Showing papers by "University of Nairobi published in 2013"

Assessment of the performance of CORDEX Regional Climate Models in Simulating East African Rainfall

Abstract: This study evaluates the ability of 10 regional climate models (RCMs) from the Coordinated Regional Climate Downscaling Experiment (CORDEX) in simulating the characteristics of rainfall patterns over eastern Africa. The seasonal climatology, annual rainfall cycles, and interannual variability of RCM output have been assessed over three homogeneous subregions against a number of observational datasets. The ability of the RCMs in simulating large-scale global climate forcing signals is further assessed by compositing the El Nino–Southern Oscillation (ENSO) and Indian Ocean dipole (IOD) events. It is found that most RCMs reasonably simulate the main features of the rainfall climatology over the three subregions and also reproduce the majority of the documented regional responses to ENSO and IOD forcings. At the same time the analysis shows significant biases in individual models depending on subregion and season; however, the ensemble mean has better agreement with observation than individual models....

Fundamentals of Remote Sensing

Abstract: Remote sensing is defined as the art, science and technology through which the characteristics of object features/targets either on, above or even below the earth’s surface are identified, measured and analyzed without direct contact existing between the sensors and the targets or events being observed, see e.g., (Jensen 2009; Lillesand et al. 2010; Richards 1994; Murai 1999) etc.

Epidemiology of ocular surface squamous neoplasia in Africa.

Abstract: objectives To describe the epidemiology and an aetiological model of ocular surface squamous neoplasia (OSSN) in Africa. methods Systematic and non-systematic review methods were used. Incidence was obtained from the International Agency for Research on Cancer. We searched PubMed, EMBASE, Web of Science and the reference lists of articles retrieved. Meta-analyses were conducted using a fixed-effects model for HIV and cigarette smoking and random effects for human papilloma virus (HPV). results The incidence of OSSN is highest in the Southern Hemisphere (16 South), with the highest age-standardised rate (ASR) reported from Zimbabwe (3.4 and 3.0 cases/year/100 000 population for males and females, respectively). The mean ASR worldwide is 0.18 and 0.08 cases/year/100 000 among males and females, respectively. The risk increases with exposure to direct daylight (2– 4h , OR = 1.7, 95% CI: 1.2–2.4 and ≥ 5hO R= 1.8, 95% CI: 1.1–3.1) and outdoor occupations (OR = 1.7, 95% CI: 1.1–2.6). Meta-analysis also shows a strong association with HIV (6 studies: OR = 6.17, 95% CI: 4.83–7.89) and HPV (7 studies: OR = 2.64, 95% CI: 1.27–5.49) but not cigarette smoking (2 studies: OR = 1.40, 95% CI: 0.94–2.09). The effect of atopy, xeroderma pigmentosa and vitamin A deficiency is unclear. conclusions Africa has the highest incidence of OSSN in the world, where males and females are equally affected, unlike other continents where male disease predominates. African women probably have increased risk due to their higher prevalence of HIV and HPV infections. As the survival of HIV-infected people increases, and given no evidence that anti-retroviral therapy (ART) reduces the risk of OSSN, the incidence of OSSN may increase in coming years.

Mobile phone text messages for improving adherence to antiretroviral therapy (ART): a protocol for an individual patient data meta-analysis of randomised trials

Abstract: Objectives Our objectives were to analyse the effects of text messaging versus usual care in improving adherence to antiretroviral therapy (ART) in people living with HIV using individual patient data meta-analysis. Adjusted, sensitivity and subgroup analyses were conducted. Setting 3 randomised controlled trials conducted between 2010 and 2012 in rural and urban centres in Cameroon and Kenya (two studies) were used. Participants A total of 1166 participants were included in this analysis (Cameroon=200; Kenya=428 and 538). Primary and secondary outcomes The primary outcome was adherence to ART >95%. The secondary outcomes were mortality, losses to follow-up, transfers and withdrawals. Results Text messaging improved adherence to ART (OR 1.38; 95% CIs 1.08 to 1.78; p=0.012), even after adjustment for baseline covariates (OR 1.46; 95% CI 1.13 to 1.88; p=0.004). Primary education (compared with no formal education) was associated with a greater intervention effect on adherence (OR 1.65; 95% CI 1.10 to 2.48; p=0.016) and also showed a significant subgroup effect (p=0.039). In sensitivity analysis, our findings were robust to a modified threshold of adherence, multiple imputation for missing data and aggregate level data pooling, but not to fixed-effects meta-analyses using generalised estimation equations. There was a significant subgroup effect for long weekly (p=0.037), short weekly text messages (p=0.014) and interactive messaging (p=0.010). Text messaging did not significantly affect any of the secondary outcomes. Conclusions Text messaging has a significant effect on adherence to ART, and this effect is influenced by level of education, gender, timing (weekly vs daily) and interactivity. We recommend the use of interactive weekly text messaging to improve adherence to ART, which is most effective in those with at least a primary level of education.

Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya

Abstract: Background The prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15–19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008–09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi.

Urban agriculture, social capital, and food security in the Kibera slums of Nairobi, Kenya

Abstract: Much of the developing world, including Kenya, is rapidly urbanizing. Rising food and fuel prices in recent years have put the food security of the urban poor in a precarious position. In cities worldwide, urban agriculture helps some poor people gain access to food, but urban agriculture is less common in densely populated slums that lack space. In the Kibera slums of Nairobi, Kenya, households have recently begun a new form of urban agriculture called sack gardening in which vegetables such as kale and Swiss chard are planted into large sacks filled with topsoil. This paper examines relationships among sack gardening, social capital, and food security in Kibera. We used a mixed methods approach, combining qualitative interviews with a household survey, as well as focus group discussions with both farmers and non-farmers. We present evidence that sack gardening increases social capital, especially for those households that undertake sack gardening in groups. We also find that sack gardening in the Kibera slums has a positive impact on household food security by improving household dietary diversity and by reducing the need to resort to painful coping mechanisms that are used during food shortages.

Scaling Up What Works: Experimental Evidence on External Validity in Kenyan Education

Abstract: The recent wave of randomized trials in development economics has provoked criticisms regarding external validity. We investigate two concerns — heterogeneity across beneficiaries and implementers — in a randomized trial of contract teachers in Kenyan schools. The intervention, previously shown to raise test scores in NGO-led trials in Western Kenya and parts of India, was replicated across all Kenyan provinces by an NGO and the government. Strong effects of short-term contracts produced in controlled experimental settings are lost in weak public institutions: NGO implementation produces a positive effect on test scores across diverse contexts, while government implementation yields zero effect. The data suggests that the stark contrast in success between the government and NGO arm can be traced back to implementation constraints and political economy forces put in motion as the program went to scale.

A population-based survey of prevalence of diabetes and correlates in an urban slum community in Nairobi, Kenya

Abstract: Urban slum populations in Africa continue to grow faster than national populations. Health strategies that focus on non-communicable diseases (NCD) in this segment of the population are generally lacking. We determined the prevalence of diabetes and associated cardiovascular disease (CVD) risk factors correlates in Kibera, Nairobi’s largest slum. We conducted a population-based household survey utilising cluster sampling with probability proportional to size. Households were selected using a random walk method and consenting residents aged 18 years and above were recruited. The WHO STEPS instrument was administered. A random capillary blood sugar (RCBS) was obtained; known persons with diabetes and subjects with a RCBS >11.1 had an 8 hours fasting blood sugar (FBS) drawn. Diabetes was defined as a RCBS of ≥ 11.1 mmol/l and a FBS of ≥ 7.0 mmol/l, or a prior diagnosis or receiving diabetes drug treatment. Out of 2061 enrolled; 50.9% were males, mean age was 33.4 years and 87% had a minimum of primary education. Only 10.6% had ever had a blood sugar measurement. Age adjusted prevalence of diabetes was 5.3% (95% CI 4.2-6.4) and prevalence increased with age peaking at 10.5% (95% CI 6.8-14.3%) in the 45–54 year age category. Diabetes mellitus (DM) correlates were: 13.1% smoking, 74.9% alcohol consumption, 75.7% high level of physical activity; 16.3% obese and 29% overweight with higher rates in women. Among persons with diabetes the odds of obesity, elevated waist circumference and hypertension were three, two and three fold respectively compared to those without diabetes. Cardiovascular risk factors among subjects with diabetes were high and mirrored that of the entire sample; however they had a significantly higher use of tobacco. This previously unstudied urban slum has a high prevalence of DM yet low screening rates. Key correlates include cigarette smoking and high alcohol consumption. However high levels of physical activity were also reported. Findings have important implications for NCD prevention and care. For this rapidly growing youthful urban slum population policy makers need to focus their attention on strategies that address not just communicable diseases but non communicable diseases as well.

Efficacy of preexposure prophylaxis for HIV-1 prevention among high-risk heterosexuals: subgroup analyses from a randomized trial.

Abstract: BACKGROUND: Daily oral antiretroviral preexposure prophylaxis (PrEP) is a promising strategy for prevention of HIV-1 acquisition. Three clinical trials demonstrated PrEP efficacy; however two PrEP trials among women did not find protection against HIV-1. One hypothesis proposed for these divergent results is that PrEP efficacy may be reduced in populations with higher HIV-1 incidence. METHODS: Using data from the Partners PrEP Study a randomized placebo-controlled trial of daily oral tenofovir (TDF) and emtricitabine/tenofovir (FTC/TDF) PrEP among heterosexual HIV-1 serodiscordant couples from Kenya and Uganda we assessed PrEP efficacy among subgroups at higher risk for HIV-1 acquisition including subgroups of women with high HIV-1 incidence. RESULTS: The overall placebo arm HIV-1 incidence was 2.0 per 100 person-years. Among higher risk subgroups placebo arm HIV-1 incidence ranged from 3.9 to 6.6 per 100 person-years. In all subgroups PrEP was protective against HIV-1 acquisition with efficacy point estimates ranging from 64 to 84%. Among subgroups of women with placebo-arm HIV-1 incidence more than 5.0 efficacy estimates ranged from 64 to 84%. Monthly visit attendance for PrEP refills and tenofovir detection in plasma were high. CONCLUSION: Among higher-risk subgroups in the Partners PrEP Study including groups solely of higher-risk women both TDF alone and combined FTC/TDF PrEP had consistently high efficacy for HIV-1 protection. PrEP when used with high adherence is a highly effective prevention strategy for higher risk heterosexuals. Prioritizing PrEP for persons at high risk of HIV-1 will maximize its prevention impact.

The impact of mobile and internet banking on performance of financial institutions in kenya

Abstract: Financial institutions have been in the process of significant transformation. The force behind the transformation of these institutions is innovation in information technology. Information and communication technology is at the Centre of this global change curve of mobile and internet banking in Kenya. Rapid development of information technology has made banking tasks more efficient and cheaper. This study sought to determine the impact of mobile and internet-banking on performance of financial institutions in Kenya where the survey was conducted on financial institutions in Nairobi. The study also sought to identify the extent of use of mobile and internet banking in financial institutions. The study investigated 30 financial institutions. The study found that the most prevalent internet banking service is balance inquiry while the least is online bill payment. Cash withdrawal was the most commonly used mobile banking service whereas purchasing commodities was the least commonly used.

Analysis of Factors Contributing to the Low Survival of Cervical Cancer Patients Undergoing Radiotherapy in Kenya

Abstract: Background: In contrast to the developed nations invasive cervical cancer (ICC) is the most common womens malignancy in Kenya and many other locations in sub-Saharan Africa. However studies on survival from this disease in this area of the world are severely restricted by lack of patient follow-up. We now report a prospective cohort study of ICC in Kenyan women analysing factors affecting tumour response and overall survival in patients undergoing radiotherapy. Methods and Findings: Between 2008 and 2010 355 patients with histologically confirmed ICC were recruited at the Departments of Gynaecology and Radiotherapy at Kenyatta National Hospital (KNH). Structured questionnaires were completed recording socio-demographics tumour response and overall survival following treatment with combinations of external beam radiation (EBRT) brachytherapy and adjuvant chemotherapy. Of the 355 patients 42% (146) were lost to follow-up while 18% (64) died during the two year period. 80.5% of patients presented with advanced stage IIB disease or above with only 6.7% of patients receiving optimal combined EBRT brachytherapy and adjuvant chemotherapy. Kaplan Meier survival curves projected two year survival at 20%. Conclusion: Cervical cancer is preventable yet poverty poor education lack of cancer awareness coupled with an absence of regular screening programs late patient presentation sub-optimal diagnosis and treatments are major factors contributing to the alarmingly low survival rate of cervical cancer patients in Kenya. It is concluded that simple cost-effective changes in clinical practice could be introduced which would have a marked impact on patient survival in this setting.

Sexual behaviour of heterosexual men and women receiving antiretroviral pre-exposure prophylaxis for HIV prevention: a longitudinal analysis

Abstract: Summary Background Scarce data are available to assess sexual behaviour of individuals using antiretroviral pre-exposure prophylaxis for HIV prevention. Increased sexual risk taking by individuals using effective HIV prevention strategies, like pre-exposure prophylaxis, could offset the benefits of HIV prevention. We studied whether the use of pre-exposure prophylaxis in HIV-uninfected men and women in HIV-serodiscordant couples was associated with increased sexual risk behaviour. Methods We undertook a longitudinal analysis of data from the Partners PrEP Study, a double-blind, randomised, placebo-controlled trial of daily oral pre-exposure prophylaxis among HIV-uninfected partners of heterosexual HIV-serodiscordant couples (n=3163, ≥18 years of age). Efficacy for HIV prevention was publicly reported in July 2011, and participants continued monthly follow-up thereafter. We used regression analyses to compare the frequency of sex—unprotected by a condom—during the 12 months after compared with the 12 months before July 2011, to assess whether knowledge of pre-exposure prophylaxis efficacy for HIV prevention caused increased sexual risk behaviour. Results We analysed 56 132 person-months from 3024 HIV-uninfected individuals (64% male). The average frequency of unprotected sex with the HIV-infected study partner was 59 per 100 person-months before unmasking versus 53 after unmasking; we recorded no immediate change (p=0·66) or change over time (p=0·25) after July, 2011. We identified a significant increase in unprotected sex with outside partners after July, 2011, but the effect was small (average of 6·8 unprotected sex acts per year vs 6·2 acts in a predicted counterfactual scenario had patients remained masked, p=0·04). Compared with before July, 2011, we noted no significant increase in incident sexually transmitted infections or pregnancy after July, 2011. Interpretation Pre-exposure prophylaxis, provided as part of a comprehensive prevention package, might not result in substantial changes in risk-taking sexual behaviour by heterosexual couples. Funding The Bill & Melinda Gates Foundation and the US National Institute of Mental Health.

Mucosal Th17 Cell Function Is Altered during HIV Infection and Is an Independent Predictor of Systemic Immune Activation

Abstract: Mucosal Th17 cells maintain the gut epithelial barrier and prevent invasion by luminal bacteria through a delicate balance of immunosuppressive and proinflammatory functions. HIV infection is characterized by mucosal Th17 depletion, microbial translocation, and immune activation. Therefore, we assessed the function of blood and sigmoid Th17 cells during both early and chronic HIV infection, as well as the impact of short- and long-term antiretroviral therapy. Th17 cells were defined as IL-17a(+) CD4 T cells, and their functional capacity was assessed by the coproduction of the inflammatory cytokines IL-22, TNF-α, and IFN-γ, as well as the immunoregulatory cytokine IL-10. Gut Th17 cells had a much greater capacity to produce proinflammatory cytokines than did those from the blood, but this capacity was dramatically reduced from the earliest stages of HIV infection. Immunoregulatory skewing of mucosal Th17 cell function, characterized by an increased IL-10/TNF-α ratio, was uniquely seen during early HIV infection and was independently associated with reduced systemic immune activation. Antiretroviral therapy rapidly restored mucosal Th17 cell numbers; however, normalization of mucosal Th17 function, microbial translocation, and mucosal/systemic immune activation was much delayed. These findings emphasize that strategies to preserve or to more rapidly restore mucosal Th17 function may have important therapeutic benefit.

Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya.

Abstract: Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population. A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors. This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale.

Soil ingestion, nutrition and the seasonality of anthrax in herbivores of Etosha National Park

Abstract: Anthrax, caused by the bacterium Bacillus anthracis, is a seasonally occurring infectious disease affecting primarily herbivorous wildlife and livestock. The seasonality of anthrax outbreaks varies among locations, making it difficult to develop a single consistent ecological description of this disease. Over 44 years of mortality surveillance, most anthrax cases in Etosha National Park, Namibia are observed in the wet season, although elephants have an anthrax mortality peak in the dry season. Focusing on three host species (plains zebra, Equus quagga; African elephant, Loxodonta africana; and springbok, Antidorcas marsupialis) occupying the endemic anthrax area of Etosha National Park, Namibia, we tested two commonly posited causes of anthrax seasonality in herbivores: increased pathogen exposure due to greater soil contact, and increased host susceptibility due to seasonal nutritional stress. These hypotheses were assessed using fecal sampling and measurement of the percentage of fecal silicates as an ...

The broader context for ICT4D projects: a morphogenetic analysis

Abstract: This paper demonstrates the value of Archer's morphogenetic approach (MA) in understanding and explaining the complexity of the broader context within which many developing country information and communication technology (ICT) projects are implemented. It does this by using MA's analytical and explanatory apparatus to examine the evolution of the context of public sector ICT provision in Kenya over the period 1963-2006. In addition to demonstrating the practical value of MA, the paper contributes to the Information Systems literature on ICT for development (ICT4D). The analysis identifies (1) global normative pressures, polity, the national socio-economic base, disruptive technology, and the emergence of multistakeholder networks as key forces in shaping the evolutionary trajectory, (2) the explicit treatment of time and temporality as key for understanding mechanisms underpinning the evolutionary process, and (3) the difficulty of cleanly isolating the implementation of individual public sector ICT projects from the broader context and ICT4D agendas. The discussion elaborates on the features of MA found to be particularly valuable in this study. The paper concludes that explicitly attending to time and temporality, and to the broader context for ICT4D projects, would contribute to the development of more nuanced accounts of such projects and a more emancipatory outlook for ICT4D research.

Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya

Abstract: Objective : The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients. Method: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes. Results : Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders. Conclusion : There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments. Keywords : Traditional Healers; Mental illness; Informal settlements; Kenya

The critical success factors and challenges in e-procurement adoption among large scale manufacturing firms in nairobi, kenya

Abstract: E-Procurement is more than just a system for making purchases online. Some companies implement e-procurement and succeed while others fail. This study was carried out on the adoption of e-procurement among large scale manufacturers in Nairobi, Kenya. The study had three objectives: To ascertain the extent to which large scale manufacturers in Nairobi have adopted e-procurement; to determine the critical success factors influencing the success of e-procurement in large manufacturing firms in Nairobi and to establish the challenges that face e-procurement adoption in large scale manufacturing firms in Nairobi. The research involved a cross-sectional survey of the large manufacturing companies operating in Kenya. The study adopted a descriptive approach in trying to establish the factors that influence the success of e-procurement projects. A sample size of 46 respondents was selected from a list of 455 large manufacturing companies. Data was collected from the respondents through a questionnaire. The collected data was analyzed using SPSS and presented in tables. The study revealed that majority of the large scale manufacturers in Nairobi, Kenya has adopted e-procurement with the following e-procurement practices: online advertisement of tenders, receiving online submission of proposals for the tenders, and short listing suppliers online among others. The five critical success factors identified were: employees and management commitment to success of adoption; reliability of information technology and supplier performance; monitoring the performance of e-procurement systems;

Sexual reproductive health service provision to young people in Kenya; health service providers' experiences.

Abstract: Background: Addressing the sexual and reproductive health (SRH) needs of young people remains a challenge for most developing countries. This study explored the perceptions and experiences of Health Service Providers (HSP) in providing SRH services to young people in Kenya. Methods: Qualitative study conducted in eight health facilities; five from Nairobi and three rural district hospitals in Laikipia, Meru Central, and Kirinyaga. Nineteen in-depth interviews (IDI) and two focus group discussions (FGD) were conducted with HSPs. Interviews were tape recorded and transcribed. Data was coded and analysed using the thematic framework approach. Results: The majority of HSPs were aware of the youth friendly service (YFS) concept but not of the supporting national policies and guidelines. HSP felt they lacked competency in providing SRH services to young people especially regarding counselling and interpersonal communication. HSPs were conservative with regards to providing SRH services to young people particularly contraception. HSP reported being torn between personal feelings, cultural and religious values and beliefs and their wish to respect young people’ sr ights to accessing and obtaining SRH services. Conclusion: Supporting youth friendly policies and competency based training of HSP are two common approaches used to improve SRH services for adolescents. However, these may not be sufficient to change HSPs’ attitude to adolescents seeking help. There is need to address the cultural, religious and traditional value systems that prevent HSPs from providing good quality and comprehensive SRH services to young people. Training updates should include sessions that enable HSPs to evaluate how their personal and cultural values and beliefs influence practice.

New systematic review methodology for visual impairment and blindness for the 2010 Global Burden of Disease study

Abstract: Purpose: To describe a systematic review of population-based prevalence studies of visual impairment (VI) and blindness worldwide over the past 32 years that informs the Global Burden of Diseases, Injuries and Risk Factors Study. Methods: A systematic review (Stage 1) of medical literature from 1 January 1980 to 31 January 2012 identified indexed articles containing data on incidence, prevalence and causes of blindness and VI. Only cross-sectional population-based representative studies were selected from which to extract data for a database of age- and sexspecific data of prevalence of four distance and one near vision loss categories (presenting and best-corrected). Unpublished data and data from studies using rapid assessment methodology were later added (Stage 2). Results: Stage 1 identified 14,908 references, of which 204 articles met the inclusion criteria. Stage 2 added unpublished data from 44 rapid assessment studies and four other surveys. This resulted in a final dataset of 252 articles of 243 studies, of which 238 (98%) reported distance vision loss categories. A total of 37 studies of the final dataset reported prevalence of mild VI and four reported near VI. Conclusion: We report a comprehensive systematic review of over 30 years of VI/blindness studies. While there has been an increase in population-based studies conducted in the 2000s compared to previous decades, there is limited information from certain regions (eg, Central Africa and Central and Eastern Europe, and the Caribbean and Latin America), and younger age groups, and minimal data regarding prevalence of near vision and mild distance VI.

Towards a framework convention on global health

Abstract: Introduction What will it take to eliminate the gross health inequities that continue to plague the world, the unconscionable health gaps between the rich and poor? The eyes of the global health community are focused on the post-2015 sustainable development goals, with the World Health Organization [WHO] advocating for universal health coverage. Adding healthy life expectancy as an overarching goal would capture the broader determinants of health and offer a richer integration of multiple sectors. Beyond improving health, the United Nations [UN] should focus on equity, human rights, inclusive participation and accountability, (2) The stage is set for the post-2015 agenda to embrace global health with justice--improving healthy lives for everyone, with particular attention to marginalized communities. The sustainable development agenda, however, cannot achieve global health with justice without robust global governance. We urge adoption of a legally binding global health treaty--a framework convention on global health grounded in the right to health. What are the purposes and content of a framework convention and how can such a treaty help to achieve global health with justice? And what steps need to be taken to galvanize support for its adoption and implementation? This perspectives paper seeks to spark international dialogue on a framework convention on global health and to explore the pathways towards a global health treaty. Core purposes and content The Millennium Development Goals were instrumental in achieving considerable progress in global health, but they failed to close the health gap. The overriding purpose of a framework convention on global health would be to dramatically reduce the health disadvantages experienced by the marginalized and the poor, both within countries and between them, while reducing health injustices across the socioeconomic gradient. Guided by principles underlying the right to health and mutual responsibility, a framework convention would universally ensure three conditions that are essential for a healthy life: a well-functioning health system providing quality health care; a full range of public health services, such as nutritious food, clean water, and a healthy environment; and broader economic and social conditions conducive to good health, such as employment, housing, income support and gender equality. Substantial improvements in health would be achieved through a population-based strategy centred on the essential conditions for the public's health, ranging from food, water and clean air to hygienic conditions, injury prevention and liveable communities conducive to physical activity and to healthful eating habits. By embedding the conditions for good health within the environment and bringing these benefits to everyone, including the poorest and most remote communities, public health services would give everyone a fair chance for a healthy life. Universal access to all levels of health care [community services and primary, secondary and tertiary care] and to financial protection [to prevent impoverishment and catastrophic health expenditures] would afford everyone the services needed to prevent and treat injury and disease. Importantly, policies and actions across the full spectrum of government ministries are needed to ensure education, employment, housing, clean energy, transportation, gender equity and all other positive social determinants of health. A framework convention would establish a health financing framework with clear obligations, and would create an accountability regime with robust standards, monitoring and enforcement. It would advance health justice through engaging marginalized and underserved populations in making and evaluating policies and through comprehensive strategies and targeted interventions designed to overcome the barriers that prevent these populations from enjoying the conditions required for good health. …

Potential impacts of climate and environmental change on the stored water of Lake Victoria Basin and economic implications

Abstract: [1] The changing climatic patterns and increasing human population within the Lake Victoria Basin (LVB), together with overexploitation of water for economic activities call for assessment of water management for the entire basin. This study focused on the analysis of a combination of available in situ climate data, Gravity Recovery And Climate Experiment (GRACE), Tropical Rainfall Measuring Mission (TRMM) observations, and high resolution Regional Climate simulations during recent decade(s) to assess the water storage changes within LVB that may be linked to recent climatic variability/changes and anomalies. We employed trend analysis, principal component analysis (PCA), and temporal/spatial correlations to explore the associations and covariability among LVB stored water, rainfall variability, and large-scale forcings associated with El-Nino/Southern Oscillation (ENSO) and Indian Ocean Dipole (IOD). Potential economic impacts of human and climate-induced changes in LVB stored water are also explored. Overall, observed in situ rainfall from lake-shore stations showed a modest increasing trend during the recent decades. The dominant patterns of rainfall data from the TRMM satellite estimates suggest that the spatial and temporal distribution of precipitation have not changed much during the period of 1998–2012 over the basin consistent with in situ observations. However, GRACE-derived water storage changes over LVB indicate an average decline of 38.2 mm/yr for 2003–2006, likely due to the extension of the Owen Fall/Nalubale dam, and an increase of 4.5 mm/yr over 2007–2013, likely due to two massive rainfalls in 2006–2007 and 2010–2011. The temporal correlations between rainfall and ENSO/IOD indices during the study period, based on TRMM and model simulations, suggest significant influence of large-scale forcing on LVB rainfall, and thus stored water. The contributions of ENSO and IOD on the amplitude of TRMM-rainfall and GRACE-derived water storage changes, for the period of 2003–2013, are estimated to be ∼2.5 cm and ∼1.5 cm, respectively.

Community perceptions of health insurance and their preferred design features: implications for the design of universal health coverage reforms in Kenya

Abstract: Background: Health insurance is currently being considered as a mechanism for promoting progress to universal health coverage (UHC) in many African countries The concept of health insurance is relatively new in Africa, it is hardly well understood and remains unclear how it will function in countries where the majority of the population work outside the formal sector Kenya has been considering introducing a national health insurance scheme (NHIS) since 2004 Progress has been slow, but commitment to achieve UHC through a NHIS remains This study contributes to this process by exploring communities’ understanding and perceptions of health insurance and their preferred designs features Communities are the major beneficiaries of UHC reforms Kenyans should understand the implications of health financing reforms and their preferred design features considered to ensure acceptability and sustainability Methods: Data presented in this paper are part of a study that explored feasibility of health insurance in Kenya Data collection methods included a cross-sectional household survey (n = 594 households) and focus group discussions (n = 16) Results: About half of the household survey respondents had at least one member in a health insurance scheme There was high awareness of health insurance schemes but limited knowledge of how health insurance functions as well as understanding of key concepts related to income and risk cross-subsidization Wide dissatisfaction with the public health system was reported However, the government was the most preferred and trusted agency for collecting revenue as part of a NHIS People preferred a comprehensive benefit package that included inpatient and outpatient care with no co-payments Affordability of premiums, timing of contributions and the extent to which population needs would be met under a contributory scheme were major issues of concern for a NHIS design Possibilities of funding health care through tax instead of NHIS were raised and preferred by the majority Conclusion: This study provides important information on community understanding and perceptions of health insurance As Kenya continues to prepare for UHC, it is important that communities are educated and engaged to ensure that the NHIS is acceptable to the population it serves

Endothelial activation biomarkers increase after HIV-1 acquisition: plasma vascular cell adhesion molecule-1 predicts disease progression.

Abstract: Objective We aimed to determine whether endothelial activation biomarkers increase after HIV-1 acquisition, and whether biomarker levels measured in chronic infection would predict disease progression and death in HIV-1 seroconverters.