Kenyatta University

The October 2020 Global TB report reviews TB control strategies and United Nations (UN) targets set in the political declaration at the September 2018 UN General Assembly high-level meeting on TB held in New York. Progress in TB care and prevention has been very slow. In 2019, TB remained the most common cause of death from a single infectious pathogen. Globally, an estimated 10.0 million people developed TB disease in 2019, and there were an estimated 1.2 million TB deaths among HIV-negative people and an additional 208, 000 deaths among people living with HIV. Adults accounted for 88% and children for 12% of people with TB. The WHO regions of South-East Asia (44%), Africa (25%), and the Western Pacific (18%) had the most people with TB. Eight countries accounted for two thirds of the global total: India (26%), Indonesia (8.5%), China (8.4%), the Philippines (6.0%), Pakistan (5.7%), Nigeria (4.4%), Bangladesh (3.6%) and South Africa (3.6%). Only 30% of the 3.5 million five-year target for children treated for TB was met. Major advances have been development of new all oral regimens for MDRTB and new regimens for preventive therapy. In 2020, the COVID-19 pandemic dislodged TB from the top infectious disease cause of mortality globally. Notably, global TB control efforts were not on track even before the advent of the COVID-19 pandemic. Many challenges remain to improve sub-optimal TB treatment and prevention services. Tuberculosis screening and diagnostic test services need to be ramped up. The major drivers of TB remain undernutrition, poverty, diabetes, tobacco smoking, and household air pollution and these need be addressed to achieve the WHO 2035 TB care and prevention targets. National programs need to include interventions for post-tuberculosis holistic wellbeing. From first detection of COVID-19 global coordination and political will with huge financial investments have led to the development of effective vaccines against SARS-CoV2 infection. The world now needs to similarly focus on development of new vaccines for TB utilizing new technological methods.

The 2017 International League Against Epilepsy classification has defined a three-tier system with epilepsy syndrome identification at the third level. Although a syndrome cannot be determined in all children with epilepsy, identification of a specific syndrome provides guidance on management and prognosis. In this paper, we describe the childhood onset epilepsy syndromes, most of which have both mandatory seizure type(s) and interictal electroencephalographic (EEG) features. Based on the 2017 Classification of Seizures and Epilepsies, some syndrome names have been updated using terms directly describing the seizure semiology. Epilepsy syndromes beginning in childhood have been divided into three categories: (1) self-limited focal epilepsies, comprising four syndromes: self-limited epilepsy with centrotemporal spikes, self-limited epilepsy with autonomic seizures, childhood occipital visual epilepsy, and photosensitive occipital lobe epilepsy; (2) generalized epilepsies, comprising three syndromes: childhood absence epilepsy, epilepsy with myoclonic absence, and epilepsy with eyelid myoclonia; and (3) developmental and/or epileptic encephalopathies, comprising five syndromes: epilepsy with myoclonic-atonic seizures, Lennox-Gastaut syndrome, developmental and/or epileptic encephalopathy with spike-and-wave activation in sleep, hemiconvulsion-hemiplegia-epilepsy syndrome, and febrile infection-related epilepsy syndrome. We define each, highlighting the mandatory seizure(s), EEG features, phenotypic variations, and findings from key investigations.

Levels of Mercury (Hg), Lead (Pb), Cadmium (Cd), Chromium (Cr), Nickel (Ni) & Thallium (Tl) were established in wastewater & soil samples obtained from 8 sites in open drainage channels at Nairobi industrial area, Kenya. Ultra-trace inductively coupled plasma mass spectroscopy (ICP-MS) was used for metal analysis. Temperature, pH & turbidity of wastewater ranged from 16.75 to 26.05 °C; 7.28 to 8.78; 160.33 to 544.69 ppm respectively and within World Health Organization (WHO) allowable limits. Wastewater conductivities in 4 sites ranged from 770 to 1074 µS/cm and above WHO limits at 25 °C. The mean concentrations of the metals in wastewater ranged from 0.0001 to 0.015 ppm in an ascending order of Tl <Cd <Hg <Ni <Cr <Pb. Levels of Cd, Cr & Ni in wastewater were within WHO, World Bank (WB), United States Environmental Protection Agency (US EPA), China, Kenya and India's Central Pollution Control Board (CPCB) limits while Hg & Tl were above US EPA limits. The mean Pb levels in wastewater (5 sites) were above WHO, US EPA and Kenya allowable limits. Mean levels of the metals in soil samples ranged from 0.085 to 199.99 ppm, with those of Hg, Pb, Cr, Cd & Ni being above WHO limits for agricultural soils. Positive correlations (P < 0.05) for Cd & Hg in soils; and Tl (wastewater) & Cd (soil) were noted. In conclusion, wastewater in open waste channels at Nairobi industrial area had elevated levels of Pb and Hg, while the soil from the same channels had high levels of Hg, Pb, Ni, Cr, and Cd. Good management of Nairobi industrial area effluents is inevitable since it borders densely populated informal settlements which are likely to suffer exposure to toxic wastes. Effective wastewater treatment and reuse is highly recommended.

Abstract: Most large carnivore species are in global decline. Conflict with local people, particularly over depredation on livestock, is a major cause of this decline, affecting both nominally protected populations and those outside protected areas. For this reason, techniques that can resolve conflicts between large carnivores and livestock farmers may make important contributions to conservation. We monitored rates of livestock depredation by lions ( Panthera leo), leopards (Panthera pardus), cheetahs (Acinonyx jubatus), and spotted hyenas (Crocuta crocuta), and retributive killing of these species by farmers in livestock‐producing areas of Laikipia District, Kenya. Farmers killed more lions, leopards, and spotted hyenas where these predators killed more livestock. Livestock husbandry had a clear effect on rates of depredation and hence on the numbers of predators killed. Cattle, sheep, and goats experienced the lowest predation rates when attentively herded by day and enclosed in traditional corrals (bomas) by night. Construction of the boma, the presence of watchdogs, and high levels of human activity around the boma were all associated with lower losses to predators. Although most of this work was carried out on commercial ranches, local Maasai and Samburu pastoralists have practiced nearly identical forms of husbandry for generations. Our study shows that traditional, low‐tech husbandry approaches can make an important contribution to the conservation of large carnivores.

Summary Baum, B. R.: Combining trees as a way of combining data sets for phylogenetic inference, and the desirability of combining gene trees. ‐ Taxoni 41: 3–10. 1992. ‐ ISSN 0040‐0262. A procedure of combining trees obtained from data sets of different kinds, similar to Brooks's technique but for a different purpose, with the aim of combining these data sets, is detailed along with examples used in five unrepeated combinations from a total of 15 published datasets. The procedure does not adjoin raw data sets, but instead combines the binary‐coded factors of the trees, each tree from a different data set, together. This allows the combining of data that are only available as pairwise distances with data obtained directly from characters of the organisms. It economizes the analysis of combined nucleotide sequence data which can be very large, and preserves information for each kind of data in the combination. The procedure allows for missing data as well, and can be regarded as a new consensus method ‐ mathematical properties have yet to be investigated. The desirability of combining gene trees, obtained from molecular data, to enable the inference of species trees is discussed in light of using this procedure.

OBJECTIVE: To review the data presented in the 2021 WHO global TB report and discuss the current constraints in the global response. INTRODUCTION AND METHODS: The WHO global TB reports, consolidate TB data from countries and provide up to date assessment of the global TB epidemic. We reviewed the data presented in the 2021 report. RESULTS: We noted that the 2021 WHO global TB report presents a rather grim picture on the trajectory of the global epidemic of TB including a stagnation in the annual decline in TB incidence, a decline in TB notifications and an increase in estimated TB deaths. All the targets set at the 2018 United Nations High Level Meeting on TB were off track. INTERPRETATION AND CONCLUSION: The sub-optimal global performance on achieving TB control targets in 2020 is attributed to the on-going COVID-19 pandemic, however, TB programs were already off track well before the onset of the pandemic, suggesting that the pandemic amplified an already fragile global TB response. We emphasize that ending the global TB epidemic will require bold leadership, optimization of existing interventions, widespread coverage, addressing social determinants of TB and importantly mobilization of adequate funding required for TB care and prevention.

Intensive agriculture is based on the use of high-energy inputs and quality planting materials with assured irrigation, but it has failed to assure agricultural sustainability because of creation of ecological imbalance and degradation of natural resources. On the other hand, intercropping systems, also known as mixed cropping or polyculture, a traditional farming practice with diversified crop cultivation, uses comparatively low inputs and improves the quality of the agro-ecosystem. Intensification of crops can be done spatially and temporally by the adoption of the intercropping system targeting future need. Intercropping ensures multiple benefits like enhancement of yield, environmental security, production sustainability and greater ecosystem services. In intercropping, two or more crop species are grown concurrently as they coexist for a significant part of the crop cycle and interact among themselves and agro-ecosystems. Legumes as component crops in the intercropping system play versatile roles like biological N fixation and soil quality improvement, additional yield output including protein yield, and creation of functional diversity. But growing two or more crops together requires additional care and management for the creation of less competition among the crop species and efficient utilization of natural resources. Research evidence showed beneficial impacts of a properly managed intercropping system in terms of resource utilization and combined yield of crops grown with low-input use. The review highlights the principles and management of an intercropping system and its benefits and usefulness as a low-input agriculture for food and environmental security.

The density of sputtered Ge2Sb2.04Te4.74 thin films upon annealing has been precisely determined by x-ray reflection and compared to the values determined from x-ray diffraction (XRD) data. The film density increases in two steps around 130 and 280 °C upon annealing up to 400 °C. These increases are consequences of phase transitions from amorphous to NaCl type and from NaCl type to hexagonal structure, respectively, as revealed by XRD. Average density values of 5.87±0.02, 6.27±0.02, and 6.39±0.02 g/cm3 were measured for the amorphous, NaCl-type, and hexagonal phases, respectively. This corresponds to density changes upon crystallization of 6.8±0.2% and 8.8±0.2% for NaCl-type and hexagonal phases, respectively. The accompanying film thickness reductions were determined to be 6.5±0.2% and 8.2±0.2%, which compares very well with the density changes. The corresponding XRD values are determined to be 6.43–6.48 and 6.48 g/cm3 for NaCl-type and the hexagonal phases, respectively. This shows that nearly void-free films are formed.

BACKGROUND: The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). METHODS: ) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations. RESULTS: The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower. CONCLUSIONS: For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children. TRIAL REGISTRATION: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012).

The Active Healthy Kids Canada (AHKC) Report Card on Physical Activity for Children and Youth has been effective in powering the movement to get kids moving by influencing priorities, policies, and practice in Canada. The AHKC Report Card process was replicated in 14 additional countries from 5 continents using 9 common indicators (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and Built Environment, and Government Strategies and Investments), a harmonized process and a standardized grading framework. The 15 Report Cards were presented at the Global Summit on the Physical Activity of Children in Toronto on May 20, 2014. The consolidated findings are summarized here in the form of a global matrix of grades. There is a large spread in grades across countries for most indicators. Countries that lead in certain indicators lag in others. Overall, the grades for indicators of physical activity (PA) around the world are low/poor. Many countries have insufficient information to assign a grade, particularly for the Active Play and Family and Peers indicators. Grades for Sedentary Behaviors are, in general, better in low income countries. The Community and Built Environment indicator received high grades in high income countries and notably lower grades in low income countries. There was a pattern of higher PA and lower sedentary behavior in countries reporting poorer infrastructure, and lower PA and higher sedentary behavior in countries reporting better infrastructure, which presents an interesting paradox. Many surveillance and research gaps and weaknesses were apparent. International cooperation and cross-fertilization is encouraged to tackle existing challenges, understand underlying mechanisms, derive innovative solutions, and overcome the expanding childhood inactivity crisis.

BACKGROUND: The primary aim of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was to determine the relationships between lifestyle behaviours and obesity in a multi-national study of children, and to investigate the influence of higher-order characteristics such as behavioural settings, and the physical, social and policy environments, on the observed relationships within and between countries. METHODS/DESIGN: The targeted sample included 6000 10-year old children from 12 countries in five major geographic regions of the world (Europe, Africa, the Americas, South-East Asia, and the Western Pacific). The protocol included procedures to collect data at the individual level (lifestyle, diet and physical activity questionnaires, accelerometry), family and neighborhood level (parental questionnaires), and the school environment (school administrator questionnaire and school audit tool). A standard study protocol was developed for implementation in all regions of the world. A rigorous system of training and certification of study personnel was developed and implemented, including web-based training modules and regional in-person training meetings. DISCUSSION: The results of this study will provide a robust examination of the correlates of adiposity and obesity in children, focusing on both sides of the energy balance equation. The results will also provide important new information that will inform the development of lifestyle, environmental, and policy interventions to address and prevent childhood obesity that may be culturally adapted for implementation around the world. ISCOLE represents a multi-national collaboration among all world regions, and represents a global effort to increase research understanding, capacity and infrastructure in childhood obesity.

PURPOSE: Previously, studies examining correlates of sedentary behavior have been limited by small sample size, restricted geographic area, and little socio-cultural variability. Further, few studies have examined correlates of total sedentary time (SED) and screen time (ST) in the same population. This study aimed to investigate correlates of SED and ST in children around the world. METHODS: The sample included 5,844 children (45.6% boys, mean age = 10.4 years) from study sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Child- and parent-reported behavioral, household, and neighborhood characteristics and directly measured anthropometric and accelerometer data were obtained. Twenty-one potential correlates of SED and ST were examined using multilevel models, adjusting for sex, age, and highest parental education, with school and study site as random effects. Variables that were moderately associated with SED and/or ST in univariate analyses (p<0.10) were included in the final models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST. RESULTS: Children averaged 8.6 hours of daily SED, and 54.2% of children failed to meet ST guidelines. In all study sites, boys reported higher ST, were less likely to meet ST guidelines, and had higher BMI z-scores than girls. In 9 of 12 sites, girls engaged in significantly more SED than boys. Common correlates of higher SED and ST included poor weight status, not meeting physical activity guidelines, and having a TV or a computer in the bedroom. CONCLUSIONS: In this global sample many common correlates of SED and ST were identified, some of which are easily modifiable (e.g., removing TV from the bedroom), and others that may require more intense behavioral interventions (e.g., increasing physical activity). Future work should incorporate these findings into the development of culturally meaningful public health messages.

Greater than 80% of malaria-related mortality occurs in sub-Saharan Africa due to infections with Plasmodium falciparum. The majority of P. falciparum-related mortality occurs in immune-naïve infants and young children, accounting for 18% of all deaths before five years of age. Clinical manifestations of severe falciparum malaria vary according to transmission intensity and typically present as one or more life-threatening complications, including: hyperparasitemia; hypoglycemia; cerebral malaria; severe malarial anemia (SMA); and respiratory distress. In holoendemic transmission areas, SMA is the primary clinical manifestation of severe childhood malaria, with cerebral malaria occurring only in rare cases. Mortality rates from SMA can exceed 30% in pediatric populations residing in holoendemic transmission areas. Since the vast majority of the morbidity and mortality occurs in immune-naïve African children less than five years of age, with SMA as the primary manifestation of severe disease, this review will focus primarily on the innate immune mechanisms that govern malaria pathogenesis in this group of individuals. The pathophysiological processes that contribute to SMA involve direct and indirect destruction of parasitized and non-parasitized red blood cells (RBCs), inefficient and/or suppression of erythropoiesis, and dyserythropoiesis. While all of these causal etiologies may contribute to reduced hemoglobin (Hb) concentrations in malaria-infected individuals, data from our laboratory and others suggest that SMA in immune-naïve children is characterized by a reduced erythropoietic response. One important cause of impaired erythroid responses in children with SMA is dysregulation in the innate immune response. Phagocytosis of malarial pigment hemozoin (Hz) by monocytes, macrophages, and neutrophils is a central factor for promoting dysregulation in innate inflammatory mediators. As such, the role of P. falciparum-derived Hz (PfHz) in mediating suppression of erythropoiesis through its ability to cause dysregulation in pro- and anti-inflammatory cytokines, growth factors, chemokines, and effector molecules is discussed in detail. An improved understanding of the etiological basis of suppression of erythropoietic responses in children with SMA may offer the much needed therapeutic alternatives for control of this global disease burden.

The balance between Th1 cytokines (tumor necrosis factor [TNF]-alpha, interferon [IFN]-gamma) and Th2 cytokines (interleukin [IL]-10, -4) may be critical in the development of severe falciparum malaria. Therefore, plasma concentrations of these cytokines were determined in children with various manifestations of malaria. Plasma levels of IFN-gamma and IL-4 were undetectable in most children. However, TNF-alpha and IL-10 were significantly elevated in children with high-density parasitemia and malaria anemia compared with children in control groups. In children with mild malaria, IL-10, but not TNF-alpha, was significantly elevated. While the highest concentrations of TNF-alpha were found in children with malaria anemia, IL-10 levels were highest in children with high-density uncomplicated malaria. The mean ratio of IL-10 to TNF-alpha was significantly higher in children with mild and high-density parasitemia (4.64, P<.005) than in children with malaria anemia (1.77). Thus, higher levels of IL-10 over TNF-alpha may prevent development of malaria anemia by controlling the excessive inflammatory activities of TNF-alpha.

Cyanobacterial mats at hot springs on the shore of the alkaline Lake Bogoria, Kenya, were investigated regarding species community and cyanobacterial toxin content. The hepatotoxins microcystin-LR, -RR, -LF and -YR, and the neurotoxin anatoxin-a were present. The mats were dominated by Phormidium terebriformis, Oscillatoria willei, Spirulina subsalsa and Synechococcus bigranulatus. The concentration of microcystins in mat samples, ranged from 221 to 845 microg microcystin-LR equivalents g(-1) DW of mat. Anatoxin-a concentrations ranged from 10 to 18 microg g(-1) DW of mat. A contribution of the cyanobacterial toxins from the hot spring mats to the mass mortalities of Lesser Flamingos is suggested by: (a), the presence of hot spring cyanobacterial cells and cell fragments, and high concentrations of the cyanobacterial hepato- and neurotoxins in flamingo stomach contents and faecal pellets; (b), observations of neurological signs of bird poisoning at the lake. Cyanobacterial toxins in stomach contents, intestine and fecal pellets were 0.196 microg g(-1) fresh weight (FW) for the microcystins and 4.34 microg g(-1) FW for anatoxin-a. Intoxication with cyanobacterial toxins could occur by uptake of detached cyanobacterial cells from the mats, as the flamingos need to drink fresh or brackish water, and to wash their feathers daily, which they do in the vicinity of the hot springs, where salinity is lower than in the main body of water of the lake.

Tsetse flies are the sole vectors of human African trypanosomiasis throughout sub-Saharan Africa. Both sexes of adult tsetse feed exclusively on blood and contribute to disease transmission. Notable differences between tsetse and other disease vectors include obligate microbial symbioses, viviparous reproduction, and lactation. Here, we describe the sequence and annotation of the 366-megabase Glossina morsitans morsitans genome. Analysis of the genome and the 12,308 predicted protein-encoding genes led to multiple discoveries, including chromosomal integrations of bacterial (Wolbachia) genome sequences, a family of lactation-specific proteins, reduced complement of host pathogen recognition proteins, and reduced olfaction/chemosensory associated genes. These genome data provide a foundation for research into trypanosomiasis prevention and yield important insights with broad implications for multiple aspects of tsetse biology.

Natural enemies respond to herbivore-induced plant volatiles (HIPVs), but an often overlooked aspect is that there may be genotypic variation in these 'indirect' plant defence traits within plant species. We found that egg deposition by stemborer moths (Chilo partellus) on maize landrace varieties caused emission of HIPVs that attract parasitic wasps. Notably, however, the oviposition-induced release of parasitoid attractants was completely absent in commercial hybrid maize varieties. In the landraces, not only were egg parasitoids (Trichogramma bournieri) attracted but also larval parasitoids (Cotesia sesamiae). This implies a sophisticated defence strategy whereby parasitoids are recruited in anticipation of egg hatching. The effect was systemic and caused by an elicitor, which could be extracted from egg materials associated with attachment to leaves. Our findings suggest that indirect plant defence traits may have become lost during crop breeding and could be valuable in new resistance breeding for sustainable agriculture.

BACKGROUND: Successful treatment of tuberculosis (TB) involves taking anti-tuberculosis drugs for at least six months. Poor adherence to treatment means patients remain infectious for longer, are more likely to relapse or succumb to tuberculosis and could result in treatment failure as well as foster emergence of drug resistant tuberculosis. Kenya is among countries with high tuberculosis burden globally. The purpose of this study was to determine the duration tuberculosis patients stay in treatment before defaulting and factors associated with default in Nairobi. METHODS: A Case-Control study; Cases were those who defaulted from treatment and Controls those who completed treatment course between January 2006 and March 2008. All (945) defaulters and 1033 randomly selected controls from among 5659 patients who completed treatment course in 30 high volume sites were enrolled. Secondary data was collected using a facility questionnaire. From among the enrolled, 120 cases and 154 controls were randomly selected and interviewed to obtain primary data not routinely collected. Data was analyzed using SPSS and Epi Info statistical software. Univariate and multivariate logistic regression analysis to determine association and Kaplan-Meier method to determine probability of staying in treatment over time were applied. RESULTS: Of 945 defaulters, 22.7% (215) and 20.4% (193) abandoned treatment within first and second months (intensive phase) of treatment respectively. Among 120 defaulters interviewed, 16.7% (20) attributed their default to ignorance, 12.5% (15) to traveling away from treatment site, 11.7% (14) to feeling better and 10.8% (13) to side-effects. On multivariate analysis, inadequate knowledge on tuberculosis (OR 8.67; 95% CI 1.47-51.3), herbal medication use (OR 5.7; 95% CI 1.37-23.7), low income (OR 5.57, CI 1.07-30.0), alcohol abuse (OR 4.97; 95% CI 1.56-15.9), previous default (OR 2.33; 95% CI 1.16-4.68), co-infection with Human immune-deficient Virus (HIV) (OR 1.56; 95% CI 1.25-1.94) and male gender (OR 1.43; 95% CI 1.15-1.78) were independently associated with default. CONCLUSION: The rate of defaulting was highest during initial two months, the intensive phase of treatment. Multiple factors were attributed by defaulting patients as cause for abandoning treatment whereas several were independently associated with default. Enhanced patient pre-treatment counseling and education about TB is recommended.

A systematic review was conducted to evaluate the status and intake of iron, vitamin A, iodine, folate and zinc in women of reproductive age (WRA) (≥15-49 years) and pregnant women (PW) in Ethiopia, Kenya, Nigeria and South Africa. National and subnational data published between 2005 and 2015 were searched via Medline, Scopus and national public health websites. Per micronutrient, relevant data were pooled into an average prevalence of deficiency, weighted by sample size (WAVG). Inadequate intakes were estimated from mean (SD) intakes. This review included 65 surveys and studies from Ethiopia (21), Kenya (11), Nigeria (21) and South Africa (12). In WRA, WAVG prevalence of anaemia ranged from 18-51%, iron deficiency 9-18%, and iron deficiency anaemia at 10%. In PW, the prevalence was higher, and ranged from 32-62%, 19-61%, and 9-47%, respectively. In WRA, prevalence of vitamin A, iodine, zinc and folate deficiencies ranged from 4-22%, 22-55%, 34% and 46%, while in PW these ranged from 21-48%, 87%, 46-76% and 3-12% respectively. Inadequate intakes of these micronutrients are high and corresponded with the prevalence figures. Our findings indicate that nationally representative data are needed to guide the development of nutrition interventions and public health programs, such as dietary diversification, micronutrient fortification and supplementation.

BACKGROUND: Insecticide-treated bed nets (ITNs) are known to be highly effective in reducing malaria morbidity and mortality. However, usage varies among households, and such variations in actual usage may seriously limit the potential impact of nets and cause spatial heterogeneity on malaria transmission. This study examined ITN ownership and underlying factors for among-household variation in use, and malaria transmission in two highland regions of western Kenya. METHODS: Cross-sectional surveys were conducted on ITN ownership (possession), compliance (actual usage among those who own ITNs), and malaria infections in occupants of randomly sampled houses in the dry and the rainy seasons of 2009. RESULTS: Despite ITN ownership reaching more than 71%, compliance was low at 56.3%. The compliance rate was significantly higher during the rainy season compared with the dry season (62% vs. 49.6%). Both malaria parasite prevalence (11.8% vs. 5.1%) and vector densities (1.0 vs.0.4 female/house/night) were significantly higher during the rainy season than during the dry season. Other important factors affecting the use of ITNs include: a household education level of at least primary school level, significantly high numbers of nuisance mosquitoes, and low indoor temperatures. Malaria prevalence in the rainy season was about 30% lower in ITN users than in non-ITN users, but this percentage was not significantly different during the dry season. CONCLUSION: In malaria hypo-mesoendemic highland regions of western Kenya, the gap between ITNownership and usage is generally high with greater usage recorded during the high transmission season. Because of the low compliance among those who own ITNs, there is a need to sensitize households on sustained use of ITNs in order to optimize their role as a malaria control tool.