionThere is a vast data gap for the national and regional greenhouse gas (GHG) budget from different smallholder land utilization types in Kenya and sub-Saharan Africa (SSA) at large. Quantifying soil GHG, i.e., methane (CH4), carbon dioxide (CO2), and nitrous oxide (N2O) emissions from smallholder land utilization types, is essential in filling the data gap.Methods We quantified soil GHG emissions from different land utilization types in Western Kenya. We conducted a 26-soil GHG sampling campaign from the different land utilization types. The five land utilization types include 1) agroforestry M (agroforestry Markhamia lutea and sorghum), 2) sole sorghum (sorghum monocrop), 3) agroforestry L (Sorghum and Leucaena leucocephala), 4) sole maize (maize monocrop), and 5) grazing land.Results and discussionThe soil GHG fluxes varied across the land utilization types for all three GHGs (p ≤ 0.0001). We observed the lowest CH4 uptake under grazing land (−0.35 kg CH4–C ha−1) and the highest under sole maize (−1.05 kg CH4–C ha−1). We recorded the lowest soil CO2 emissions under sole maize at 6,509.86 kg CO2–Cha−1 and the highest under grazing land at 14,400.75 kg CO2–Cha−1. The results showed the lowest soil N2O fluxes under grazing land at 0.69 kg N2O–N ha−1 and the highest under agroforestry L at 2.48 kg N2O–N ha−1. The main drivers of soil GHG fluxes were soil bulk density, soil organic carbon, soil moisture, clay content, and root production. The yield-scale N2O fluxes ranged from 0.35 g N2O–N kg−1 under sole maize to 4.90 g N2O–N kg−1 grain yields under agroforestry L. Nevertheless, our findings on the influence of land utilization types on soil GHG fluxes and yield-scaled N2O emissions are within previous studies in SSA, including Kenya, thus fundamental in filling the national and regional data of emissions budget. The findings are pivotal to policymakers in developing low-carbon development across land utilization types for smallholders farming systems.
We present a case of a young, previously asymptomatic East-African black male presenting with large territory ischemic infarct at first diagnosis of Takayasu arteritis (TA). To our knowledge, this is the first published report of a male patient in East Africa with a stroke at the first presentation of TA.
HIV-1 drug resistance testing in children and adolescents in low-resource settings is both important and challenging. New (more sensitive) drug resistance testing technologies may improve clinical care, but evaluation of their added value is limited. We assessed the potential added value of using next-generation sequencing (NGS) over Sanger sequencing for detecting nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutations (DRMs). Participants included 132 treatment-experienced Kenyan children and adolescents with diverse HIV-1 subtypes and with already high levels of drug resistance detected by Sanger sequencing. We examined overall and DRM-specific resistance and its predicted impact on antiretroviral therapy and evaluated the discrepancy between Sanger sequencing and six NGS thresholds (1%, 2%, 5%, 10%, 15%, and 20%). Depending on the NGS threshold, agreement between the two technologies was 62% to 88% for any DRM, 83% to 92% for NRTI DRMs, and 73% to 94% for NNRTI DRMs, with more DRMs detected at low NGS thresholds. NGS identified 96% to 100% of DRMs detected by Sanger sequencing, while Sanger identified 83% to 99% of DRMs detected by NGS. Higher discrepancy between technologies was associated with higher DRM prevalence. Even in this resistance-saturated cohort, 12% of participants had higher, potentially clinically relevant predicted resistance detected only by NGS. These findings, in a young, vulnerable Kenyan population with diverse HIV-1 subtypes and already high resistance levels, suggest potential benefits of more sensitive NGS over existing technology. Good agreement between technologies at high NGS thresholds supports their interchangeable use; however, the significance of DRMs identified at lower thresholds to patient care should be explored further. IMPORTANCE HIV-1 drug resistance in children and adolescents remains a significant problem in countries facing the highest burden of the HIV epidemic. Surveillance of HIV-1 drug resistance in children and adolescents is an important public health strategy, particularly in resource-limited settings, and yet, it is limited due mostly to cost and infrastructure constraints. Whether newer and more sensitive next-generation sequencing (NGS) adds substantial value beyond traditional Sanger sequencing in detecting HIV-1 drug resistance in real life settings remains an open and debatable question. In this paper, we attempt to address this issue by performing a comprehensive comparison of drug resistance identified by Sanger sequencing and six NGS thresholds. We conducted this study in a well-characterized, vulnerable cohort of children and adolescents living with diverse HIV-1 subtypes in Kenya and, importantly, failing antiretroviral therapy (ART) with already extensive drug resistance. Our findings suggest a potential added value of NGS over Sanger even in this unique cohort.
Background Despite many countries working hard to attain Universal Health Coverage (UHC) and the Health-related Sustainable Development Goals, access to healthcare services has remained a challenge for communities residing along national borders in the East Africa Community (EAC). Unlike the communities in the interior, those along national borders are more likely to face access barriers and exclusion due to low health investments and inter-state rules for non-citizens. This study explored the legal and institutional frameworks that facilitate or constrain access to healthcare services for communities residing along the national borders in EAC. Methods This study is part of a broader research implemented in East Africa (2018–2020), employing mixed methods. For this paper, we report data from a literature review, key informant interviews and sub-national dialogues with officials involved in planning and implementing health and migration services in EAC. The documents reviewed included regional and national treaties, conventions, policies and access rules, regulations and guidelines that affect border crossing and access to healthcare services. These were retrieved from official online and physical libraries and archives. Results Overall, the existing laws, policies and guidelines at all levels do not explicitly deal with cross border healthcare access especially for border residents, but address citizen rights and entitlements including health within national frameworks. There is no clarity on whether these rights can be enjoyed beyond one’s country of citizenship. The review found examples of investments in shared health infrastructure to benefit all EAC member countries – a signal of closer cooperation for specialized health care, this had not been accompanied by access rule for citizens outside the host country. The focus on specialized care is unlikely to contribute to the every-day health care needs of border resident communities in remote areas of EAC. Nevertheless, the establishment of the EAC entail opportunities for increased collaboration and integration beyond the trade and customs union to included health care and other social services. The study established active cooperation aimed at disease surveillance and epidemic control among sub-national officials responsible for health and migration services across borders. Health insurance cards, national identification cards and official travel documents were found to constrain access to health services across the borders in EAC. Conclusion In the era of UHC, there is need to take advantage of the EAC integration to revise legal and policy frameworks to leverage existing investments and facilitate cross-border access to healthcare services for communities residing along EAC borders.
Since the production of the earliest Kalenjin traditional albums in the 1920s, the community’s traditional songs have evolved and transformed. This article traces this historical process by considering how these songs developed from folk songs performed during Kambaget (sports competitions) and from the earliest compositions of Bekyibei arap Mosonik, Kipchamba arap Tapotuk and their contemporaries, to the modern-day Kalenjin popular hits. The article documents the earliest recordings of Kalenjin music tracks as well as the bands, and traces the legacies of Kipchamba’s Koilong’et Band from the artists of 1940s and those of the later decades through to the younger generations of the 1990s, 2000s and today. This is done in order to determine the zones of contact as well as departures from prototypical and popular Kalenjin traditional songs. Taking the 1990s liberation of the airwaves as focus, this essay analyses the extraordinary variety and complexity of “The Oldies” and compares these to contemporary artistic products that have recycled aspects of this historical canon.
Water is essential for survival, but one in three individuals worldwide (2.2 billion people) lacks access to safe drinking water. Water intake requirements largely reflect water turnover (WT), the water used by the body each day. We investigated the determinants of human WT in 5604 people from the ages of 8 days to 96 years from 23 countries using isotope-tracking (2H) methods. Age, body size, and composition were significantly associated with WT, as were physical activity, athletic status, pregnancy, socioeconomic status, and environmental characteristics (latitude, altitude, air temperature, and humidity). People who lived in countries with a low human development index (HDI) had higher WT than people in high-HDI countries. On the basis of this extensive dataset, we provide equations to predict human WT in relation to anthropometric, economic, and environmental factors.
Despite the global prioritization of addressing adolescent girls’ and young women’s sexual and reproductive health (SRH) and participatory rights, little research has examined their lived experiences in shaping their engagement in SRH decision-making processes in the global South. Further, few studies have explored how structural and societal factors influence their agency and participation. This critical and focused ethnography, informed by postcolonial feminist and difference-centred citizenship theories, conducted in Malawi (2017–2018) elicited perspectives of youth and key informants to help address these knowledge gaps. Our findings show that the effective implementation and uptake of global discourse on participation and gender equity is hindered by inadequate consideration of girls’ and young women’s local political, cultural and social realities. Many girls and young women demonstrate passion to participate in SRH policymaking as agents of change. However, patriarchal and gerontocratic political and social structures/institutions, and gendered and adultist norms and practices limit their active and meaningful participation in SRH decision-making. In addition, donors’ roles in SRH policymaking and their prioritization of the “girl child” highlight an enduring postcolonial power over agenda-setting processes. Understanding young people’s experiences of gendered participation and scrutinizing underlying systemic forces are critical steps toward realizing young women’s SRH and participatory rights.
Introduction Residual soils covering large areas of the earth have been chiefly discovered in the last 30 years in most volcanic tropical and subtropical countries. Understanding their behaviour is essential for various infrastructure developments. Methods The physical and mechanical properties of the soils are affected by their mineralogical composition. There is a need to determine the mineralogical composition of the soils and investigate the impact on properties. This paper presents the results of a laboratory study conducted on red clay soil from Ruaka, a suburb in Kenya, to investigate the effect of mineral and chemical composition on the soil’s physical and mechanical properties. Disturbed and undisturbed samples were subjected to different tests such as Atterberg limits, soil classification, consolidation test, X-ray fluorescence, X-ray diffraction and petrology test based on the British Standard soil classification system (1377-1994). The soils were classified as clay with high plasticity, and high clay content varied between 59-79% resulting in mechanical instability of the soil in this site. Results The mineral and chemical analysis indicated the formation of unique minerals like Halloysite, Quartz, Kaolinite, and Mica, which influenced the geotechnical properties of clay. The index properties of clay recorded high values; the moisture content and plastic limit varied between 37- 46% with a slight increase as depth increased; the liquid limit varied between 63-68% with increased depth. Conclusion The average value of maximum dry density was reported as around 1247 kg/m3 with high optimum moisture content, reaching 35.5%. Besides that, the soil had a high void ratio of 1.145 to 1.63, which increased the permeability of the clay to 1.223E-5 cm/s. The properties of red clay soils in more than ten tropical regions in Kenya compared with the soil under study are also presented in this paper.
The purpose of this study was to investigate whether intellectual capital (IC) moderates the relationship between income diversification and bank risk-taking. Quantitative data were collected from 50 East African banking firms between 2010 and 2021, yielding 600 bank-year observations. Bank risk-taking is measured using Z-SCORE and non-performing loans (NPLs). The value added intellectual capital (VAIC) and its coefficients: human capital efficiency (HCE), structural capital efficiency (SCE), and capital employed efficiency are used as proxy measures of IC. The system-generalized moment (GMM) was employed as the estimation model. According to the findings, banks with a higher non-interest income share take on excessive risk. Similarly, the findings show that VAIC, HCE, and CEE have a positive and statistically significant relationship with risk-taking. SCE, on the other hand, significantly reduces risk-taking. The findings also show that VAIC and its coefficients (HCE, SCE, and CEE) moderate the relationship between income diversification and risk-taking. These findings have implications for management and policy-makers. First, bank managers can use these findings to make strategic decisions about diversifying their income streams, mitigating associated risks, and determining how to best leverage IC to maximize profits. Second, regulators should increase oversight of non-lending activities by banks and, if necessary, impose regulatory ceilings. Furthermore, mandatory IC disclosure is required to uncover hidden bank value, which may inform risk management decisions among stakeholders. This is one of the first studies to provide empirical evidence of the relationship between income diversification and risk-taking in the East African region. Previous research on the relationship between income diversification and risk-taking has been contradictory; this paper adds to the body of knowledge by investigating whether IC moderates the relationship between income diversification and bank risk-taking.
Background: Hospital referral and admission in many- low and middle-income countries are not feasible for many young infants with sepsis/possible serious bacterial infection (PSBI). The effectiveness of simplified antibiotic regimens when referral to a hospital was not feasible has been shown before. We analysed the pooled data from the previous trials to compare the risk of poor clinical outcome for young infants with PSBI with the two regimens containing injectable procaine penicillin and gentamicin with the oral amoxicillin plus gentamicin regimen currently recommended by the World Health Organization (WHO) when referral is not feasible. Methods: Infant records from three individually randomised trials conducted in Africa and Asia were collated in a standard format. All trials enrolled young infants aged 0-59 days with any sign of PSBI (fever, hypothermia, stopped feeding well, movement only when stimulated, or severe chest indrawing). Eligible young infants whose caretakers refused hospital admission and consented were enrolled and randomised to a trial reference arm (arm A: procaine benzylpenicillin and gentamicin) or two experimental arms (arm B: oral amoxicillin and gentamicin or arm C: procaine benzylpenicillin and gentamicin initially, followed by oral amoxicillin). We compared the rate of poor clinical outcomes by day 15 (deaths till day 15, treatment failure by day 8, and relapse between day 9 and 15) in reference arm A with experimental arms and present risk differences with 95% confidence interval (CI), adjusted for trial. Results: A total of 7617 young infants, randomised to arm A, arm B, or arm C in the three trials, were included in this analysis. Most were 7-59 days old (71%) and predominately males (56%). Slightly over one-fifth of young infants had more than one sign of PSBI at the time of enrolment. Severe chest indrawing (45%), fever (43%), and feeding problems (25%) were the most common signs. Overall, those who received arm B had a lower risk of poor clinical outcome compared to arm A for both per-protocol (risk difference = -2.1%, 95% CI = -3.8%, -0.4%; P = 0.016) and intention-to-treat (risk difference = -1.8%, 95% CI = -3.5%, -0.2%; P = 0.031) analyses. Those who received arm C did not have an increased risk of poor clinical outcome compared to arm A for both per-protocol (risk difference = -1.1%, 95% CI = -2.8%, 0.6%) and intention-to-treat (risk difference = -0.8%, 95% CI = -2.5%, 0.9%) analyses. Overall, those who received arm B had a lower risk of poor clinical outcome compared to the combined arms A and C for both per-protocol (risk difference = -1.6%, 95% CI = -3.5%, -0.1%; P = 0.035) and intention-to-treat (risk difference = -1.4%, 95% CI = -2.8%, -0.1%; P = 0.049) analyses. Conclusions: Analysis of pooled individual patient-level data from three large trials in Africa and Asia showed that the WHO-recommended simplified antibiotic regimen B (oral amoxicillin and injection gentamicin) was superior to regimen A (injection procaine penicillin and injection gentamicin) and combined arms A and C (injection procaine penicillin and injection gentamicin, followed by oral amoxicillin) in terms of poor clinical outcome for the outpatient treatment of young infants with PSBI when inpatient treatment was not feasible. Registration: AFRINEST study  is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12610000286044. SATT Bangladesh study  is registered with ClinicalTrials.gov: NCT00844337. SATT Pakistan study  is registered at ClinicalTrials.gov: NCT01027429.
Background and objective: One of the major factors affecting access to quality oral healthcare in low- and middle-income countries is the under-supply of the dental workforce. The aim of this study was to use Geographical Information System (GIS) to analyse the distribution and accessibility of the dental workforce and facilities across the Kenyan counties. Methods: This was a cross-sectional study targeting dental professionals and their practices in Kenya in 2013. Using QGIS 3.16, these data were overlaid with data on population size and urbanization levels. For access measurement, buffers were drawn around each clinic at distances of 2.5, 5, 10 and 20 km, and the population within each determined. Findings: Nine hundred six dental professionals in 337 dental clinic locations were included in the study. Dentists, community oral health officers (equivalent to dental therapists) and dental technologists comprised 72%, 15% and 12%, respectively. Nairobi county with 100% urbanization and >4000 people/km2 had 43% of the workforce and a dentist to population ratio of 1:9,018. Wajir with an urbanization level of 15% and 12 people/km2 had no dental facility. Overall, 11%, 19%, 35% and 58% of the Kenyan population were within 2.5, 5, 10 and 20 km radius of a dental clinic respectively. Conclusion: Maldistribution of dental workforce in Kenya persists, particularly in less urbanized and sparsely populated areas. GIS map production give health planners a better visual picture of areas that are most in need of health care services based on population profiles.
Natural zeolite is among the low-cost materials that can be used to remove contaminants in biogas. The cleaning of biogas increases its energy density and reduces possible negative effects. The current study aimed to upgrade biogas using natural zeolites. The activation of natural zeolite was done using sodium hydroxide. The adsorbent samples were characterised using an XRF machine, while the biogas samples were analysed using Shimadzu gas chromatography and a portable digital gas detector. The effect of zeolite-to-water ratio on the carbonation process was investigated. In addition, the effects of biogas flow rate, adsorbent dose and contact time on the dry adsorption process were studied. The maximum CO2 uptake of zeolite was 4.8 and 0.2 mmol/g by dry adsorption and wet carbonation process, respectively. The results indicate that surface adsorption favoured by a low Si2O3/Al2O3 ratio was more prominent than carbonation that requires high basic oxides. The results showed that an increase in the dose of activated clay from 2.5 to 35 g increased the removal efficiency of CO2 from 11.2% to 79.8%, while the CO2 uptake decreased from 4.8 to 2.5 mmol/g. Furthermore, the experimental data fitted best to pseudo-first-order kinetics and the Bohart-Adams model for the breakthrough curve.
Countries in Sub-Saharan Africa are increasingly adopting mandatory social health insurance programs. In Kenya, mandatory social health insurance is being implemented through the national health insurer, the National Hospital Insurance Fund (NHIF), but the level of coverage and affordability especially for rural informal households is unclear. This study provides as assessment of affordability of NHIF premiums, the need for financial risk protection, and the extent of financial protection provided by NHIF among rural informal workers in western Kenya. Methods: We conducted a mixed methods study with a cross-sectional household survey (n = 1773), in-depth household interviews (n = 36), and 6 FGDs with community stakeholders. We estimated unaffordability of the monthly NHIF premiums (defined as the premium representing > 5% of total household expenditure) and the incidence and intensity of catastrophic and impoverishing health expenditures. Logistic regression was used to assess sociodemographic characteristics associated with incurring catastrophic health expenditures. We qualitatively explored households’ views on affordability and coverage of health insurance, their experiences with healthcare costs and coping strategies using framework analysis. Results We found that a vast majority of rural households did not have health insurance (88.4%) exposing them to financial risk while seeking healthcare. Health insurance was not affordable for majority of households - both insured (60%) and uninsured (80%). Rural households spent an average of 12% of their household budget on OOP spending which was catastrophic to 11.7% of the households. While uninsured households experienced higher and more intense levels of CHE compared to the insured households, both insured and uninsured households reported high OOP spending and similar levels of impoverishments by OOP. Insured households were exposed to OOP because of under-coverage of services by NHIF and weaknesses in health service delivery. Participants expressed concerns about value of health insurance coverage given its cost, services, and financial protection relative to other social and economic needs that they face on daily basis. Households resulted to borrowing, fundraising, taking short term loans from family and friends and sale of family assets in order to meet healthcare costs Conclusion: Rural informal workers have increased vulnerability to financial risk related to healthcare costs and lack adequate financial risk protection through public health insurance. Not only is the NHIF premium unaffordable to majority of these households but the financial protection that is provides is inadequate to shield households against catastrophic healthcare payments because inadequate benefit package and the unavailability of health services in public facilities.
Background Abacavir is a nucleoside reverse transcriptase inhibitor that is used as a component of the antiretroviral treatment regimen in the management of the human immunodeficiency virus for both adults and children. It is efficacious, but its use may be limited by a hypersensitivity reaction linked with the HLA-B*57:01 genotype. HLA-B*57:01 has been reported to be rare in African populations. Because of the nature of its presentation, abacavir hypersensitivity is prone to late diagnosis and treatment, especially in settings where HLA-B*57:01 genotyping is not routinely done. Case report We report a case of a severe hypersensitivity reaction in a 44-year-old Kenyan female living with the human immunodeficiency virus and on abacavir-containing antiretroviral therapy. The patient presented to the hospital after recurrent treatment for a throat infection with complaints of fever, headache, throat ache, vomiting, and a generalized rash. Laboratory results evidenced raised aminotransferases, for which she was advised to stop the antiretrovirals that she had recently been started on. The regimen consisted of abacavir, lamivudine, and dolutegravir. She responded well to treatment but was readmitted a day after discharge with vomiting, severe abdominal pains, diarrhea, and hypotension. Her symptoms disappeared upon admission, but she was readmitted again a few hours after discharge in a hysterical state with burning chest pain and chills. Suspecting abacavir hypersensitivity, upon interrogation she reported that she had taken the abacavir-containing antiretrovirals shortly before she was taken ill. A sample for HLA-B*57:01 was taken and tested positive. Her antiretroviral regimen was substituted to tenofovir, lamivudine, and dolutegravir, and on subsequent follow-up she has been well. Conclusions Clinicians should always be cognizant of this adverse reaction whenever they initiate an abacavir-containing therapy. We would recommend that studies be done in our setting to verify the prevalence of HLA-B*57:01.
Institution pages aggregate content on ResearchGate related to an institution. The members listed on this page have self-identified as being affiliated with this institution. Publications listed on this page were identified by our algorithms as relating to this institution. This page was not created or approved by the institution. If you represent an institution and have questions about these pages or wish to report inaccurate content, you can contact us here.