No abstract

Medical diagnostic laboratories have always played a significant role in determining clinical decisions. Given that laboratory diagnosis accounts for up to 70% of all medical decisions, reliable laboratory services is therefore critical to basic clinical care and universal healthcare coverage (UHC) programme. Apparently, a pilot UHC programme in four counties ahead of nationwide roll-out was being tested in Kenya from December 2018 to December 2019. Significantly, a reliable laboratory diagnostic service also support a sustainable functional referral system. However, in majority of low to middle income countries (LMICs) and through-out sub-Saharan Africa including Kenya, common infrastructural, technical and human resource deficiencies are endemic, consequently impacting on the coverage of services, quality, availability, affordability and accessibility of diagnostic tests as well as their ability to provide basic clinical care. For that reason, studies to determine the current status of laboratory diagnostic services, especially at the primary health care (PHC), coverage and their readiness to provide basic clinical care as well as in supporting UHC. The purpose of this pilot descriptive study was to investigate the status and readiness of laboratory diagnostic services in three counties in Kenya to support UHC at a resource-limited PHC setting. By use of structured, pretested questionnaires, general observations and key informant interviews, the study-specific information was obtained from participants. The data was analyzed using SPSS statistical package, interpreted, summarized and presented in tables and bar graphs. Based on the WHO-defined three categories of essential diagnostic list (EDL) for UHC at PHC, all the general basic tests were available in the sampled facilities. However, for the disease-specific and infectious diseases-specific tests there were major gaps in their availability. In addition to common infrastructural, technical, human resource deficiencies, only in 3% of the facilities, the more advanced, molecular-based disease-specific and infectious diseases-specific tests were available. This indicated low readiness to provide reliable basic clinical care and to support of UHC programme implementation at PHC level. Therefore, building of capacities of these services at PHC will have a direct impact not only in the diagnosis, treatment and prevention of diseases but also help in the successful up-scaling nationwide of the UHC programme, hence assisting in attainment of the 'Big Four' agenda of UHC, United Nations (UNs) sustainable development goals (SDG) number three (3) on ensuring health for all and promoting well-being for all ages, and the Kenya's Vision 2030 economic blue print.

According to the National AIDS Control Council (NACC) of Kenya, Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) prevention starts and ends with behavior change and anything else comes in between. Importantly, "although antiretroviral therapy (ART) was working, countries will not be able to treat their way out of the HIV/AIDS pandemic, as it is not sustainable in the long run". This highlights the critical role of healthy behavioral change, HIV status awareness, distigmatisation, stopping of new infection, inclusion of key populations, support groups and psychosocial support of people living with HIV (PLWH) in HIV/AIDS management and prevention strategies. Significantly, high levels of HIV/AIDS knowledge do not always translate to a positive behavior change. The purpose of this descriptive survey was to investigate the levels of HIV/AIDS knowledge, awareness, perceptions and attitudes towards the virus and PLWH among members of staff a public university in Kenya. This was a descriptive survey in which all the members of staff (due to the small population of only 288) were targeted as participants, issued with self-administered questionnaire, structured according to the NACC guidelines for public sector. The data was analyzed using descriptive statistics with IBM SPSS version 22 software. Significantly, HIV/AIDS knowledge levels were adequately high as indicated by the 83% female and 69% male employees who strongly agreed that the risk of HIV infection can be reduced by having one uninfected partner. Similarly, 60% females, 58% males strongly disagreed that mosquitoes could transmit HIV, while 57% males, 63% females strongly disagreed that one could get HIV by sharing food with an infected person. However, despite the high HIV/AIDS knowledge, awareness levels, HIV-associated stigma (18% males & 10% females), ignorance of effectiveness of condom in prevention (10% females & 7% males) still persisted. Essentially, if these drawbacks are not decisively dealt with, they will reverse the gains so far achieved in the HIV/AIDS response. These findings are important in informing stakeholders, policy makers such as work place HIV/AIDS policy makers in formulation, implementation, designing healthy behavioral change, HIV status awareness, stopping of new infections, distigmatisation and preventive strategies in workplaces. This will have a direct impact on HIV/AIDS management, prevention and thus help in attainment of the United Nations (UN) Sustainable Development Goal (SDG) number 3 on ensuring health for all, promoting well-being for all at all ages, 90-90-90 strategy and the Kenya's vision 2030 of a HIV free country.

Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is the leading cause of death among adolescents in Kenya according to National AIDS Control Council (NACC)

Cancer killed approximately 8.8 million people in 2015 globally. Furthermore, more than 27,000 Kenyans die annually from cancers, making it number three killers after infectious and cardiovascular diseases. The current therapeutic strategies are limited in their approach, therefore not effective enough to achieve complete remission. A radical multifactorial approach targeting early events in carcinogenesis is required. The purpose of this descriptive study was to review existing studies for knowledge, research gaps in the role of oxidative stress, inflammation, immune activation in carcinogenesis and cancer hallmarks, to stimulate new research ideas which can accelerate future therapeutic target discoveries. PubMed, ScienceDirect and Google scholar databases were searched using the keywords: cancer, oxidative stress, inflammation, immune activation, carcinogenesis and cancer hallmarks. Although widely recognized, little research on oxidative stress, inflammation, immune activation, as cancer therapeutic targets has been done. In addition, studies relating oxidative stress, inflammation, immune activation with cancer hallmarks, especially replicative immortality, immune evasion, and evading growth suppression are inadequate. To highlight this, out of a total of 8,680,095 hits, only 139,694 hits related to oxidative stress, inflammation, immune activation as therapeutic targets making this area a fertile ground for future research. Similarly, out of 271, 194 hits, only 4,595 were relating oxidative stress, inflammation and immune activation with replicative immortality as a cancer hallmark. Subsequently, after pearling, 129 articles that were directly relevant to the study were selected. After critical appraisal, identified studies were analyzed, results compared and presented in form of summary tables. Despite enough documented evidence of the essential role oxidative stress, inflammation, immune activation, plays in carcinogenesis, specific role in induction of cancer hallmarks, whether causal or consequence is not clear. An understanding of the early changes that marks initiation, maintenance and progression of cancer will accelerate development of future novel therapeutic targets and prevention strategies. This will have a direct impact on prevention, early diagnosis, management and treatment of cancers in Africa, thereby helping in attainment of United Nations sustainable development goal (SDG) number three.