Assessment Methods Used during Clinical Years of Undergraduate Medical Education at Moi University School of Medicine, Kenya

Background: Assessment is the systematic collection, review, and use of information about educational programs undertaken to improve teaching and learning. It ensures quality in training programmes, motivates, and directs students’ learning. Assessment is also used for verification of achievement of objectives of training, feedback to students, licencing, certification, and screening of students for advanced training. It is guided by several principles, including the aims of the assessment (why assess), who to assess, timing (when to assess), what to assess, methods (how to assess), and the criteria for determining the usefulness of the assessment. Objective: To describe the assessment methods used during clinical years of the undergraduate programme at Moi University School of Medicine (MUSOM) and determine the student’s perspectives concerning the comprehensiveness, relevance, objectivity of various assessment methods and challenges faced. Methodology: The study was carried out at MUSOM and a cross-sectional study design was employed. Ten study participants were studied using convenience sampling. Data were collected using an interview guide and was analyzed using content analysis. An informed consent was obtained from the study participants. Results: The methods used during clinical years at MUSOM for assessing knowledge and its applications include multiple-choice questions (MCQ), short answer questions (SAQ), modified essay questions (MEQ), long essay questions (LEQ), and oral exam. Whereas the methods for assessing clinical competence include long case, short cases, objective structured clinical examinations (OSCE), and logbook. Students felt that MCQs were comprehensive, objective, and relevant to the curriculum content. They reported that feedback was not provided after assessments. Conclusion: The assessment methods used at MUSOM during clinical years include MCQ, SAQ, MEQ, LEQ, Short cases, long cases, and OSCE. Students reported varied perceptions of the different assessment methods but favored MCQ and OSCE over other formats for assessing knowledge and clinical skills respectively.

Variation in Progesterone Levels and Urinary Tract Infections in Pregnant Women Attending Moi Teaching and Referral Hospital, Eldoret, Kenya

Background and Aims: Urinary tract infections (UTIs) are common among pregnant women and major predisposing factors for pyelonephritis linked to obstetrical complications including preterm labour and low infants’ birth weights. This study sought to determine the relationship(s) between pregnancy trimesters, UTIs and changes in progesterone levels among pregnant women. Materials and Methods: The study was conducted in 2016 at Moi Teaching and Referral Hospital (MTRH) antenatal clinic which is a referral facility that attends to patients from most Counties in western region of Kenya. A cross-sectional study design was used to collect blood and urine specimens from 78 participants. Blood was used to determine progesterone levels using ELISA technique and urine cultures with bacterial colony counts ≥ 105 were appropriately identified to species level. Trimester periods and participants’ demographic information were obtained using a structured questionnaire. Results: Culture results showed that the most abundant bacterial species isolated in urine from the pregnant women was Escherechia coli (63.7%). The more affected age-group was women between 30 - 39 years during trimester three, suggesting that bacterial colonization of genital track occurred more frequently in older compared to the younger women. There was an exponential increase in progesterone levels among the pregnant women during trimester three compared to other trimesters, although these increases occurred independent of age. However, high levels of progesterone among pregnant women in third trimester corresponded with increased number of E. coli causing UTI. Conclusion: The results showed that progesterone levels increase with trimester and the most prevalent bacteria associated with this was E. coli even though age and increase in progesterone levels had no significant impact on E. coli infection.

Knowledge and Utilisation of Emergency Contraception Pills among Female Undergraduate Students at the University of Nairobi, Kenya

Background: Emergency Contraception (EC) is used after unprotected sexual intercourse, following sexual abuse, misuse of regular contraception or non-use of contraception. Seventeen percent of pregnancies in Kenya are unintended, potentially leading to unsafe abortion that contributes to the high maternal mortality rate in Country. According to 2016 Kenya Demographic and Health Survey (KDHS), the maternal mortality ratio was 362 maternal deaths per 100,000 live births. Female students in University or College are vulnerable to unplanned pregnancies and illegal abortions resulting in mortality, morbidity and psychosocial problems. Knowledge on EC is very important for students as they are not in stable relationships and not using regular contraception. Therefore, the aim of this study was to determine the knowledge and use of Emergency Contraception among female undergraduate students in the University of Nairobi. Materials and Methods: We used an institution-based cross sectional, quantitative study to sample was employed among 383 female undergraduate students at the University of Nairobi. The University of Nairobi has six colleges and systematic random sampling was used to select study participants from each college. Data were collected using self-administered questionnaires and analysed using SPSS Version 16. Bivariate analysis and logistic regression were used to determine sample characteristics significantly associated with knowledge and utilisation of Emergency Contraception. Results: Most (53%) of the respondents were sexually active, and only 20% of the sexually active female students had ever used Emergency Contraception. Emergency Contraception awareness was high at 86.4%. However, based on a predefined criterion, accurate knowledge of Emergency Contraception was low at 42.6%.The majority (82.5%) of the respondents depended on mass media as a source of information on Emergency Contraception. Factors associated with Emergency Contraception knowledge on bivariate analysis were: age 20 years and above (p = 0.001), enrolment in college of health science (p = 0.001), being in year three of study and above (p = 0.0001) and having an insurance cover (p = 0.021). Ever use of Emergency Contraception was associated with enrolment in the College of health science (p = 0.025) and age 20 years and above (p = 0.050). In multivariate analysis, older age (Aor 1.885 p = 0.003) as well as being in the College of health science (Aor 0.001) were significantly associated with increased probability of being knowledgeable about Emergency Contraception. Conclusion: Although University of Nairobi female undergraduate students are aware of the existence of Emergency Contraception, their specific knowledge on correct timing of taking EC after unprotected sex and on effectiveness is poor. EC use is also low, compounded by underutilisation of public facilities as a source of the EC and underutilisation of health workers as a source of EC information. Therefore, an educative forum may be needed to improve the knowledge of EC among University of Nairobi female students. Health education on the availability of EC in public facilities needs to be addressed. Possible use of informal sources of information such as peer education could be an area to explore in client education on EC knowledge and use. Further research is recommended to establish factors that influence utilisation of public health workers as a source of EC information.

Prevalence and Anti-Microbial Susceptibility of Methicillin Resistant Staphylococcus aureus at Moi Teaching and Referral Hospital Eldoret

Background: Methicillin-resistant Staphylococcus aureus (MRSA) are pathogens that have major negative impact in all aspects of patient care and are increasingly being recognized as troublesome pathogens in the community. The MRSA are multi-drug resistant bacteria responsible for higher morbidity, mortality and cost of treatment in the affected patients. Research on MRSA antimicrobial susceptibility and resistance in developing countries is limited;hence accurate burden is not certain. Objective: To determine the prevalence and susceptibility pattern of MRSA in S. aureus isolates from patients treated in various units at Moi Teaching and Referral Hospital. Study Design: Cross-sectional design was used to conduct the study. Methods and Materials: Staphylococcus aureus stored isolates from patients at various units at Moi Teaching and Referral Hospital (MTRH) were identified by laboratory conventional methods. Methicillin resistant Staphylococcus aureus was determined using cefoxitin and oxacillin, discs and confirmed by Penicillin Binding Protein (PBP2a’) latex agglutination test. Susceptibility testing was performed according to the Clinical Laboratory Standards Institute procedures. Control strains used were: ATCC 43300 for Methicillin resistant S. aureus (MRSA) strains and ATCC 29213 for methicillin susceptible S. aureus (MSSA) strains. Nine anti-microbials (Erythromycin, Gentamycin, Tetracycline, Vancomycin, Rifampin, Linezolid, Ciprofloxacin, Clindamycin and Fucidicacid) were used to test the anti-microbial susceptibility patterns. Control organisms were run along with the isolates for quality Assurance. The data was analyzed using STATA version 11. Categorical variables were summarized as frequencies and the corresponding percentages. Results were presented using tables and graphs. Results: A total of 107 isolates of S. aureus were obtained, of which 39 (37%) were MRSA. Most of the MRSA, 13 (33%) and 7 (17%), were found in pus and tracheal aspirate samples respectively. Majority of the MRSA isolates were from surgical wards and intensive care unit. The MRSA isolates were highly resistant to erythromycin (92%;36/39) and tetracycline (92% 36/39) and moderately susceptible to linezolid (77% 30/39), Vancomycin (75% 29/39) and fucidic acid (67% 26/39). A total of 28 (74.4%) MRSA isolates were Clindamycin inducible resistant. Conclusions and Recommendations: This study showed that MRSA is a significant pathogen at MTRH. The MRSA were most detected in pus specimens and least in peritoneal aspirates. Routine Screening of S. aureus isolates for MRSA strains at MTRH is therefore imperative. Infection control measures should be put in place to reduce prevalence and prevent the spread of MRSA at MTRH.

Sulfonation of 1,4-diaminoanthraquinone leuco by chlorosulfonic acid:Kinetics and process intensification

The work herein employed a rotating packed bed(RPB)to intensify the sulfonation process of 1,4-diaminoanthraquinone leuco(DL)in an attempt to improve the yield of the product 1,4-diaminoanthra quinone-2-sulfonic acid(DSA).First,the effects of operating conditions in a stirred tank reactor(STR),including stirring speed,chlorosulfonic acid/DL molar ratio(η),solvent/DL mass ratio(ζ),reaction temperature and dropping speed of chlorosulfonic acid,on the yield of DSA were investigated.The yield of DSA can reach 87.34%under the optimal operating conditions:stirring speed of 500 r·min^(-1),ηof 4.5,ζof 7,reaction temperature of 150℃,dropping speed of 0.61 ml·min^(-1).In addition,the kinetics of the sulfonation process via the shrinking core model revealed that the reaction is controlled by diffusion via a product layer under the reaction temperature of 140℃.Furthermore,the RPB was employed to intensify the mass transfer between liquid and solid phases during the sulfonation reaction process.The results showed that the DSA yield of 92.69%obtained by RPB was 5.35%higher than that by STR,indicating that RPB can significantly intensify the mass transfer in the liquid-solid phase sulfonation reaction process.

Phytochemicals, polyphenols content, in vitro antioxidant and antibacterial activities of Albizia coriaria Welw ex. Oliver flowers

Albizia coriaria Welw ex.Oliver(hereafter A.coriaria)is a revered medicinal tree whose organs are used by indigenous African societies for managing various ailments.Herein,we assessed the secondary metabolites,total polyphenolics,free radical scavenging and antimicrobial activities of A.coriaria flowers.The dry powdered sample was extracted serially with ethyl acetate,ethanol and distilled water.Results of classical phytochemical screening showed that saponins,phenols,alkaloids,flavonoids,tannins and terpenes were the dominant phytochemicals.The highest total polyphenolic content(10.37±0.02 mg QE/g DW and 72.09±0.09 mg GAE/g DW)and free radical scavenging potential(IC50=24.23±0.04 mg/mL)were for the ethyl acetate extract.It also had a higher bacteriostatic activity than the ethanolic extract against Pseudomonas aeruginosa,Salmonella typhi,Escherichia coli and Staphylococcus aureus with diameters of inhibition ranging from 7.00±0.00 to 22.00±1.73 mm.The aqueous extract showed no appreciable antibacterial effect on the tested microorganisms.This is the first report which support the use of floral extracts of this species in the management of ailments in African traditional medicine.

Laboratory Diagnosis of Acute Leukemia in Kenya: The Gaps and Opportunities

Acute leukemia (AL) is a malignant disease of the bone marrow in which hematopoietic precursors are arrested in an early stage of development. The diagnosis of leukemia and lymphomas, beyond morphology, is limited in low-resource countries including Kenya. Morphological diagnosis includes Cytological and Histological assessment of blood, bone marrow aspirates and tissues on suspected Acute leukemia patients. The World Health Organization (WHO, 2016) international guidelines on Acute leukemia diagnosis recommend that cytogenetic analysis, appropriate molecular genetics, Fluorescent in situ Hybridization (FISH) testing, and flow cytometric immuno-phenotyping should be done in addition to a morphologic assessment of Acute Leukemia. In facilities where resources are relatively available, immunophenotypic and genetic features have resulted not only in providing a more accurate leukemia diagnosis but also in identifying antigens or genes that can then be targeted for therapy. This article will look at the gaps in the diagnosis of Acute leukemia in low-resource settings like Kenya and opportunities available to improve diagnosis.

Controllable Fabrication of Spider-Web-Like Structured Anaphe Panda Regenerated Silk Nanofibers / Nets via Electrospinning / Netting

An Anaphe panda silk nanofibers / nets( NFN) membrane with attractive structures consisting of common electrospun nanofibers and two-dimensional( 2D) spider-web-like structured nano-nets were successfully fabricated via electrospinning / netting technology. The unique structures of NFN membranes such as extremely small diameter( < 20 nm),high porosity,large specific surface area. and biocompatibility make this Anaphe panda silk NFN membrane a promising candidate for biomedical applications. In the present study, field emission scanning electron microscopy( FESEM) was used to investigate the influence of polymer solution and humidity on nano-nets coverage and morphology. The FE-SEM images revealed that nano-net coverage area increased with increase in concentration of solution while lowering the humidity increased the nano-nets formation. Moreover,the mechanical properties of the membrane were also tested and the result showed that the silk NFN membrane displayed a breaking stress of 3. 7 MPa and breaking strain of 13. 8%. For further structural elucidation, Fourier transform infrared spectroscopy( FT-IR) was used to analyze the structural conformation changes from random coil to β-sheet in the NFN membrane which was an important factor effecting the usability of membrane. Thus,the results above confirmed the feasibility of Anaphe panda NFN structures applicability in cell tissue culture and other biomedical applications.

静电纺丝纳米炭纤维的电容去离子化技术用于海水淡化

电容去离子技术(CDI)已迅速发展成为极具前景的海水淡化方法之一,该技术主要通过在两个多孔电极之间施加电势,使水中的带电物质向电极表面移动,去除水中的盐分进行海水淡化。当离子可以在电极材料的多孔结构中畅通无阻地通过时,海水淡化的效果最佳。纳米结构的多孔炭材料具有较高的比表面积和表面活性,因此更有利运用CDI进行海水淡化。从这个意义上来说,高比表面积静电纺丝炭纳米纤维(CNFs)是非常理想的炭材料,可以在其表面进行掺杂/接枝活性剂增强表面特性。与传统的用粉状材料制备得到的电极不同,CNF可以无需使用黏合剂自支撑形成电极,从而避免了电极材料微观结构和导电性的改变。因此,中孔和微孔均匀分布的分层孔结构使得CNF电极具有较好的海水淡化性能。此外,CNFs与法拉第材料的复合材料可以通过双电层(EDL)和赝电容机制的协同作用进一步增强离子的存储能力。本文重点综述了在CDI工艺中静电纺丝CNFs电极的主要前驱体材料、结构改性及其在盐离子电吸附中的性能。

Integrated environmental education for sustainable forest management: the case of Nandi Hills Forests, Kenya

Environmental education （EE） is a vital dimension of modern day acumen that portends a great promise in solving the myriad environmental resource management challenges at global, regional and local levels. A study was carried out in 18 locations in the Nandi North, Nandi South and Nandi Hills districts of Kenya, which cover the Nandi Hills and Nandi Forests in Nandi County, major water catchments for Lake Victoria. A mixed methodological approach, incorporating both qualitative and quantitative data obtained from focus group discussions, key informant interviews, household survey and observations was embraced in data collection and analysis. The study reveals that there are several strategies that have been adopted by the local population and institutions involved in the management of the Nandi Hills Forests （NHFs） and that these strategies have contributed to an improvement in the perceptions of the local population in terms of the importance of environmental management of the forests. This paper highlights EE as a vehicle for ensur- ing a sustainable management of the Nandi Hills Forests. As such, it illuminates the great potential that lies in sustainably managing the NHFs by integrating formal and informal EE approaches. It further points out the functional gaps in the management of NHFs and proposes best-practices that could be adopted and/or domesticated in NHFs management regimes.

Distance decay of place attachment and perceived authenticity of mountain tourism destinations in China

Place attachment has been a research focus in the fields of park and recreation management.Place attachment plays an important role in promoting sustainable development of parks and mountain tourism destination,however,there are limited studies that identified the spatial patterns of place attachment,especially in the context of mountain tourism destinations in China.Also,the geospatial spectrum of visitors is usually broad,examining the multivariate relationships among spatial proximity,perceived authenticity,and place attachment are essential for mountain tourism destinations to promote destination image and strengthen emotional bonding with targeted visitor groups.In this study,we selected an iconic and highly visited park,Jiuzhai Valley National Park in China,as our study site and conducted an on-site visitor survey to collect 557 samples.Study uses factor analysis and the structure equation model to analyze the relationship among spatial proximity,perceived authenticity,and place attachment.Results validate the two-dimension structure of place attachment and perceived authenticity.Study findings suggest that spatial proximity has significant impacts on existential authenticity and place identity,but has no significant impacts on place dependence.Perceived authenticity has a positive impact on place attachment.Study results advance the theories of place attachment and provide effective strategies to enhance emotional attachment between visitors and mountain tourism destinations.

Evaluation of the Completeness in the Filling of Laboratory Request Forms Submitted to the Haematology Laboratory at a Tertiary Hospital in Kenya

Background information: The laboratory request form is a communication link between the clinicians and the laboratory staff. It contains demographic details of the patient including full names, age and gender;the test required;location of the patient;date and time of request among other details. Incomplete and inaccurate filling of the request forms may cause errors which can impact on the quality of the patient care. Methodology: The study was a descriptive cross sectional where 289 laboratory request forms submitted consecutively to the haematology laboratory during the month of January 2018 were evaluated. Data was collected using a data collection form and analyzed by use of frequency table. Ethical clearance was sought from Institutional Research and Ethical Committee of Moi University and Moi Teaching and Referral Hospital. Results: Of all the 289 forms evaluated, only 1% (3/289) had all the required information. The parameters with the most information were patient’s name (100%), hospital number (100%), sex (99.7%), age (98.3%), investigation requested (97.6%), the location of the patient (96.9%), clinician’s name (96.9%) and signature (96.5%). The least information was recorded for clinical history (14.7%) and address of the patient (4.8%). Conclusion: The study showed that there were inadequacies in the recording of the required information in the laboratory request form. The parameters which were completely filled were the patient’s name and the hospital number, whereas the address and the clinical history had the least completion rates.

Enhancing Maize Grain Yield in Acid Soils of Western Kenya Using Aluminium Tolerant Germplasm

Maize （Zea mays L.） is one of the world＇s most important cereals and is a staple food for many people in developing countries. However, in acid soils （pH 〈 5.5）, its productivity is limited by aluminium （AI） toxicity, besides other factors. The objectives of this study were to： develop AI tolerant maize inbred lines for a maize breeding program in Kenya, develop single cross hybrids （SCHs） from some of the tolerant inbred lines and determine AI tolerance levels of the SCHs. One hundred and seventy five inbreds and 49 SCHs were developed and screened in nutrient culture containing 0 or 222μM using Relative Net Root Growth （RNRG）, hematoxylin staining （HS） and under AI saturated field conditions （44%-45.6%） at Sega and Chepkoilel. Seedling root growth was inhibited in 95% of the inbreds. F hybrids obtained from inbreds varying in A1 tolerance, exhibited tolerance equal to or greater than that of the more tolerant parent indicating a positive transgressive inheritance to AI toxicity. Fifty eight percent of the F SCHs were heterotic for tolerance to AI toxicity. AI tolerance estimated by RNRG was well correlated to that of HS （r2 = 0.88, P 〈 0.005） but minimally correlated with the field estimates （r2 = 0.24-0.35）, implying that RNRG can predict field selection under AI toxic soils by between 24% and 35%. Plant breeders should therefore employ both approaches in selecting cultivars under AI stress. This study has developed and identified A1 tolerant inbreds and SCHs for use in the acid soils of Kenya and similar regions.

Effects of Tour Guides Training on Their Performance in Kenya

It is important for a completive tourism destination to ensure that tourists get the company of a professional tour guide who guides and interprets attraction in the areas visited. Undefined level of education, lack of standardized training curriculum, and lack of barrier to the guiding career have affected the performance of tour guides in Kenya. Limited research in Kenya has been conducted to establish the role of guides in satisfying customer and protecting the environment. The study objective was to examine tour guides＇ interpretation knowledge and their opinion on areas that require more training so as to improve their performance. The study hypothesized that tour guides＇ opinions on their training needs are independent on the level of education, work experience and qualification. It is hypothesized that guides require additional training in flora and fauna of East Africa, cultural heritage and customer service. They require training in ICT （Information Communications Technology）, eco-tourism principles, and at least one foreign language. The study hypothesizes that the higher the level of a guide＇s training, the more resourceful the guide will be. The study used qualitative and quantitative research approaches where questionnaires, interviews and focus groups discussion （FGDs） were used to collect the primary data. The finding shows that tour guides＇ opinions on areas they require further training were independent of their highest level of education, work experience and qualification. Most guides irrespective of their level of education, work experience and qualifications were of the opinion that they needed more training on mammals and plants （χ^2 = 1.07, df= 2, P = 0.583）, training on birds and insects （χ^2 = 0.254, df= 2, P = 0.885） and training on culture and history of East Africa （χ^2 = 1.140, df= 2, P = 0.566）. Respondents＇ training needs were independent on the duration of tour guiding course training had taken. Guides trained for less than six months, one year and more than two years agreed that training on foreign language （χ^2 = 4.84, df = 2, P = 0.196）, ecotourism principles （χ^2 = 1.62, df = 2, P = 0.653） and tour planning and costing （χ^2 = 399, df = 3, P = 0.262） would improve their performance. The study concludes that tour guides are aware of the areas that they need to be trained and should be consulted before organizing such training. They require more training irrespective of their level of education, certification and work experience. The study recommends tour guide curriculum be standardized and all guides should sit for an exam before they are licensed to guide and only those with such license be allowed to practice guiding.

Design and Implementation of Mobile Portal for Kenyan Pastoralists

A mobile portal is an internet gateway that provides online services primarily accessed via mobiles and other handheld devices. Mobile portals are part of web 3.0 that is starting to revolutionize online services. Such portals can help pastoralists in Kenya access essential information and marketing services online. The aim of the study was to design and implement a mobile portal that will help Kenyan pastoralists improve their yields. The study adopted systems development life cycle (SDLC) methodology to design, implement and test the portal and used structured interviews and observation to collect user requirements. The portal was coded in J2ME, JSP and SQL languages and developed using Java Development Kit (JDK), Sun Wireless Toolkit, Lightweight User Interface Toolkit (LWUIT), Struts, Tomcat and MySQL. The outcome of the study was the mobile portal successfully developed, tested and deployed.

Ozonation of o-phenylenediamine in the presence of hydrogen peroxide by high-gravity technology

The study herein investigated the effectiveness of simultaneous use of ozone and hydrogen peroxide(O_3/H_2O_2 process) to degrade o-phenylenediamine(o-PDA) in a simulated wastewater. A rotor–stator reactor(RSR) was employed to create a high-gravity environment in order to enhance ozone-liquid mass transfer rate and possibly improve the degradation rate of o-PDA. The degradation efficiency of o-PDA(η) as well as the overall gas-phase volumetric mass transfer coefficient(KGa) were determined under different operating conditions of H_2O_2 concentration, initial o-PDA concentration, temperature of reaction, initial p H and rotation speed of RSR in attempt to establish the optimal conditions. Chemical oxygen demand reduction rate(rCOD) of wastewater treated at a particular set of conditions was also analyzed. Additionally, the intermediate products of degradation were identified using a gas chromatography-mass spectrometer(GC/MS) to further evaluate the extent of o-PDA degradation as well as establish its possible degradation pathway. Results were validated by comparison with those of sole use of ozone(O_3 process), and it was noted that η, KGa and rCODachieved by O_3/H_2O_2 process was 24.4%,31.6% and 25.2% respectively higher than those of O_3 process, indicating that H_2O_2 can greatly enhance ozonation of o-PDA. This work further demonstrates that an RSR can significantly intensify ozone-liquid mass transfer rate and thus provides a feasible intensification means for the ozonation of o-PDA as well as other recalcitrant organics.

Factors associated with financial support in old age for young and middle-aged rural residents in China

This study examined the factors associated with financial support in old age from three primary mechanisms-personal savings,family support,and social insurance-to explore the implications for the future development of China's rural social welfare system.Cross-sectional surveys of 1392 young and middle-aged rural residents were conducted in July and August2012.The results showed that while social insurance was increasingly acceptable,personal savings and family support still had fundamental value.Combining the three mechanisms,the rural old-age welfare system presented nontraditional features.China's new rural endowment insurance is discussed as a means to address the need for financial support among the rural aging population.

Nexus between selected macroeconomic variables and carbon emission in Kenya

Agriculture is not only influenced by climate change,but it is also one of the significant contributors of CO_(2) emission.Understanding CO_(2) emission and macroeconomic variables is critical to solving the challenges and threats faced by Kenya’s agriculture and environment.This study used the Environmental Kuznets Curve(EKC)hypothesis and the autoregressive distribution lag model(ADLM)to analyze the relationships of CO_(2) emission with agricultural output,government direct investment,trade openness,and inflation rate in Kenya from 1983 to 2019.The study found that there exists a positive(direct)relationship between CO_(2) emission and foreign direct investment in the long run in Kenya.Additionally,CO_(2) emission and trade openness have a negative(indirect)and statistically significant relationship after the error correction term adjustment in the long run.Moreover,the relationship between CO_(2) emission and agricultural output is positive(direct)and statistically significant in the long run.There is a positive(direct)and statistically insignificant relationship between CO_(2) emission and inflation rate in the short run.Notably,the EKC hypothesis indicated that the Kenya’s economy is still on the environmental degradation trade-off through the gradual increase of both CO_(2) emission and agricultural output.Our results are important to Kenya’s economy because the derived insights will assist in relevant departments to formulate sustainable strategies to minimize environmental degradation.

Lay perceptions of breast cancer in Western Kenya

AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer. METHODS: In October-November 2012, we recruited men and women(18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool,the breast cancer awareness measure(BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions. RESULTS: Most respondents were female, middle-aged(mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following(in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity(n = 193, 12.3%); types of food consumed(n = 187, 11.9%); witchcraft and curses(n = 108, 6.9%); some family planning methods(n = 56, 3.6%); and use of alcohol and tobacco(n = 46, 2.9%). When asked what they thought of breast cancer's severity, the most popular response was "it is a killer disease"(n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, earlystage symptoms and signs were not widely recognized. Some respondents(14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A minority reported alternative medicine as providing relief to patients. CONCLUSION: The impoverished knowledge in these surveys suggests that lay education as well as better screening and treatment should be part of breast cancer control in Kenya.

Preference and adoption of Farmer Field School (FFS) Prosopis juliflora management practices: Experiences in Baringo District, Kenya

This research was carried out to evaluate the preference and adoption of harvesting, uprooting, stump burning, pruning and thinning practices for controlling the spread ofProsopisjuliflora （prosopis） within Marigat Division of the Baringo District, Kenya. A survey methodology was employed using a random sample of 25 Farmer Field School （FFS） members and 5 non=FFS members from each of the five locations of Marigat Division. In total, 100 FFS members and 25 non-FFS members participated in the study; addi- tional supplementary data were collected from the Kenya Forestry Research Institute （KEFRI）, a major facilitator and trainer of the identified FFS activities and practices in the study area since 2004. More than 80% of the local community never undertook any form of prosopis management practice; however, this changed after FFS training, indicating an acquisition and retention of knowledge which probably diffused to the non-FFS counterparts, through either formal or informal ways. Harvesting was the most preferred （100%） and stump burning the least preferred （46%） practice of managing the spread of prosopis. The success and preference of any prosopis management practice was attributed to wood and non-wood benefits derived from prosopis and growing of animal fodder and food crops on rehabilitated land. More than 80% of respondents attributed ineffectiveness of any prosopis management practice to coppicing and viable seed banks of the tree, while 50% highlighted a lack of consistency and integration in carrying out manage- ment practices. The reported negative attitude towards prosopis changed after training with none of the view to eradicate it. Labor intensity and frequent regeneration of seedlings were identified as the major challenges faced during the implementation of proso- pis management practices. In conclusion, the study shows that harvesting, uprooting, stump burning, pruning and thinning realized through consistent holistic integration contribute to containing the spread of prosopis trees in Baringo, Kenya.