Profile of the female athlete triad among elite Kenyan endurance athletes and non-athletes

Women participating in endurance sports are at risk of presenting with low energy availability (EA), menstrual dysfunction (MD), and low bone mineral density (BMD), collectively termed the female athlete triad (FAT or TRIAD). Therefore, the purpose of the study was to determine the profile of the TRIAD among elite Kenyan female athletes and among non-athletes. There were 39 participants (athletes: 25, non-athletes:14) who provided the data for this study. Exercise energy expenditure (EEE) was deducted from energy intake (EI), and the remnant energy normalized to fat free mass (FFM) to determine energy availability (EA). Weight of all food and liquid consumed during three consecutive days determined EI. EEE was determined after isolating and deducting energy expended in exercise or physical activity above lifestyle from the total energy expenditure output as measured by Actigraph GT3X+. Dual energy x-ray absorptiometry (DXA) determined both FFM and BMD. Menstrual function was determined from a daily temperature-menstrual log kept by each participant for nine continuous months. Low EA (<45 kcal/kgFFM.d-1) was evident in 61.53% of the participants (athletes: 28.07 ±11.45 kcal/kgFFM.d-1, non-athletes: 56.97 ±21.38 kcal/kgFFM.d-1). The overall 36% MD seen among all participants was distributed as 40% among the athletes, and 29% among non-athletes. None of the athletes was amenorrheic. Low BMD was seen in 79% of the participants (athletes: 76%, non-athletes:86%). Overall, 10% of the participants (athletes: 4, non-athletes: 0) showed simultaneous presence of all three components of the TRIAD. The Independent sample t-test showed significant difference (t=5.860; p< 0.001) in prevalence of the TRIAD between athletes and non-athletes. The hypothesized higher prevalence of the TRIAD among athletes compared to non-athletes was partially accepted. To alleviate conditions arising from low EA, both athletes and their coaches need regular education on how to ensure they adequately meet specific dietary and nutritional requirements for their competition events

Association between energy availability and menstrual function in elite Kenyan runners

Low energy availability (EA) has been recognized as an instigator of menstrual dysfunction and subsequent hypoestrogenism that leads to deterioration in bone health. Elite Kenyan male athletes have been reported to often function under low energy balance. Therefore, the purpose of this study was to determine EA and menstrual function (MF) among elite Kenyan female athletes; and to explore the association between EA and MF in the athletes. The data were collected from 25 elite Kenyan runners and 14 non-athletes. Energy intake (EI) minus exercise energy expenditure (EEE) normalized to fat free mass (FFM) determined EA. EI was determined through weight of all food and liquid consumed over three consecutive days. EEE was determined after isolating and deducting energy expended in exercise or physical activity above lifestyle level from the total energy expenditure output as measured by Actigraph GT3X+. FFM was assessed using DXA. A daily temperature-menstrual log kept for nine continuous months was used to establish menstrual function. Overall, EA below 45 kcal/kgFFM.d-1 was seen in 61.53% of the participants (athletes: 28.07 ±11.45 kcal/kgFFM.d-1, non-athletes:56.97 ±21.38 kcal/kgFFM.d-1). Results on menstrual dysfunction were as follows: oligomenorrhea (athletes: 40%; non-athletes: 14.3%) and amenorrhea (non-athletes: 14.3%). None of the athletes were amenorrheic. Results did not show any significant association between EA and MF, but the low to sub-optimal EA among elite Kenyan female athletes raises concern for their future menstrual and bone health. . Educating the athletes and coaches will enhance achievement of the specific dietary and nutritional needs appropriate to their competition events

Factors Underlying Taking a Child to HIV Care: Implications for Reducing Loss to Follow-up among HIV-Infected and Exposed Children

Objective: With the aim of reducing pediatric loss to follow-up (LTFU) from HIV clinical care programs in sub-Saharan Africa; we sought to understand the personal and socio-cultural factors associated with the behavior of caregivers taking HIV-infected and -exposed children for care in western Kenya.Methods: Between Mayand August; 2010; in-depth interviews were conducted with 26 purposively sampled caregivers caring for HIVinfected(7); HIV-exposed (17) and HIV-unknown status (2) children; documented as LTFU from an urban and rural HIV care clinic. All were women with a majority (77) being biological parents. Interviews were audio-recorded; transcribed and content analyzed.Results: Thematic content analysis of the women's perceptions revealed that their decision about routinely taking their children to HIV care involved multiple levels of factors including: (1) intrapersonal: transport costs; food availability; time constraints due to work commitment; disclosure of HIV status for both mother and child; perception that child is healthy and religious beliefs; (2) interpersonal: unsupportive male partner; stigma by the family and family conflicts; (3) community: cultural norms; changing community dynamics and perceived stigma; (4) health care system: clinic location; lack of patient-centered care; delays at the clinic and different appointment schedules (mother and child). Furthermore; the factors across these different levels interacted with each other in a complex way; illustrating the challenges women face in taking their children to HIV care.Conclusion: The complexity and interconnectedness of the factors underlying retention of children in HIV care perceived by these women caregivers suggests that interventions to reduce pediatric LTFU need to be holistic and address multiple socio-ecological levels. Patient-centered care that integrates a family-centered approach to HIV pediatric care is recommended

Cellular immunity to Echinococcus granulosus cysts

A fundamental feature of Echinococcus granulosus infection is its chronicity. There are many reasons for this; including weak natural immunity and the ability of the larval stages to evade or resist elimination by the hosts' specific immune responses. To identify the types of hosts' cellular immune response; a series of ultrastructral studies of hydatid cysts surgically removed from Turkana patients was conducted based on transmission electron microscopy. Ultrastructurally; the ectocyst (adventitial layer) is organised into three layers; an inner layer containing mainly the infiltrating mononuclear leukocytes; a middle; loose connective tissue layer with inflammatory cells mainly plasma cells; fibroblasts; scant neutrophils; eosinophils and lymphocytes; and an outer loose connective tissue layer that blends with the surrounding host tissue. The mast cells and basophils were not observed. This study has showm that the adventitial layer of hydatid cysts infiltrated by leukocytes; principally by macrophages and plasma cells