Gender responsive multidisciplinary doctoral training program: the Consortium for Advanced Research Training in Africa (CARTA) experience.

Doctoral training has increasingly become the requirement for faculty in institutions of higher learning in Africa. Africa, however, still lacks sufficient capacity to conduct research, with just 1.4% of all published research authored by African researchers. Similarly, women in Sub-Saharan Africa only constitute 30% of the continent's researchers, and correspondingly publish little research. Challenging these gendered inequities requires a gender responsive doctoral program that caters for women's gender roles that likely affect their enrollment in, and completion of, doctoral programs. In this article, we describe a public and population health multidisciplinary doctoral training program - CARTA and its approach to supporting women. This has resulted in women's enrollment in the program equaling men's and similar throughput rates. CARTA has achieved this by meeting women's practical needs around childbearing and childrearing and we argue that this has produced some outcomes that challenge gender norms, such as fathers being child minders in support of their wives and creating visible female role models.

Heavy Sexual Content Versus Safer Sex Content: A Content Analysis of the Entertainment Education Drama Shuga.

Extremely popular with Kenyan youth, the entertainment-education drama Shuga was designed with specific goals of promoting condom use, single versus multiple sexual partners, and destigmatization of HIV. Almost as soon as it aired, however, it generated controversy due to its extensive sexual themes and relatively explicit portrayal of sexual issues. To determine how safer sex, antistigma messages, and overall sexual content were integrated into Shuga, we conducted a content analysis. Results indicated that condom use and HIV destigmatization messages were frequently and clearly communicated. Negative consequences for risky sexual behavior were communicated over the course of the entire series. Messages about multiple concurrent partnerships were not evident. In addition, in terms of scenes per hour of programming, Shuga had 10.3 times the amount of sexual content overall, 8.2 times the amount of sexual talk, 17.8 times the amount of sexual behavior, and 9.4 times the amount of sexual intercourse as found in previous analysis of U.S. entertainment programming. Research is needed to determine how these factors may interact to influence adolescent viewers of entertainment education dramas.

Factors influencing the utilization of Voluntary Counselling and Testing services among university students in Kenya.

Voluntary Counselling and Testing (VCT) is recognized as a critical component of effective HIV prevention initiative and has therefore been promoted nationally and within universities in Kenya. Upon successful counselling and testing those found to be HIV negative are informed to take the necessary measures to protect themselves while the infected are advised to start the required medication. This study examined the attitudes toward VCT services among university students in four Kenyan universities. 980 students filled self administered questionnaires. Results showed that 38.5% of the subjects had tested for HIV in the last 12 months and students (55.8%) felt less susceptible to HIV infection. Findings from a factor analysis revealed that the intention to seek the services was associated with five attitude subscales that were ranked as follows (i) people's and personal concerns, (ii) friends concerns, (iii) value of testing, (iv) confidentiality and support, and (v) perceived susceptibility. The first three items are associated with stigma which was evidenced in the subjects' report that admitting that one should test for HIV would imply that one has engaged in immoral behaviour. Secondly, subjects felt that their friends would look down on them if they tested for HIV. Knowing the students' attitudes will therefore assist in the development of appropriate VCT interventions that will promote HIV testing and behaviour change.

Immunostimulatory responses to crude extracts of Warburgia ugandensis (Sprague) subsp ugandensis (Canellaceae) by BALB/c mice infected with Leishmania major.

INTRODUCTION: To determine the immunostimulatory potential of crude extracts of Warburgia ugandensis subsp. ugandensis with a soluble leishmanial antigen in vaccinating BALB/c mice. METHODS: Seventy two female BALB/c mice were randomly assigned into six groups. The mice were vaccinated with soluble leishmania antigens (SLA) alone, hexane, ethyl acetate, and dichloromethane extract co-administered with SLA. Unvaccinated mice formed the control group. The induction of cell-mediated immunity following vaccination was determined by measuring in vitro lymphocyte proliferation and the production of interleukin (IL)-4 and gamma interferon (IFN-γ) determined by flow cytometry. Protection against L. major was determined by quantifying parasite burdens in L. major infected footpads using a limiting dilution assay and by measuring lesion sizes of the infected footpad compared to the contralateral uninfected footpad. RESULTS: On vaccination with extracts of W. ugandensis subsp. ugandensis alone or as adjuvants when used in combination with Leishmania antigens, the hexane extract and the dichloromethane extract plus SLA stimulated moderate production of IFN-γ and low levels of IL-4.These mice were partially protected from cutaneous leishmaniasis as shown by the slow development of lesions and comparatively less parasite burdens. CONCLUSION: These data suggest that extracts of W. ugandensis subsp. ugandensis are suitable adjuvants for Leishmania vaccines. However, since W. ugandensis subsp. ugandensis has been shown to be effective against Leishmania parasites in vitro and in vivo, further studies ought to be conducted to determine its immunochemotherapeutic potential when co-administered with a soluble leishmanial antigen in vaccinating BALB/c mice.

Malaria healthcare policy change in Kenya: implications on sales and marketing of antimalarials.

BACKGROUND & OBJECTIVES: Malaria healthcare policy change in Kenya aimed at improving the control of malaria but faced a number of challenges in implementation related to marketing of the drugs. This research investigated the effect of the change of the national malaria policy on drug sales and strategic marketing responses of antimalarial pharmaceutical companies in Kenya. STUDY DESIGN: A descriptive cross-sectional design was employed to describe the existing state of antimalarials market in Kenya after the change of the malaria healthcare policy. RESULTS & CONCLUSION: Policy change did result in an increase in the sales of Coartem®. Novartis Pharma recorded a 97% growth in sales of Coartem® between 2003 and 2004. However, this increase was not experienced by all the companies. Further, SPs (which had been replaced as first-line therapy for malaria) registered good sales. In most cases, these sales were higher than the sales of Coartem®. Generally, the sales contribution of SPs and generic antimalarial medicines exceeded that of Coartem® for most distributors. The most common change made to marketing strategies by distributors (62.5%) was to increase imports of antimalarials. A total of 40% of the manufacturers preferred to increase their budgetary allocation for marketing activities. In view of the fact that continued sale of SP drugs and limited availability of AL poses the risk of increasing the incidence of malaria in Kenya, it is therefore, recommended that pharmacy surveillance systems be strengthened to ensure drugs that have been rendered non-viable or that prescription-only medicines are not sold contrary to the national guidelines.

Lifestyles and practices that enhance malaria and typhoid fever in Njoro District, Kenya.

Unhygienic practices have been associated with the spread of parasitic and bacterial infections in rural areas. This study was designed to verify the link between the frequencies of malaria and typhoid fever with selected rural practices in Njoro District, Kenya. A cross-sectional study involving observations, questionnaires and interviews was conducted to determine the socio-economic variables and practices/lifestyles in 336 randomly selected homesteads. Frequencies of malaria and typhoid fever in two randomly selected health centers were determined through a retrospective study for the period from 2004 to 2009. The respondents had large families (68%), low education level (67%) and high responsibility burden (67%). Individuals who did not boil drinking water constituted 61%. Boiling drinking water was less common among the poor, Odds Ratio (OR) of 2.36, χ(2) = 9.88, 95% Confidence Interval (CI) of 1.38-4.03. Respondents who washed their hands in a basin after using the latrines comprised 79.8% while 4.8% did not. 18.5% of the respondents did not use a soap to wash their hands after using the latrine. One third (33.6%) of the homesteads had dirty and inappropriate pit latrines while 2.7% of the homesteads lacked latrines. Failure to use mosquito bed nets was more likely to occur among the poor respondents, OR of 1.44, χ(2) = 1.74, 95% CI of 0.84-2.48. The frequencies of malaria and typhoid fever were an average of 29 and 24% respectively. Malaria and typhoid fever cases were relatively frequent due to adoption of inappropriate lifestyles and practices that predisposed the residents to infectious agents. Poverty seemed to play a significant role in the spread of malaria and typhoid fever.

Factors Associated With the Motivation of Community Drug Distributors in the Lymphatic Filariasis Elimination Programme in Kenya

Annual mass drug administration (MDA) is the main strategy for elimination of lymphatic filariasis (LF); globally. In Kenya; community drug distributors (CDDs) are used to deliver drugs to household members. To determine factors influencing CDDs' motivation; a retrospective cross-sectional study based on qualitative data was conducted in Kwale and Malindi districts after the 2008 MDA. In Kwale; Tsimba location represented high and Gadini low compliance while in Malindi; Goshi and Gongoni locations represented high and low compliance areas; respectively. Fifteen CDDs; 80 opinion leaders; 80 LF patients; five health personnel; four LF coordinators and the National Programme Manager were purposively selected and interviewed. Sixteen focus group discussions (FGDs) were conducted with single-sex adult and youth male and female groups. The factors that possibly had a positive influence on CDDs' motivation were: higher education level; trust and familiarity with community members. All CDDs reported that getting recognised; being trained on LF and an innate desire to help their communities raised their motivation. Factors that possibly had negative influence included: inadequate training; drug supplies and community sensitisation and lack of supervision. The majority of the CDDs reported a lack of or outdated record-keeping books; a limited drug distribution period; inadequate moral support and incentives as negative factors on their motivation. Factors that motivate CDDs are those that enhance their capacities to perform their duties and endear respect in the communities where they serve

Giant condyloma acuminatum of the scrotum in a man with AIDS: a case report.

INTRODUCTION: Giant condyloma acuminatum, also called a Buschke-Löwenstein tumor, first described in 1925, is a slow-growing, locally aggressive, destructive tumor of the ano-genital region. Scrotal tumors are rare. Reports on giant condyloma acuminatum lesions in patients with HIV and AIDS are surprisingly even rarer. CASE PRESENTATION: In this report, we present the case of a 42-year-old African man with AIDS who was undergoing anti-retroviral therapy. He was found to have a giant condyloma acuminatum of the scrotum. Wide surgical excision and scrotal reconstruction with a pedicled anterolateral thigh flap was performed, significantly improving his quality of life. CONCLUSION: Decision making regarding the goals of surgical intervention in the terminally ill is a complex process. The options include conservative medical palliation or palliative excision versus a curative excision that has the potential for significant morbidity. Wide surgical excision with local flap reconstruction significantly improved the quality of life of the patient described herein. The challenges presented by emerging or unusual presentations of surgical pathology secondary to HIV and AIDS in patients who are on anti-retroviral therapy provide an opportunity for research and the establishment of guidelines for the use of adjuvant chemotherapy in these patients.

Experimental chemotherapy with Allium sativum (Liliaceae) methanolic extract in rodents infected with Leishmania major and Leishmania donovani.

BACKGROUND & OBJECTIVES: Several plant products have been tested and found to possess antileishmanial activity. The present study was undertaken to establish whether methanolic extract of Allium sativum Linn has antileishmanial activity in comparison to standard drugs. METHODS: Methanolic extract of A. sativum bulbs was screened for in vitro and in vivo antileishmanial activity against Leishmania major strain (NLB 145) and L. donovani strain (NLB 065). Pentostam and Amphotericin B were used as standard drugs. BALB/c mice and golden hamsters (Mesocricetus auratus) were used in in vivo studies on L. major and L. donovani respectively. RESULTS: The extract exhibited very low cytotoxicity (IC50 >450 µg/ml) against Vero cells. The extract had significantly better (p <0.001) leishmanicidal activity against both species (IC50 34.22 µg/ml to L. major, 37.41 µg/ml to L. donovani) than Pentostam. However, the activity was significantly lower (p <0.001) than that of Amphotericin B against both the species. At a concentration of 250 µg/ml, the extract induced the production of 60 µM of nitric oxide, a ten-fold up-regulation in activated macrophages. The multiplication indices for L. major amastigotes treated in 100 µg/ml were significantly different (p <0.05). Treatment with the extract, daily for 28 days led to a significant reduction (p <0.05) in footpad swelling in BALB/c mice; similar activity noticed in the treatment with standard drugs. The Leishman-Donovan Units (LDU) for the extract treated animals were significantly higher (p <0.05) than those of standard drugs, but lower compared to the negative control. INTERPRETATION & CONCLUSION: Since the mechanism of action for the methanolic extract is apparently immunomodulatory, garlic compounds could be purified and tried as complementary medicine in the management of leishmaniases.

The potential of the extracts of Tagetes minuta Linnaeus (Asteraceae), Acalypha fruticosa Forssk (Euphorbiaceae) and Tarchonanthus camphoratus L. (Compositae) against Phlebotomus duboscqi Neveu Lemaire (Diptera: Psychodidae), the vector for Leishmania major Yakimoff and Schokhor.

BACKGROUND & OBJECTIVES: Harmful effects of synthetic chemical insecticides including vector resistance, environmental pollution and health hazards have necessitated the current significance in the search for plant-based insecticide products that are environmentally safe and effective to leishmaniases control. The insecticidal activity of Tagetes minuta Linnaeus (Asteraceae), Acalypha fruticosa Forssk (Euphorbiaceae) and Tarchonanthus camphoratus L. (Compositae) extracts were investigated against Phlebotomus duboscqi Neveu Lemaire (Diptera: Psychodidae). METHODS: The extracts were prepared from dried aerial parts soaked in methanol and ethyl acetate twice until the filtrates became clear, filtered and dried out by rotary evaporation at 30-35 degrees C. The solid extracts obtained were later prepared into 2.5, 5 and 10 mg/ml. Two millilitres of the solutions were blotted on filter papers, which were dried overnight and placed into jars where adult sandflies were aspirated. Males and females were assayed separately. RESULTS & CONCLUSION: The extracts had significant mortality (p<0.05) in both males and females bioassays but were not significantly different between sexes. The extracts of Acalypha fruticosa and Tagetes minuta had significantly higher mortality rates than those of Tarchonanthus camphoratus and the different concentrations used showed significantly different mortality rates and 10 mg/ml was the most effective concentration. Cent percent mortality was obtained at 96 h of exposure to 5 and 10 mg/ml concentrations except for Tarchonanthus camphoratus which had a mortality of only 46.7% in 10 mg/ml bioassay. These extracts were found to be insecticidal to adult sandflies.

Effects of long-lasting insecticidal nets and zooprophylaxis on mosquito feeding behaviour and density in Mwea, central Kenya.

BACKGROUND & OBJECTIVES: Zooprophylaxis is a strategy that can control malaria by attracting mosquitoes to domestic animals that act as dead-end hosts. The objective of this study was to establish the effects of zooprophylaxis and long-lasting insecticidal nets (LLINs) on malaria transmission in an agro-based ecosystem with seasonal transmission. METHODS: The mosquito samples were collected indoors using the space spray catch method before and after intervention between October 2005 and March 2006 to determine the mosquito densities and the feeding patterns of Anopheles spp in Mwea, Kenya. RESULTS: A total of 4148 mosquito samples were collected, out of which 11 (0.2%) were tested positive for sporozoites. Ten were Anopheles gambiae species and one was An. funestus species. Results on blood meal ELISA showed that in the household categories that used bednets and kept one cow there was a decrease in relative change ratio (post-/pre-intervention) of 87.5 and 19.6% (p <0.05) in human and cattle blood intake respectively. For households that kept 2-4 cattle and used bednets, there was a decrease in cattle blood index (CBI) by 61.9% and an increase in human blood index (HBI) by 2%, which was not significant (p <0.05). In households with <4 cattle and bednet, there was significant reduction (p >0.05) in CBI of 37.5% as compared to the reduction of 10.3% in HBI. The ratios of man biting rates (MBR) decreased significantly, as you move up from households with one cattle with or without LLINs to households with more than four cattle with or without LLINs with a regression coefficient of -0.96; SE = 0.834; p = 0.017. Similarly, the HBI decreased significantly with the regression coefficient of 0.239; SE = 0.039; p = 0.015 (p <0.05) especially in households with >4 cattle. INTERPRETATION & CONCLUSION: This study demonstrated that there were additive effects of zooprophylaxis and LLINs in the control of mosquito density and reduction of human risk to the mosquito bites. However, in Integrated Vector Management (IVM), the number of animals per household should not be more than four.

In vivo efficacy of oral and intraperitoneal administration of extracts of Warburgia ugandensis (Canellaceae) in experimental treatment of Old World cutaneous leishmaniasis caused by Leishmania major.

The antileishmanial activity of extracts of Warburgia ugandensis Spraque (Canellaceae), a known traditional therapy in Kenya was evaluated in vivo. Treatment of infected BALB/c mice with W. ugandensis extracts orally resulted in a reduction of the size of lesions compared to the untreated control. The lesion sizes differed significantly for the four extracts (p=0.039) compared to the untreated control. For mice treated by intraperitoneal injection, the lesion sizes increased initially for the hexane, dichloromethane and ethyl acetate extracts and healed by day 42. The lesion sizes for mice treated with methanol increased steadily from 2.47mm to 3.57mm. The parasitic burden was significantly higher (p<0.001) in mice treated with methanol extracts and PBS compared to those treated with hexane, dichloromethane and ethyl acetate. This study demonstrated the antileishmanial potential of extracts of W. ugandensis.