University of Nairobi Journal Systems
Not a member yet
1034 research outputs found
Sort by
Is it Time to Abandon Stavudine? The Safety and Tolerability of Low Dose Stavudine versus Zidovudine in Urban Kenya
No full textBackground: Stavudine (d4T) and zidovudine (AZT) form the backbone of the most commonly used first-line highly active antiretroviral therapy (HAART) regimens in Kenya. In 2012, more than 60 % of patients undergoing combination antiretroviral therapy were either on AZT or d4T based regimens, mainly due to their affordability and availability in fixed dose combinations. Following, the World health Organization’s recommendation in 2010 that d4T should be phased out due to safety concerns, Kenya has been steadily withdrawing d4T from HIV/AIDS treatment programmes. Despite these decisions, questions as to whether stavudine ought to be altogether abandoned in resource constrained settings continue to elicit debate among clinicians, researchers and patient groups. Objective: This study was consequently designed to compare the tolerability and efficacy of AZT with low dose d4T in treatment of HIV infected adults in urban Kenya, and to generate data on the safety of low dose stavudine. Method: The design was an analytic retrospective hospital- based cohort study that involved examination of records of patients on antiretroviral therapy. The study had two comparator arms: (i) ART-naive adult patients initiated on stavudine 30 mg based HAART, and (ii) ART-naive adult patients initiated on zidovudine based HAART. Quantitative variables were described with medians or means, and compared between groups using Wilcoxon rank sum test. Association effects were determined by use of Chi-square test. Categorical variables were summarized using proportions. The time to event analysis was estimated using the Kaplan–Meier product limit method. Cox Proportional Hazards regression was used to model the hazard rates of regimen switching. Results: The incidence rate (IR) of switching regimen was higher in patients initiated on zidovudine than in patients initiated on low dose stavudine (11.3 % and 7.0 % respectively). The most common reason for regimen switch was toxicity (79.2 %). In patients initiated on stavudine, lipodystrophy was the main reason for treatment change (53.2 %) followed by peripheral neuropathy (23.4 %). Amongst patients initiated on zidovudine, anaemia was the main reason for treatment change (33.3 %). There was no significant difference in median change in CD4 cell counts between the two treatment groups. Conclusion: The study has showed that patients initiated on a zidovudine based regimen were more likely to change their treatment compared to those on a low dose stavudine. Stavudine therefore still has its benefits, and public health programmes should not altogether abandon it. Keywords: Stavudine phase out, low dose stavudine, zidovudin
Potential for Women Fish Traders to Upgrade within the Fish Trade Value Chain: Evidence from Kenya
Get PDFFishing is an important economic activity in Kenya which provides employment, income and food to a significant share of Kenyan population particularly the local community around Lake Victoria. Over the last decade the aggregate landings of fish from inland waters have increased tremendously within Lake Victoria contributing about 98% of production from Kenya’s inland lakes, and constitute about 93% of all fish landed in2011. In spite of these enormous contributions, population round the Lake has remained relatively poor in economic terms. Moreover, gender and cultural barriers impede participation by women in some activities within the fish value chain. This paper investigates the location of women fish traders in the fish value chain and the rewards accruing to them. One of the major findings of this paper is that women traders in Lake Victoria are located in the lower nodes of the chain whose returns are low. In addition, women fish traders tend to operate in very micro-scale enterprises.Women fish traders are also challenged by cultural and gender constraints in terms of their potential to upgrade within the value chain. The paper recommends the need for affirmative action to empower women in the fish trade to upgrade. This can be achieved through tailor made training on business practices, assisting them to register as community based organization in order to link them with formal institutions; and finally to assist them acquire modernized technology that can help them grow.Keywords: Affirmative action, upgrading, women entrepreneurs, women empowerment,value chai
Forecasting Patient Needs in a Donor Funded Health Care Project in Kenya
Get PDFForecasts are crucial for practically all economic and business decisions. The focus of this research paper is in the area of forecasting. The research approach adopted is a case study of the Nutrition and HIV Program (NHP), which is a donor funded public health project. The general objective of this paper was to forecast the demand for patient needs in a donor funded project. Specifically, this paper sought to establish a suitable forecasting method that can accurately predict demand for nutrition commodities. In order to establish a more suitable forecasting method, Univariate Box – Jenkins (UBJ) methodology was used and two models were tested and Auto Regressive Integrated Moving Average (ARIMA (0, 1, 2)) model provided a better fit and was chosen as the model of choice for a short run forecast horizon. The main conclusion drawn from this paper is that, UBJ-ARIMA models are useful as benchmarks for forecasting and thereforethey should be viewed as complements to a reliable forecasting process. This paper recommends that public health projects need to consider adopting business forecasting methods that will provide a better glimpse of the future based on historical events rather than relying on disease morbidity data trends.Key words: Autocorrelation function, ARIMA, partial autocorrelation function, public health project, residual autocorrelations short run forecast, stationarity, UBJ, un-difference
Human Resource Practices, the Relationship between Locus of Control and Employee Outcomes
Get PDFThis paper explores the effect of human resource practices on the relationship between locus of control and employee outcomes. Personality is a stable characteristic that employees bring to the work place. It is presumed that locus of control will influence employee outcomes but the strength of its effect will be influenced by the implementation of human resource practices in the organization. Human resource practices were expected to moderate these relationships. Predicted relationships were drawn from prior theory that identified how human resource practices influence employee outcomes and on how locus of control affected employee outcomes. The individual’s locus of control was evaluated based on the external and internal continuum. Employee outcomes studied were job satisfaction, trust, employee commitment and organizational citizenship behaviour. Results obtained from 181 questionnaires from respondents in Kenyan public corporations indicated that human resources practices influenced the relationship between locus of control with job satisfaction, employee commitment, trust and organizational citizenship behaviours. Data were analyzed using multiple regression and the moderating effect was shown by the changes in r values. Implications for theory and managerial practice are given.Keywords: Locus of control, Human resource Practices, employee outcome
The quality of PMTCT services and uptake of ARV prophylaxis amongst HIV positive pregnant women in Kakamega district, Kenya
No full textBackground: The success of a PMTCT programme depends on the quality of services offered at health facilities. Indicators of quality include the competence and attitude of the counsellor and uptake of ARV prophylaxis. Objective: This study looked at the relationship between quality of prevention of mother to child transmission of HIV (PMTCT) services and the maternal ARV prophylaxis uptake in Kakamega district, Kenya. Methods: The study was a cross-sectional study. Thirty health facilities and health care workers were sampled using multistage sampling. From these health facilities, 119 HIV positive pregnant women were sampled by convenience sampling. The PMTCT counsellors and HIV positive pregnant were interviewed using a structured questionnaire. Statistical analysis: Descriptive data analysis was carried out on all variables. Categorical variables across groups were compared using the Fisher Exact test. Logistic regression was used to identify determinants of uptake of ARV prophylaxis at facility level Results: About 86.7% of the health facilities sampled had satisfactory quality of PMTCT services and 89% of HIV positive pregnant women reported that they received satisfactory PMTCT counselling services. About 90% of the counsellors have received PMTCT training and the mean score in a knowledge test was 77.2%. However, providers generally had a negative attitude towards their clients. On regression analysis, there was no significant association between various aspects of quality and infant ARV prophylaxis uptake. Uptake at facility level was determined by the district and type of health facility. Conclusion: The quality of service in the sampled facilities was generally good but this did not influence the level of uptake of maternal or infant ARV prophylaxis. Key words: Prevention of Mother to Child Transmission (PMTCT), ARV prophylaxis, HIV-positive pregnant women
Anti-inflammatory and analgesic effects of Lonchocarpus cyanescens root in mice
No full textBackground: The root of Lonchocarpus cyanescens is one common remedy of the Ibibios of Akwa Ibom State, Nigeria for the treatment of pain and inflammatory disorders. Objective: To study and validate the anti-inflammatory and analgesic potentials of the ethanol extract and fractions of L. cyanescens root in mice. Methodology: The ethanol extract and the partitioned fractions were tested using carrageenan-induced inflammation, xylene–induced ear oedema models as well as on pains induced chemically and thermally in mice. Results: L. cyanescens root extract and fractions demonstrated anti-inflammatory effects in all the models, suppressed acute oedema as well as exhibited dose and time dependent analgesic properties with butanol fraction showing the highest effects. Discussion: Since the extract and its fractions significantly affected oedema and pain in the various models of this study, it therefore justify the use of the root traditionally in the treatment of pain and inflammatory diseases. Keywords: Anti-inflammatory, analgesic, pain, Lonchocarpus cyanescen
Validation of Safety and Efficacy of Antitussive Herbal Formulations
Get PDFBackground: Cough is an important defensive pulmonary reflex that removes irritants, fluids or foreign materials from the airways. Frequently, cough is non-productive and requires suppression and opioid receptor agonists such as codeine are commonly used as antitussive agents. However, opioids produce side effects that include sedation, addiction potential and constipation. Novel cough suppressant therapies should maintain or improve upon the antitussive efficacy profile of opioids but with minimum or no side effects. Objective: To evaluate antitussive activity of combination of herbal medicines as formulations in sulphur dioxide - induced cough model in rats. Methodology: Wister rats of either sex, weighing 150 - 200 g, were divided into 7 groups (n = 6). Group 1 served as a control and received normal saline, groups 2 received codeine phosphate, group 3 and 4 received the coded market samples and groups 5, 6 and 7 received the test samples, respectively. Thirty or sixty minutes following administration, the rats were exposed to sulphur dioxide gas for 1 minute and then placed in an open chamber for counting of cough bouts. Results: The formulations exhibited cough inhibitions of between 15 and 27%, and 14 and 38%, with respect to the control group, 30 and 60 minutes after sample administration respectively. Conclusion: The herbal formulations demonstrated significant (p < 0.05) antitussive activity in sulphur dioxide induced cough model. Key words: Antitussive activity; herbal formulations; sulphur dioxide; coug
Investigation of the antimicrobial potentials of some phytochemical extracts of leaf and stem bark of Berlinia grandiflora (Leguminoceae) Caesalpinioidae against pathogenic bacteria
Get PDFIntroductionBerlinia comprises about 20 species which are confinedto tropical Africa with almost all the species found inWest and Central Africa (Hutchison and Dalziel, 1963).Berlinia grandiflora is widespread in Guinea, Mali,Nigeria, Central Africa and Democratic Republic ofCongo (Hutchison and Dalziel, 1963). It is a forest treethat is sometimes planted as ornamental tree and shadetree in villages and coffee plantations. It is occasionallybrowsed by livestock especially sheep and goats. TheIgbos of South Eastern Nigeria refers to it in their locallanguages as abaa, dokar, rafi, and ububa while theYorubas of the South West Nigeria refer to it as apado.Its bark sap is applied to sores and wounds, and barkdecoctions are administered to treat haemorrhoids andliver complaints (Gill, 1992). The bark is used to easelabour during child birth and gastrointestinal disorders.A decoction of the leafy twigs is used as febrifuge andantiemetic while leafy decoctions are taken as tonic(Gill, 1992). Reports of its biological activities are scantyand include analgesic activity of stem bark extract(Asuzu et al, 1993), antihelminthic activity of stem bark(Enwerem et al, 2001), antihelminthic activity of stembark and its active principle, betulinic acid (Enwerem etal, 2001).In South Eastern Nigeria, the leaf and the stem barkextracts of the plant are used by traditional herbalists totreat microbial infections. However, this ethnomedicinaluse of the plant parts has not been validatedscientifically. This study investigated the antimicrobialpotential of the aqueous, methanol and butanol extractsof the leaves and stem bark against pathogenic bacteriaas part of our evaluation of its antimicrobial activity
Antioxidant, acetylcholinesterase inhibitory activity and cytotoxicity assessment of the crude extracts of Boophane disticha
Get PDF1. IntroductionAlzheimer’s disease (AD) is the most commonneurodegenerative disease and is characterized bymemory impairment, cognitive dysfunction, behavioraldisturbances and deficits in daily living (Konrath et al,2012). Approaches to enhance cholinergic function inAD have included stimulation of cholinergic receptorsor prolonging the availability of acetylcholine (ACh)released into the neuronal synaptic cleft by inhibitingACh hydrolysis through the use of acetylcholinesterase(AChE) inhibitors (Howes and Houghton, 2003). Tacrinewas the first widely used AChE inhibitor (Summers,2006). Second generation AChE inhibitors with longerhalf-lives than tacrine, such as donepezil, galanthamineand rivastigmine, have since been developed and arecurrently in use (Shah et al, 2008). In addition, severallines of evidence indicate that reactive oxygen speciesare associated with the pathogenesis of AD, as somecellular characteristics of this disease are either causesor effects of oxidative stress (Zhu et al, 2004; Sultana etal, 2006; Konrath et al, 2012). Generally, thephysiological role of antioxidant compounds is toattenuate the oxidation chain reactions by removingfree-radical intermediates (Liu and Nair, 2010). Since alarge amount of evidence demonstrates that oxidativestress is intimately involved in age-relatedneurodegenerative diseases, there have been a numberof studies which have examined the positive effects ofantioxidants in reducing or blocking neuronal deathoccurring in the pathophysiology of these disorders(Ramassamy, 2006). Consequently, the use ofantioxidants has been explored in an attempt to slowAD progression and neuronal degeneration (Howes andHoughton, 2003).Toxicity testing is an essential requirement for thedevelopment of modern pharmaceutical compounds.Medicinal plants are assumed to have low toxicity dueto their long-term consumption by humans and animals(Luseba et al, 2007; Verschaeve and van Staden, 2008;Aremu et al, 2011). However, several studies haveshown that many plants used as food or medicine, havepotential toxic effects (Du Plooy et al, 2001; Barlow andSchlatter, 2010). Almost all known AChE inhibitors haveseveral drawbacks, such as hepatotoxicity, shortduration of biological action, low bioavailability,adverse cholinergic side effects in the periphery andnarrow therapeutic windows (Lee et al, 2011). Somecommon synthetic antioxidants including butylatedhydroxyanisole (BHA) and butylated hydroxytoluene(BHT) have been reported to be toxic (Aremu et al,2011). Therefore, the search for new AChE inhibitorsand antioxidants, particularly from natural products,with low toxicity and higher efficacy continues.Many plants are reputed to have ‘anti-ageing’ or‘memory-enhancing’ effects and are used traditionallyto treat several neurodegenerative diseases (Howes andHoughton, 2003). One such plant, Boophane disticha(L.f.) Herb. belongs to the family Amaryllidaceae. It is anattractive, deciduous bulbous plant with a thickcovering of dry scales above the ground and is widelydistributed in Africa, ranging from Sudan in the north tothe Western Cape Province in the south (Wrinkle,1984). Decoctions of bulb scales are given to sedateviolent, psychotic patients while bulb infusions arereported to be used to treat mental illness (van Wykand Gericke, 2000; Sobiecki, 2002). Bulb decoctions arealso used in the treatment of headaches, abdominalpain, weakness, sharp chest pains and persistentbladder pains, as well as treatment of varicose ulcers,relief of urticaria, and cancer (Botha et al, 2005). Thisstudy was aimed at evaluating the AChE inhibitory andantioxidant activity of the bulbs and roots of B. distichato partially justify its traditional use in treatment ofneurodegenerative diseases. The safety of using thisplant in traditional medicine was also investigated byassessing its toxicity using the MTT and neutral redassays
Perceived Factors affecting Performance Management among Local Authorities in Kenya: A Case of the City Council of Nairobi
Get PDFOrganizations are investing ever-increasing amounts of resources into performance management though it is still not clear what they can expect in return or how this might influence the likelihood of positive system outcomes. An effective performance management system clearly defines expectations and helps to align employee behavior with the culture and business needs of the organization. In an increasingly competitiveworld, performance management is not optional but rather it is essential for enhancing organization`s effectiveness and competitiveness. Today`s organizations have to face a turbulent environment where change seems to be the only constant. To meet this challenge, organizations are forced to accelerate effectiveness in all activities, be flexible to changes in the internal and external environment, improve quality and service delivery, reduce cost and fully use their intellectual capacity. Furthermore, as thesystem is becoming more complex, emphasis is given to the process orientation and cross functional approaches. To succeed, knowledge, skills, experience and perspectives of a wide range of people must be integrated. There needs to be understanding of the relationship between strategy, people, organizational design and performance systems in order for performance management to be achieved in the Public Sector. The objective of the study was to establish the perceived factors that affect employee performance management in the City Council of Nairobi. A descriptive research design was adopted with the total population of the study comprising of 10,600 employees with 7% being from senior management, 27% from middle level management and 66% from lower level management. Stratified sampling was used for ease of classifying the sample into the three categories with the sample comprising of 10% from each strata of the target population. A five point Likert scale questionnaire was used to collect data and averages, percentages and correlation analysis used. The study found out that the perceived factors that influenced performance management were understanding of performance management, stakeholder involvement, continuous monitoring, feedback, dissemination and learning from results, organizational culture and leadership commitment. The study recommended that the council should involve all the stakeholders in coming up with policy decisions that will affect them as this involvement will help reduce resistance to implementation of the decisions. In addition, to help in adapting the council`s culture to deliver quality services, the council should allocate adequate resources for the training and development of its staff. Key Words- Performance Management, stakeholders, effectiveness, service delivery, intellectual capacity, perception, business strategy, communication, stakeholder involvement and trainin