Magister Public Health - MPH / Although the Kenyan government implemented safe motherhood programme two decades ago, available data indicate that prevalence of home delivery is still high among women in Garissa District. The aim of this thesis was to investigate the factors influencing the choice of place of childbirth. Methodology: A descriptive cross-sectional study was carried out among 224 women who delivered babies two years prior to December 2010. Using a statcalc program in Epi Info 3.3.2, with expected frequency of home delivery at 83% +5% and a 95% confidence level, the calculated sample size was 215. Furthermore, with a 95% response rate the adjusted minimum sample size was 226.There were two none-responses hence 224 women were interviewed. Stratified sampling was used. Data were collected using pre-tested structured questionnaires and analyzed using SPSS. Descriptive, bivariate and multivariate analysis was performed. A binary logistic regression analysis using the Enter method was performed to determine independent predictors for use or non-use of healthcare services for childbirth. The threshold for statistical significance was set at 0.05. Results: The result was presented in text and tables. The study found 67% (n=224) women delivered at home and 33% delivered in hospital. The study found low level of education, poverty, none-attendance of ANC, distance, cost of services, poor quality services, negative attitude towards midwives, experience of previous obstetric complications and decision-making to be significant predictors in home delivery at the bivariate level (p<0.05). The study did not find relationship between age, marital status, religion and place of childbirth (p>0.05). At multivariate level, the following variables were still found to be significant predictors of home delivery: no education OR=8.36 (95% CI; 4.12-17.17), no occupation OR=1.43(95% CI; 1.08–5.49) experience of obstetric complications OR=1.38 (95% CI; 1.15-2.12), none-attendance of antenatal clinic OR=1.11 (95% CI; 1.03–1.51), Rude midwives OR=5.60 (95% CI; 2.66-11.96). Conclusions: high prevalence of home delivery was noted due to lack of education, poverty and inaccessible maternity services hence the need to empower women in education and economy to enhance hospital delivery.

In many African countries, including South Africa, sorghum is malted for the brewing of traditional beer. In South Africa, most sorghum malting is by traditional outdoor floor malting, whereby the sorghum grain is steeped for about 8 hours, left outdoors to germinate in an uncontrolled environment. These malting conditions (wet grain and more or less ambient temperature) encourage microbial proliferation. Microorganisms may themselves negatively impact on the safety of the malts. Of more concern is the proliferation of fungi which can potentially produce highly poisonous mycotoxins in the sorghum malt. Microbial proliferation can also affect the quality of malt, and thereby resulting in undesirable malts. Therefore there is a need for efficient and safe ways to control microbial growth during sorghum malting. The aim of this research was to determine processes to produce sorghum malt that is free of unwanted yeasts, coliforms, moulds and mycotoxins. The first process investigated involved turning the grains during germination. The second process involved the addition of dilute sodium hydroxide (NaOH)/ caustic soda and calcium hydroxide [(Ca(OH)2]/lime during steeping and the third process was by the use of biological control methods which involved inoculation with microbial starter cultures. The effect of the three processes on the levels of moulds, coliforms, mycotoxins (aflatoxins, fumonisins, deoxynivalenol and zearalenone), cytotoxicity, expressed in terms of their IC50 (Inhibitory concentration resulting in 50% inhibition of the cleavage activity) and quality in terms of diastatic power (DP) of sorghum malt were investigated. Turning the sorghum grains during germination did not affect the microbial load of the malt. The total bacterial counts were at high levels of 107-109 cfu/g, fungi at 104-106 cfu/g and coliforms at 103-105 cfu/g. Turned and unturned grains produced malt which showed contamination by about 8 different mould species. Some of these moulds (Fusarium verticillioides, Phoma sorghina. Aspergillus flavus, Alternaria alternata and Penicillium spp.) are known to produce mycotoxins. Malt samples contained fumonisins, deoxynivalenol and zearalenone at levels of < 0.25-2 _g/g, 15-20 and 10-15 _g/kg, respectively. However, they all had very low cytotoxicity (IC50 from 31.2 to > 500 mg/kg). Turning had the negative effect of decreasing the DP of the sorghum malt. The reason that turning did not reduce the microbial load is probably due to the fact that the blending of malt as a result of turning ensured that bacteria and moulds were evenly distributed throughout the malt bed. Steeping sorghum grains in 0.2% NaOH reduced the level of microbial contamination in the malt. Coliforms and moulds were reduced from 104 and 105 cfu/g respectively, to levels of 102 cfu/g in the malt that do not pose health hazards. The high pH (10-13) that resulted from the addition of NaOH probably caused the inhibition of coliforms and moulds by distorting their cell membranes, destroying the proton gradient of the bacterium cell and thus leading to their death. Steeping in 0.2% NaOH resulted in malts with no detectable amounts of mycotoxins and no indication of cytotoxicity in the sorghum malt. A further advantage was that the DP of the 0.2% NaOH steeped malts was doubled. The addition of about 107-108 cfu/ml of Saccharomyces spp. and Pediococcus. pentosaceus cultures to steep water reduced moulds in the malt from 104 cfu/g to 102 cfu/g and coliforms from 104 cfu/g to 102 and <101 cfu/g, respectively. The antimicrobial activity of the Saccharomyces spp. appears to be mainly due to the competition with the other microorganisms. The antimicrobial activity of P. pentosaceus is mainly attributed to the low pH. In addition to the low pH, production of CO2, competition for nutrients and the production of antimicrobial activity could have been responsible for the overall antimicrobial activity of P. pentosaceus. Steeping with microbial cultures resulted in malts that contained no traces of mycotoxins and cytotoxicity. The DPs of the sorghum malts were not affected by steeping with microbial cultures. Turning of grains during germination is not a good method to control microbial load during sorghum malting. The addition of dilute NaOH in steeping water is proposed as a chemical method for the control of bacterial and fungal contamination during sorghum malting whereas the use of the Saccharomyces spp. and P. pentosaceus cultures offers a potential alternative as natural, biocontrol agents. However, dilute alkaline steeping is a more favoured method because it is an easier and practical method to put into operation. / Thesis (PhD (Food Sciences))--University of Pretoria, 2007. / Food Science / unrestricted

Traditional leafy vegetables (TLVs) have formed a part of rural household food security strategies for generations. In an effort understand their role in household food security, the role and production of TLVs (morogo/ miroho/imifino) were determined in three culturally and agro-ecologically diverse rural communities in South Africa. A questionnaire survey was combined with qualitative methodologies to access the indigenous knowledge associated with the utilisation and production of these crops. TLV production is a female-oriented agricultural activity, as households mainly utilise TLVs for household consumption. Marketing of mainly dried TLVs was limited and income generated from these sales was used to complement household income. The importance of the different TLVs for household consumption varies according to the specific socio-economic situation of the household at a specific time, although they are very important in the period just before other crops are harvested. Cultural beliefs and taboo’s associated with agricultural activities were reported widely. Expenditure on agricultural inputs is low in all three villages. TLVs are commonly intercropped with maize, therefore their production and management practices are linked with maize. Uncultivated TLVs are generally harvested from maize fields and fallow lands. Variations between the villages were found for seedbed preparation, pest control management, fertilisation and irrigation practices. Interactions between crops in the production system and varieties produced had an influence on production decisions made. The socio-economic conditions of households determined the growth stages at which TLVs were harvested. Villages differed with regard to the TLVs mixed into a dish, the proportions of the different TLVs and the plant parts harvested (seed, stalks, flowers, growth points and fruit). Differences in preparation methods of crops existed and were reflected in the preparation method (frying, boiling), type of dish prepared (relish, incorporated into the porridge) and additions to dishes (adding of ash, peanut flour, bicarbonate of soda, mashed pumpkin seed, exotic vegetables, flowers and immature or mature fruit). The types of TLVs dried, preservation methods utilised, storage management and length of storage varied considerably between the three villages. Most of the dried TLVs were stored for up to one year, but the bulk was used within six months. Cowpea was perceived as an ideal dried crop for drought survival strategies as the dried leaves have a long shelf life. Villagers perceived TLVs to be nutritious, but it was not promoted amoungst vulnerable groups. The loss of indigenous knowledge (IK) was identified as a possible cause for this. The decline in utilisation of TLVs found in all three villages is mainly due to poor production systems (drought, low soil fertility, loss of IK and lack of seed). Seed systems for uncultivated plants were unstructured, although the older women had very sophisticated knowledge about seed quality. Differences in the utilisation and production of TLVs were found between the three villages. The main contributing factors towards the utilisation differences are caused by the climate and degree of indigenous knowledge in a specific area. Production differences are influenced by the bio-physical and socio-economic elements in the area. / Dissertation (MSc(Agric))--University of Pretoria, 2009. / Agricultural Economics, Extension and Rural Development / unrestricted

Symphony No. 1 "Concertante" is a work of approximately twenty-two minutes duration for chamber orchestra. The work is scored for flute (doubling piccolo), oboe (doubling English horn), B-flat clarinet, bassoon, trumpet, F horn, trombone, tuba, percussion, harp, piano (doubling celesta), solo violin, solo viola, solo cello, solo double bass, and strings.The percussion battery, which is to be played by one performer, includes three timpani, vibraphone, orchestra bells, xylophone, chimes, suspended cymbal, bass drum, snare drum, and two triangles. One group of instruments, including the eight winds, percussion, and the four solo strings, is treated primarily in a soloistic manner although it also functions as a part of the ensemble. The remaining group, piano, harp, and strings, functions primarily as an accompanying group although it does get some soloistic treatment. The work is in four movements, each of which uses the traditional symphonic form. Movement I is in sonata-allegro form, movement II a simple ternary "song" form, movement III a scherzo and trio, and the final movement is a theme and variations. These traditional forms apply only to thematic use and development, however, for the tonal scheme is developed in a broader design which unfolds throughout the course of the four movements. All important melodic ideas are based on the same pitch set that serves as the basis for the tonal scheme.

In Africa, the importance of medicinal plants in folklore medicine and their contribution to primary healthcare is well recognized. Across the continent, local herbal mixtures still provide the only therapeutic option for about 80% of the population. The vast floral diversity and the intrinsic ethnobotanical knowledge has been the backbone of localized traditional herbal medical practices. In Africa, an estimated 5400 of the 60000 described plant taxa possess over 16300 therapeutic uses. Similarly, with a therapeutic flora comprising of approximately 650 species, herbal medical practitioners in South Africa, make use of a plethora of plants to treat different human diseases and infections. Over the years, studies have identified numerous plant species with potential against chronic metabolic diseases including type 2 diabetes mellitus (T2DM). Globally, the incidence and prevalence of T2DM have reached epidemic proportions affecting people of all ages, nationalities and ethnicity. Considered the fourth leading cause of deaths by disease, T2DM is a global health crisis with an estimated diagnosis and mortality frequency of 1 every 5 seconds and 1 every 7 seconds respectively. Though the exact pathophysiology of T2DM is not entirely understood, initial peripheral insulin resistance in adipose tissue, liver, and skeletal muscle with subsequent pancreatic β-cell dysfunction resulting from an attempt to compensate for insulin resistance is a common feature of the disease. The current approach to treating T2DM is the use of oral antidiabetic agents (OAAs), insulin, and incretin-based drugs in an attempt to achieve glycaemic control and maintain glucose homeostasis. However, conventional anti-T2DM drugs have been shown to have limited efficacies and serious adverse effects. Hence, the need for newer, more efficacious and safer anti-T2DM agents. Sutherlandia frutescens subsp. microphylla is a flowering shrub of the pea family (Fabaceae/Leguminaceae) found mainly in the Western Cape and Karoo regions of Southern Africa. Concoctions of various parts of the plant are used in the management of different ailments including T2DM. However, despite extensive biological and pharmacological studies, few analyses exist of the chemical constituents of S. frutescens and no Triple Time of Flight Liquid Chromatography with Mass Spectrometry (Triple TOF LC/MS/MS) analysis has been performed. The initial aim of this study was to investigate the phytochemical profile of hot aqueous, cold aqueous, 80% ethanolic, 100% ethanolic, 80% methanolic and 100% methanolic extracts of a single source S. frutescens plant material using colorimetric and spectrophotometric analysis. The hot aqueous extractant was found to be the best extractant for S. frutescens, yielding 1.99 g of crude extract from 16 g fresh powdered plant material. This data suggests that application of heat and water as the extractant (hot aqueous) could play a vital role in extraction of bioactive compounds from S. frutescens and also justifies the traditional use of a tea infusion of S. frutescens. Colorimetric analysis revealed the presence of flavonoids, flavonols, tannins, and phenols in all extracts with varying intensity. The organic extracts 100% methanol, 80% and 100% ethanol exhibited high color intensity (+++) for flavonoids and flavonols respectively, while all the extracts exhibited a moderate color intensity (++) for tannins and phenols. Spectrophotometric analysis of S. frutescens extracts revealed that all the organic extracts contained a significantly higher concentration (in mg/g of extract) of flavonols and tannins when compared to the aqueous extracts. All extracts contained approximately equal levels of phenols. These data confirm the presence of all four groups of bioactive phytocompounds in the S. frutescens extracts used in this study, and also confirm that different solvent extractants possess the capability to differentially extract specific groups of phytocompounds. in individual extracts. Further comparison of these compounds with online databases of anti-diabetic phytocompounds led to the preliminary identification of 10 possible anti-diabetic compounds; α-Pinene, Limonene, Sabinene, Carvone, Myricetin, Rutin, Stigmasterol, Emodin, Sarpagine and Hypoglycin B in crude and solid phase extraction (SPE) fractions of S. frutesecens. Furthermore, using two hepatic cell lines (Chang and HepG2) as an in-vtro model system, the anti-T2DM properties of crude aqueous and organic extracts of S. frutescents was investigated and compared. Both aqueous and organic extracts of S. frutescens were found to decrease gluconeogenesis, increase glucose uptake and decrease lipid accumulation (Triacylglycerol, Diacylglycerol, and Monoacylglycerol) in Chang and HepG2 hepatic cell cultures made insulin resistant (IR) following exposure to high concentration of insulin and fructose. Using real-time quantitative reverse transcriptase polymerase chain reaction (qRT-PCR), the aqueous and organic extracts of S. frutescens were confirmed to regulate the expression of Vesicle-associated membrane protein 3 (VAMP3), Mitogen-activated protein kinase 8 (MAPK8), and Insulin receptor substrate 1 (IRS1) in insulin resistant hepatic cells. IR-mediated downregulation of VAMP3, MAPK8, and IRS1 mRNA in IR HepG2 hepatic cell cultures was reversed in the presence of aqueous and organic extracts of S. frutescens. The hot aqueous extract displayed the highest activity in all the assays, while all the organic extracts displayed similar potency. In conclusion, this study reports that aqueous and organic extracts of S. frutescens possess numerous anti-diabetic compounds that can be further investigated for the development of new, more efficacious and less toxic anti-diabetic agents. The presence of multiple compounds in a single extract does suggest a synergistic or combinatorial therapeutic effect. These findings support the burgeoning body of in-vivo and in-vitro literature evidence on the anti-diabetic properties of S. frutescens and its use in folklore medicine.

The incidence of Type 2 Diabetes Mellittus (T2DM) is increasing world wide. In Africa the limited access to health care and the insidious course of the disease lead to more severe illness and diabetic complications. There is a need to find alternative approaches to treatment and prevention that address the problems and needs of Africa. Sutherlandia frutescens (S.frutescens) is a traditional herbal plant with known anti-diabetic properties, the precise mechanism of action of S.frutescens is not known. In order to develop new approaches for treatment and prevention of T2DM the pathophysiology of T2DM must be understood. T2DM is the final outcome of a multi-organ disease characterized by early defects in muscle, adipocytes, hepatocytes and pancreatic β-cells. In this study the role of the liver was investigated because of its central role in glucose and lipid metabolism. It is hard to differentiate between all the influences in an in vivo model, so the aim of this study was to develop an in vitro model of T2DM in Chang liver cells and to determine if S.frutescens can reverse the state of insulin resistance in this model. Different culture media conditions were screened to identify a method that can be used as the T2DM model in Chang liver cells. Serum free medium (MCBD-201) supplemented with human diabetic serum, (2.5%-10%), high insulin concentrations (0.1μM-1μM), high fructose concentrations (1-10mM). and a combination of high insulin and high fructose was used for this screening. Chang liver cells cultured in MCBD-201 medium supplemented with 1mM fructose and 0.1μM insulin showed reduced glucose uptake and increased lipid accumulation. The effect of two S.frutescens extracts, two anti-diabetic drugs, metformin and ciglitazone, and a hypolipidemic drug ciprofibrate were determined and shown to increase glucose uptake and reduce lipid accumulation. It was postulated that exposing the cells to excess nutrients in the form of high fructose would stimulate the cells to become adipogenic and accumulate lipids, which would interfere with the glucose uptake and induce insulin resistance. Gene expression of PPARγ, PPARα, and SREBP-1 transcription factors regulating lipid metabolism was determined in Chang liver cells cultured in insulin resistance inducing medium over a 48 hour time course. The expression of PPARγ, known to stimulate adipogenesis was increased after 6, 24 and 48 hours of exposure (P(H1)<0.0001). The expression of PPARα, known to stimulate β-oxidation expression, was significantly decreased after 24 hours of exposure (P(H1)<0.0001). The presence of the plant extracts in the insulin resistance inducing media protect against this increase in adipogenesis and decrease in β-oxidation after 48 hours of exposure by increasing PPARα expression and decreasing PPARγ expression. A PCR Array was performed which identified 32 more potential molecular targets of S.frutescens. Five of the 32 targets identified with the PCR Array were validated using qRT-PCR. These genes play a role in lipid and glucose metabolism and protection against oxidative stress and inflammation. In summary a cellular model of insulin resistace in hepatocytes has been established and the capacity of S.frutescens to reverse this process has been demonstrated by acting as a dual PPARγ/α agonist. New genes have been identified in the development of insulin resistance and as targets of S.frutescens.

A follow-up of traditional medicinal plants uses is an important tool in highlighting their therapeutic potentials, as they have been found to be a source of a wide range of bioactive compounds that can be used as base compounds for new pharmaceutical drugs. This study therefore focuses on assessing the anti-Listerial properties of the seeds of Garcinia kola (Heckel) plant, which is a traditional medicinal plant of west and central African origin, and was and is still used to traditionally treat several ailments. Four different solvents crude extracts of the seeds were assessed for their anti-Listerial activities in-vitro, against a panel of 42 Listeria bacteria, which included Listeria monocytogenes, Listeria ivanovii and Listeria grayi species. At 10 mg/ml concentration the aqueous extract had activity against 29% of the test isolates while the other three crude extracts namely dichloromethane, n-hexane and the methanol extracts had activity against 45% of the test bacteria. The minimum inhibitory concentration (MIC) ranges of the extracts were 0.079-0.313 mg/ml for the dichloromethane extract; 0.079-0.625 mg/ml for the n-hexane extract; 0.157-0.625 mg/ml for the methanol extract; and 10->10 mg/ml for the aqueous extract. The minimum bactericidal concentration (MBC) ranges of the extracts were 0.625–10 mg/ml for both the n-hexane and the dichloromethane extract; 5-10 mg/ml for the methanol extract; and those for the aqueous extract were above 10 mg/ml against all the susceptible Listeria isolates. The rate of kill analysis was then determined for the three most active crude extracts that is excluding the aqueous extract and it was assessed against four representative Listeria species namely L. monocytogenes (LAL 8), L. grayi (LAL 15), L. ivanovii (LEL 30) and L. ivanovii (LEL 18). All the three extracts showed a general trend of being concentration and time dependent in their rate of kill profiles such that most bacteria cells were killed at the highest test concentration of 4× MIC value after the maximum exposure time of 2 h. The n-hexane, dichloromethane and methanol extracts were bactericidal against 4, 3 and 1 isolates out of the four test Listeria isolates respectively.

Urease of Helicobacter pylori is an important virulence factor implicated in the pathogenesis of many clinical conditions, such as chronic gastritis, peptic ulceration, and gastric cancer. Many urease inhibitors have been discovered, like phosphorodiamidates, hydroxamic acid derivatives, and imidazoles. Despite good activities at the enzyme level and excellent kinetic properties most of them have not been used as therapeutic agents in vivo because of their side effects, toxicity and instability. This has led to much attention to focus on exploring the novel urease inhibitory activities of natural products because of their low toxicity and good bioavailability. Honey, a natural product has been used in folk medicine due to its antitumor, antioxidant, antimicrobial and anti-inflammatory properties. The aims of this study were to isolate, characterise, purify urease produced by H. pylori and investigate the inhibitory effects of solvent honey extracts on its enzymatic activity. Urease was found to be both surface-associated and cytoplasmic. Maximum cytoplasmic urease activity was found to occur after 72 hr whereas maximum extracellular urease activities were found to occur after 96 hr. Characterization of the crude cytoplasmic urease revealed optimal activity at a pH of 7.5 and temperature of 40°C. The kinetic parameters Vmax and Km were 45.32 U ml-1 and 61.11 mM respectively.The honey extracts inhibited the activity of the crude urease in a concentration dependent manner. The Lineweaver-Burk plots indicated a non-competitive type of inhibition against H. pylori urease. The two honey extracts gave promising inhibitory activities against urease of H. pylori. Thus the results of this study delineates that inhibition of urease can ease development in therapeutic and preventative approaches based on the enzymatic activity of this Helicobacter protein.

While Western science education has always been ubiquitous in the Canadian educational system and society, many researchers have recognized the scientific and educational values of Traditional Ecological Knowledge (TEK). This study aims to contribute to the understanding of TEK and the integration of TEK into science curricula. The prevalence and representation of TEK in grades 7 and 8 official science curriculum documents used in Canada were examined. To describe TEK in the documents, both quantitative and qualitative content analyses were conducted. The results show the high variation of the prevalence and representations of TEK. Overall, Nunavut and Saskatchewan show the highest prevalence and representation of TEK in their curriculum documents, which could establish a benchmark for developing a national learning framework for integrating TEK.

Comme toute forme artistique, le film qui s'exprime à travers le langage cinématographique est une communication entre émetteur (réalisateur) et récepteur (spectateur). Voici un exposé de mes recherches personnelles et de mes expériences de cinéaste, relatives au processus de la fabrication d’un film. / As any art form, a movie that expresses itself through cinematographic language is a communication between a sender (the director) and a receiver (the spectator). Here is a presentation of my personal researches and experiences as a film-maker, concerning the process of fabricating a movie.