Improving Access to Safe Water in Rural Schools of Kenya: Qualitative Multisectoral Insights.

BACKGROUND: Comprehensive strategies in water, sanitation, and appropriate hygiene behaviors can improve school enrolment and improve gender parity disparities. Lack of safe drinking water negatively impacts the social capital of people, especially school-going children in rural areas. In this study, we systematically evaluated and documented evidence on the barriers and facilitators in the access and adoption of safe water practices in rural schools in Laikipia County, Kenya. METHODS: An ethnographic formative, collaborative implementation research design was used in an iterative and participatory process to evaluate community, socio-economic, and health system-related factors affecting water, hygiene, and sanitation strategies. Qualitative data was collected using key informant interviews (n=5) and focus groups (n=3) from various multisectoral participants. Directed content analysis was used to develop codes, categories, and themes from textual data. Data was organized according to the Promoting Action on Research Implementation in Health Services framework. RESULTS: The findings were classified and described under three key elements: context, evidence, and facilitation. Contextual elements showed an association of diarrhea outbreaks with unsafe hygiene practices compounded by water scarcity. The evidence elements were indicative of the applicability of water backpacks in strengthening handwashing, storage, and transport of water. Facilitation elements indicated evidence of gaps in synergy between the school health and public health systems, necessitating multisectoral collaboration and social capital capacity building. CONCLUSION: The national and county governments play an imperative role in ensuring access and continuous supply of safe drinking water in schools. This is fundamental in efforts towards reducing social inequalities of health among school-going children and building their social capital. Participatory, collaborative, multisectoral interventions and decision-making are crucial, leveraging on creating local ownership, in meeting the water consumption needs of children and communities in water-scarce regions.

Nutritional intake and food sources in an adult urban Kenyan population.

Urbanisation is hastening the transition from traditional food habits to less healthy diets, which are becoming more common among Kenyans. No up-to-date studies on usual dietary intake and the main food sources of adult Kenyans are available. The aim of the present study was to identify the main food sources of nutrients in the diet of urban adult Kenyans and explore potential associations with demographic variables including age, sex, level of education, occupation and body mass index. The study adopted a cross-sectional design. The dietary intake of 486 adult Kenyans from Nairobi was assessed using a validated, culture-sensitive, semi-quantitative food frequency questionnaire. Binary logistic regression models were used to evaluate associations between food sources and demographic variables. Macronutrient intakes as a proportion of total energy intake (TEI) were within international dietary guidelines. Cereals and grain products (34.0%), sugar, syrups, sweets and snacks (9.8%), fruits (9.7%) and meat and eggs (8.8%) were the major contributors to TEI. Cereals and grain products contributed 42.5% to carbohydrates, followed by fruits (12.4%) and sugar, syrups, sweets and snacks (10.6%). The most important sources of protein and total fat were cereals and grain products (23.3% and 19.7%, respectively) and meat and eggs (22.0% and 18.7%, respectively). Sex, age and level of education were associated with the choice of food groups. Although macronutrient intakes were within guidelines, the Kenyan diet was revealed to be high in sugars, salt and fibre, with differences in food sources according to demographic variables. These results can act as an incentive to national authorities to implement nutritional strategies aiming to raise awareness of healthier dietary patterns among Kenyans.

Devolved health system capacity in the provision of care for sick newborns and young infants in four counties serving vulnerable populations in Kenya.

Possible severe bacterial infections (PSBI) is one of the three leading causes of newborn and young infant mortality globally that can be prevented by timely diagnosis and treatment using suitable antibiotics. High impact interventions such as use of out-patient injectable gentamicin and dispersible Amoxicillin with community-based follow up have been shown to reduce mortality in clinical trials. The objective of this study was to assess the health systems' preparedness and organizational gaps that may impact execution in providing care for newborns and sick young infants. This formative research study was embedded within a three-year implementation research project in 4 Counties in Kenya. The indicators were based on facility audits for existing capacity to care for newborns and young infants as well as County organizational capacity assessment. The organizational capacity assessment domains were derived from the World Health Organization's Health Systems Building blocks for health service delivery. The scores were computed by adding average scores in each domain and calculated against the total possible scores to generate a percentage outcome. Statistical analyses were descriptive with adjustment for clustering of data. Overall, the Counties have inadequate organizational capacity for management of sick young infants with Organizational Capacity Index scores of between 61-64%. Among the domains, the highest score was in Health Management Information System and service delivery. The lowest scores were in monitoring and evaluation (M&E). Counties scored relatively low scores in human resources for health and health products and commodities with one scoring poorly for both areas while the rest scored average performance. The four counties revealed varying levels of organizational capacity deficit to effectively manage sick young infants. The key underlying issues for the below par performance include poor coordination, low funding, inadequate supportive supervision, and M&E to enable data utilisation for quality improvement. It was evident that newborn and young infant health services suffer from inadequate infrastructure, equipment, staffing, and coordination. As Kenya, continuously rolls out the guidelines on management of sick young infants, there is need to focus attention to these challenges to enhance sustainable adoption and reduction of young infant morbidity and mortality.

mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale.

BACKGROUND: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. OBJECTIVE: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). METHODS: The "Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)" checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima's architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. RESULTS: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO's Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. CONCLUSIONS: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains.

Family and provider perceptions of quality of care in the management of sick young infants in primary healthcare settings in four counties of Kenya.

BACKGROUND: Understanding the perceptions of quality of care given to sick young infants in primary healthcare settings is key for developing strategies for effective uptake and utilisation of possible severe bacterial infection guidelines. The purpose of this study is to assess families and providers' perceptions of care given to sick young infants at primary healthcare facilities in four diverse counties in Kenya. METHODS: A cross-sectional qualitative design involving 37 in-depth interviews and 39 focus group discussions with very young (15-18 years), young (19-24 years) and older (25-45 years) caregivers of young infants aged 0-59 days; and key informant interviews with community-based and facility-based front-line health providers (14) in primary healthcare facilities. Qualitative data were captured using audio tapes and field notes, transcribed, translated and exported into QSR NVivo V.12 for analysis. A thematic framework approach was adopted to classify and analyse data. RESULTS: Perceived care given to sick young infants was described around six domains of the WHO framework for the quality of maternal and newborn healthcare: evidence-based practices for routine and emergency care; functional referral systems; effective communication; respect and preservation of dignity; availability of competent, motivated human resources; and availability of physical resources. Views of caregivers and providers regarding sick young infant care in primary healthcare settings were similar across the four sites. Main hindrance to sick young infant care includes stockout of essential drugs, limited infrastructure, lack of functional referral system, inadequate providers which led to delays in receiving treatment, inadequate provider skills and poor provider attitudes. Despite these challenges, motivation and teamwork of health providers were key tenets in care provision. CONCLUSION: The findings underscore the need to prioritise improving quality of sick young infant services at primary healthcare settings by building capacity of providers through training, ensuring continuous supply of essential medicines and equipment and improving infrastructure including referral.

PEERNaija: A Gamified mHealth Behavioral Intervention to Improve Adherence to Antiretroviral Treatment Among Adolescents and Young Adults in Nigeria.

BACKGROUND: HIV is the leading cause of death for youth in Sub-Saharan Africa (SSA). The rapid proliferation of smart phones in SSA provides an opportunity to leverage novel approaches to promote adherence to life-saving antiretroviral therapy (ART) for adolescents and young adults living with HIV (AYA-HIV) that go beyond simple medication reminders. METHODS: Guided by the Integrate, Design, Assess and Share (IDEAS) framework, our multidisciplinary team developed a peer-based mHealth ART adherence intervention-PEERNaija. Grounded in Social Cognitive Theory, and principles of contingency management and supportive accountability, PEERNaija delivers a multi-faceted behavioral intervention within a smartphone application to address important obstacles to adherence. RESULTS: PEERNaija was developed as a gamified Android-based mHealth application to support the behavioral change goal of improving ART adherence among AYA-HIV within Nigeria, a low- and middle- income country (LMIC). Identified via foundational interviews with the target population and review of the literature, key individual (forgetfulness and poor executive functioning), environmental (poor social support) and structural (indirect cost of clinic-based interventions) barriers to ART adherence for AYA-HIV informed application features. Further informed by established behavioral theories and principles, the intervention aimed to improve self-efficacy and self-regulation of AYA-HIV, leverage peer relationships among AYA to incentivize medication adherence (via contingency management, social accountability), provide peer social support through an app-based chat group, and allow for outreach of the provider team through the incorporation of a provider application. Gamification mechanics incorporated within PEERNaija include: points, progress bar, leaderboard with levels, achievements, badges, avatars and targeted behavior change messages. PEERNaija was designed as a tethered mobile personal health record application, sharing data to the widely deployed OpenMRS electronic health record application. It also uses the secure opensource Nakama gamification platform, in line with Principles of Digital Development that emphasize use of opensource systems within LMICs. CONCLUSIONS: Theory-based gamified mHealth applications that incorporate social incentives have the potential to improve adherence to AYA-HIV. Ongoing evaluations of PEERNaija will provide important data for the potential role for a gamified, smartphones application to deliver multifaceted adherence interventions for vulnerable AYA-HIV in SSA.

A culture-sensitive semi-quantitative FFQ for use among the adult population in Nairobi, Kenya: development, validity and reproducibility.

OBJECTIVE: To develop a semi-quantitative FFQ and to evaluate its validity and reproducibility for the assessment of total dietary intake of Kenyan urban adult population, given its non-existence in Kenya. DESIGN: The current study adopted a cross-sectional design. A culture-sensitive semi-quantitative FFQ was developed and its validity was tested relative to three non-consecutive 24-h recalls (24hR). Reproducibility was tested by the test-retest method, with a 3-week interval. Spearman's correlation coefficients and intra-class correlation coefficients were calculated for several macro- and micronutrients. Cross-classification into quartiles and Bland and Altman plots were analysed. SETTING: Nairobi county (Dagoreti South and Starehe constituencies). PARTICIPANTS: A convenient sample was recruited in three different clusters in Nairobi. RESULTS: A culture-sensitive 123-food-item semi-quantitative FFQ showed higher nutrient intakes compared with the 24hR (total energy median 12543·632 v. 8501·888 kJ, P < 0·001). Energy-adjusted and deattenuated Spearman's correlations for macronutrients ranged between 0·21 (total fat) and 0·47 (protein). The agreement in the same quartile varied from 28 % (protein) to 41 % (carbohydrates). Including adjacent quartiles, the range increased: 76 % (protein and fat) to 81 % (carbohydrates). The extreme disagreement was low. The first FFQ application resulted in higher mean values for all nutrients compared with the second FFQ (total energy median 12459·952 v. 10485·104 kJ, P < 0·001). Energy-adjusted correlations for macronutrients ranged from 0·28 (carbohydrates) to 0·61 (protein). Intra-class correlation coefficients for macronutrients were moderate, between 0·6 and 0·7. CONCLUSIONS: The developed semi-quantitative FFQ was shown to be a valid and reproducible tool for ranking urban adult Kenyans according to their dietary intake.

Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya.

BACKGROUND: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change. METHODS: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants. RESULTS: Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment. CONCLUSIONS: The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.

A fission yeast platform for heterologous expression of mammalian adenylyl cyclases and high throughput screening.

The fission yeast Schizosaccharomyces pombe uses a cAMP signaling pathway to link glucose-sensing to Protein Kinase A activity in order to regulate cell growth, sexual development, gluconeogenesis, and exit from stationary phase. We previously used a PKA-repressed fbp1-ura4 reporter to conduct high throughput screens (HTSs) for inhibitors of heterologously-expressed mammalian cyclic nucleotide phosphodiesterases (PDEs). Here, we describe the successful expression of all ten mammalian adenylyl cyclase (AC) genes, along with the human GNAS Gαs gene. By measuring expression of an fbp1-GFP reporter together with direct measurements of intracellular cAMP levels, we can detect both basal AC activity from all ten AC genes as well as GNAS-stimulated activity from eight of the nine transmembrane ACs (tmACs; AC2-AC9). The ability to use this platform to conduct HTS for novel chemical probes that reduce PKA activity was demonstrated by a pilot screen of the LOPAC®1280 library, leading to the identification of diphenyleneiodonium chloride (DPI) as an inhibitor of basal AC activity. This screening technology could open the door to the development of therapeutic compounds that target GNAS or the ACs, an area in which there is significant unmet need.

Nutritional status of children 7-36 months old from millet consuming communities of Masindi District, Western Uganda.

BACKGROUND: Several national reports have indicated poor nutritional status among children from Western Uganda where millet porridge is a predominant complementary food. However, little is known about the nutritional status of 7-36 months old children from millet consuming communities of Western Uganda. METHODS: A cross-sectional study was conducted in Bujenje County of Masindi District. A total of 636 children from 23 villages within Bwijanga and Budongo sub counties were randomly selected. Anthropometric measurements of children were taken. Data on demographic and socioeconomic characteristics of children's households, their dietary practices and morbidity patterns was collected using a self-administered questionnaire. A statistical Package for the Social Sciences (SPSS) version 20 and Emergency Nutritional Assessment (ENA) Software Version 2010 were used for analysing data. The relationship between demographic and socioeconomic characteristics of households and children's nutritional status was determined using Chi-square tests. Pearson's correlation coefficient was used to determine the association between children's nutritional status and the amount of millet porridge consumed. A p-value of < 0.05 indicated statistical significance. RESULTS: A proportion of 30.5% children were stunted, 11.6% underweight and 7.4% wasted. Underweight and wasting were significantly high in Budongo sub county at p = 0.044 and p = 0.005 respectively. Stunting and underweight were highest between 12 and 23 months at p = 0.005 and 0.020 respectively. Although millet porridges formed the bulk of children's meals, they could only cater for < 60% of the recommended daily nutrient intake. Children with diarrhoea were 1.4 and 2 times likely to become stunted and underweight at p = 0.025 and 0.007 respectively. Feeding practices for children with diarrhoea were contrary to World Health Organisation's recommendations in more than 50% of the studied children. There was a significant association between Height-for-Age Z scores, Weight-for-Height Z scores and the amount of millet porridge consumed by children (r = - 0.20, p < 0.001 and r = 0.14, p < 0.001 respectively). CONCLUSIONS: Results showed slightly higher percentages of stunted, underweight and wasted children compared to national figures. This was attributed to high incidences of diarrhoea and inadequate feeding practices especially for children 12-36 months old.

Reproductive health knowledge among college students in Kenya.

BACKGROUND: Reproductive health knowledge is vital in the growth and development of young people and this impact greatly on their educational and personal outcome as they proceed to adulthood. There has been an increasing occurrence of sexually transmitted infections in institutions of higher learning. The study sought out the strategies used by university students to prevent unplanned pregnancy and determined their knowledge of contraception methods and sexually transmitted infections in Mount Kenya University, main campus. METHODS: Stratified sampling was employed. After a signed consent was obtained, a self-administered questionnaire was used to collect data. Data were explored, analyzed and percentages used to quantify the level of knowledge. Pearson's chi-square was used to measure associations between categorical variables and independent t-test used to measure the means and relationships of continuous variables. RESULTS: Condom use was established as the most prevalent strategy in prevention of unplanned pregnancy at 48.5 and 46.4% in prevention of STI and HIV/AIDS. Almost two thirds (58%) of respondents reported that they were conversant with only one method of contraception, 60% had knowledge of more than two types of STIs, and 62.4% indicated that they were conversant with only hospitals as facilities providing reproductive health services. CONCLUSION: Young people in college require educational initiatives to sensitize them on STI, methods of contraception and positive social behaviors. There is need to improve the accessibility of reproductive health services through strengthening of services provided at campus health clinics.

Metabolic syndrome and its components among university students in Kenya.

BACKGROUND: Metabolic syndrome refers to a cluster of interrelated disorders which occur together causing an increase in the risk of developing cardiovascular disease and diabetes. The university population is an understudied group despite the increase in the frequency of related disorders and metabolic risk factors e.g. obesity and diabetes, majorly due to the assumption that they are in their most active phase of life therefore healthy. This study looked at metabolic syndrome, the sedentary lifestyles and dietary habits present among university students attending Mount Kenya University, main campus. METHODS: Stratified sampling was used to select participants. Self-administered questionnaires were issued to participants after a signed consent had been obtained following which clinical assessments and biochemical measures were performed. They included blood pressure, fasting blood glucose, triglycerides, high density lipoprotein-cholesterol, anthropometric measurements; height, weight, BMI and waist circumference. Pearson's chi-square tests and non-parametric independent t-test were used to analyze the prevalence of metabolic syndrome criteria per gender, the number of metabolic syndrome criteria per BMI and prevalence of metabolic syndrome criteria per BMI category. RESULTS: The study established that 1.9% of the participants met the criteria for diagnosis of metabolic syndrome according to HJSS criteria. Among the elements, there was statistical difference in gender BMI and waist circumference. 11.8% of subjects had two metabolic syndrome components while 3.1% had three components while none of the subjects had all six components. Elevated triglycerides was the most prevalent defining component for metabolic syndrome. There is a statistically significant relationship between sedentary lifestyle and dietary habits as risk factors to metabolic syndrome. CONCLUSION: Young adults in university have begun developing metabolic syndrome and the risk of developing the syndrome continues to increase with the components being reported in early age. Educational initiatives to encourage healthy eating should be conducted within school premises in order to reinforce the message on healthy diets and physical exercise. Pre-admission screening to identify at risk students should be conducted. Targeted interventions development through a mandatory extra co-curricular program should be enforced to positively engage those at risk.

Prevalence of foodborne pathogens in food from selected African countries - A meta-analysis.

Food safety information in the African region is insufficient and fragmented due to lack of surveillance, documentation and reporting, thereby resulting in inefficient utilization of resources, duplication of activities, and lack of synergy among the countries of the region. This paper reviews the prevalence of foodborne pathogens in seven African countries (Benin, Botswana, Ghana, Kenya, Nigeria, Sudan and Uganda) from papers in regional or international journals published between January 2000 and December 2015. One hundred and sixteen publications that dealt with food microbiology were reviewed for general analysis, while 66 papers on contamination of pathogenic bacteria were used for meta-analysis of prevalence. The food items were split into two categories: raw foods and ready-to-eat (RTE) foods (including street food and beverages) for meta-analysis. Majority of the reviewed studies (67.2%, 78/116) dealt with food of animal origin: 38.8% for meat and eggs, 17.2% for dairy products and 11.2% for aquatic products. Only 8.6% examined foods of plant origin (fruits and vegetables). The remaining 24.1% was the composite RTE food and beverages. Enterobacteriaceae, Escherichia coli, Salmonella, Staphylococcus aureus and Listeria monocytogenes were the most frequently reported organisms in those studies. Although the data were highly heterogeneous, a striking feature is high prevalence of the major pathogens in RTE foods, almost as high as in raw foods. E. coli averaged at 37.6% in raw foods and 31.6% in RTE foods. The corresponding prevalence for Salmonella was 19.9% vs 21.7%; S. aureus, 27.8% vs 25.1% and L. monocytogenes, 19.5% vs 6.7%. The average prevalence of foodborne pathogens in these countries was 34.2% (29.0-39.3%). Differences in food types as well as non-uniform protocols for sampling and identification might have contributed to high heterogeneity (I2 >97%) although some high prevalence data could be factual with extensive varieties of raw and RTE foods. Need for improved hygienic practices in handling of raw or RTE foods are suggested. Implementation of surveillance programs that use uniform laboratory protocols across the region could give homogeneous results.

Evaluation of an Android-based mHealth system for population surveillance in developing countries.

OBJECTIVE: In parts of the developing world traditionally modeled healthcare systems do not adequately meet the needs of the populace. This can be due to imbalances in both supply and demand--there may be a lack of sufficient healthcare and the population most at need may be unable or unwilling to take advantage of it. Home-based care has emerged as a possible mechanism to bring healthcare to the populace in a cost-effective, useful manner. This study describes the development, implementation, and evaluation of a mobile device-based system to support such services. MATERIALS AND METHODS: Mobile phones were utilized and a structured survey was implemented to be administered by community health workers using Open Data Kit. This system was used to support screening efforts for a population of two million persons in western Kenya. RESULTS: Users of the system felt it was easy to use and facilitated their work. The system was also more cost effective than pen and paper alternatives. DISCUSSION: This implementation is one of the largest applications of a system utilizing handheld devices for performing clinical care during home visits in a resource-constrained environment. Because the data were immediately available electronically, initial reports could be performed and important trends in data could thus be detected. This allowed adjustments to the programme to be made sooner than might have otherwise been possible. CONCLUSION: A viable, cost-effective solution at scale has been developed and implemented for collecting electronic data during household visits in a resource-constrained setting.

Use of Lactobacillus strains to start cassava fermentations for Gari production.

Two Lactobacillus strains, Lactobacillus plantarum BFE 6710 and Lactobacillus fermentum BFE 6620, were used to start cassava fermentations in a pilot study under field production conditions in Kenya, to determine their potential to establish themselves as predominant lactobacilli during the fermentation. Predominant strains from three fermentations were isolated throughout the 48 h fermentation period. The use of these strains in high numbers clearly resulted in 1 to 2 log higher lactic acid bacteria (LAB) counts over the course of the fermentation when compared to the uninoculated control. 178 predominant LAB isolates were grouped based on their phenotypic characteristics, and were characterised to strain level by RAPD-PCR, followed by PFGE strain typing. Overall, L. plantarum strains represented the majority of the isolates, followed by Weissella confusa and Lactococcus garvieae strains. The results of RAPD-PCR and PFGE strain typing techniques indicated that L. plantarum BFE 6710 was successful in asserting itself as a predominant strain. In contrast, L. fermentum BFE 6620 failed to establish itself as a predominant organism in the fermentation. The success of the L. plantarum strains to predominate in the cassava fermentation demonstrates the potential for development of Lactobacillus starter cultures to industrialise the Gari production process.

Functional characteristics of Lactobacillus spp. from traditional Maasai fermented milk products in Kenya.

In this study functional characteristics of 23 representative Lactobacillus strains isolated from the Maasai traditional fermented milk 'Kule naoto' were determined. The Lb. acidophilus group strains showed resistance to gastric juice and bile. In addition, some Lb. acidophilus strains expressed bile salt hydrolase activity, and had ability to assimilate cholesterol in vitro. In-vitro adhesion to HT29 MTX cells of up to 70% was recorded. Lb. fermentum strains showed almost 100% survival under simulated stomach acidic conditions and physiological salt concentrations of bile salts, hydrophobicity values were over 80%. Most strains of the Lb. casei and Lb. acidophilus groups showed aggregation abilities of above 50%. Many strains expressed a protective effect against N-methyl-N'-nitro-N-nitrosoguanidine induced DNA damage according to the 'comet assay' and none was virulent. The antibiotic minimum inhibitory concentration of selected strains was established. According to these results, the Lactobacillus spp associated with 'Kule naoto', contain potentially probiotic (functional) strains.

Functional properties of Lactobacillus plantarum strains isolated from Maasai traditional fermented milk products in Kenya.

Lactobacillus plantarum was the major species among the lactic acid bacterial strains isolated from traditional fermented milk of the Maasai in Kenya. Selected strains were characterized for their functional properties using in vitro standard procedures. All strains expressed acid tolerance at pH 2.0 after 2-h exposure of values that ranged from 1% to 100%, while bile tolerance of acid-stressed cells at 0.3% oxgal varied from 30% to 80%. In vitro adhesion to the mucus-secreting cell line HT 29 MTX and binding capacity to extracellular protein matrices was demonstrated for several strains. The four strains tested in a simulated stomach duodenum passage survived with recovery rates ranging from 17% to 100%. Strains were intrinsically resistant to several antibiotics tested. From these in vitro studies, a number of Lb. plantarum strains isolated from the Maasai traditional fermented milk showed probiotic potential. The strains are good candidates for multifunctional starter culture development.

Controlled polymerization of substituted diacetylene self-organized monolayers confined in molecule corrals.

We have shown that STM-tip-induced chain polymerization of 10,12-tricosadiynoic acid (TCDA) in a self-organized monolayer at the liquid-solid interface of TCDA on highly oriented pyrolytic graphite is possible. The oligomers thus produced started at the point where a voltage pulse was applied between the STM tip and the sample during a short period when the feedback condition was momentarily suspended (as it is for scanning tunneling spectroscopy). Polymerization probabilities depended upon the length of the applied voltage pulse and were generally higher for longer pulse widths in the 10-ms to 100-micros time scales, approaching unit probability for the former and decreasing quickly to a few tens of percent for the latter. The polymerization could be confined to certain nanometer-sized areas by using "molecule corrals,"and polymerization appeared to be governed by topochemical constraints. Polymerization across domain boundaries, or over molecule corral edges, was never observed in over approximately 150 observations. Due to the constant supply of nonpolymerized molecules from the covering solution, a dynamic exchange between molecules on the surface and in the solution was possible. This exchange occurred on a time scale that was comparable to the image acquisition time (approximately 10(1) s), and appeared to depend weakly upon the length of the desorbing oligomer. The desorption process was probably also influenced by interactions with the STM tip.

Isolation, identification and characterisation of the dominant microorganisms of kule naoto: the Maasai traditional fermented milk in Kenya.

From 22 samples of kule naoto, the traditional fermented milk products of the Maasai in Kenya, 300 lactic acid bacterial strains were isolated and phenotypically characterised by their ability to ferment different carbohydrates and by additional biochemical tests. Lactic acid bacteria (LAB), especially the genus Lactobacillus, followed by Enterococcus, Lactococcus and Leuconostoc, dominated the microflora of these samples. The major Lactobacillus species was Lactobacillus plantarum (60%), with a lower frequency of isolation for Lactobacillus fermentum, Lactobacillus paracasei and Lactobacillus acidophilus. Most strains produced enzymes such as beta-galactosidase and peptidases, which are of relevance to cultured dairy product processing, and exhibited similar patterns of enzymatic activity between species. Enterobacteriaceae could not be detected in 15 out of 22 samples (detection level 10(2)/ml). Conversely, yeasts (detection level 10(1)/ml) were detected in those samples in which Enterobacteriaceae were not found. The pH values of all these samples were < 4.5.