Dietary supplement of fermented grass forage regulates growth performance, antioxidant capacity, and immune response of broiler chickens.

The current study aimed to determine the effects of different levels of fermented Juncao grass (FG) on growth parameters, blood constituents, immunity, and antioxidative properties of broilers. A total of 240 (21-d-old) broiler chicks were randomly distributed to four dietary treatments of sixty birds, with six replicate pens and ten birds in each. Fermented grass was added to the basal diet at four levels with 0, 5, 10, and 15% FG. The results revealed that broilers fed 5% FG had significantly higher (P < 0.05) final body weight (FBW), average daily gain (WG) and average daily feed intake (ADFI). The best conversion ratio (FCR) was recorded for broilers supplemented with 5% FG compared to the group supplemented with 15% FG (P < 0.05). Increasing FG % decreased (P < 0.05) anti-inflammatory cytokines IL-4, IL-6, and IL-10. However, FG increased (P < 0.05) proinflammatory cytokines IFN-γ, IL-1, IL-2, IL-12, and TNF-α (P < 0.05). Moreover, IgA, IgG, and IgM levels increased (P < 0.05) with increasing FG %. In addition, increasing FG % in broiler rations significantly increased (P < 0.05) serum antioxidant levels of T-AOC, GSH-PX, SOD, CAT, NO and GSH, but decreased (P < 0.05) MDA levels compared to the control group. Conclusively, fermented Juncao grass would be considered a novel herbal feed additive for improving broiler performance, immunity, antioxidant, and health status. Nevertheless, further research at the molecular level is needed to quantify the effects of these herbal components on cellular and humoral immune functions in broiler chickens.

Sheltered from the heat? How tents and shade covers may unintentionally increase air temperature exposures to unsheltered communities.

Objective: Heat vulnerability and homelessness are central public health concerns in cities globally, and public health implementation should address these two challenges in tandem to minimize preventable heat-related morbidity and mortality. Populations facing unsheltered homelessness use tents (or similar shelters) with shading features to minimize sun and heat exposure. This study evaluates the efficacy of different tent cover (shading) materials and how they moderate the in-tent air temperature (Tair) exposures of tent users during extreme summer conditions. Study design: Within-tent Tair monitoring using Kestrel Drop devices occurred across three full typical summer days in Phoenix, Arizona in July 2022. Methods: In-tent Tair were statistically compared between six small side-by-side identical tents with different cover materials (control (no cover), mylar, white bedsheet, tarp, sunbrella fabric, aluminum foil), as well as with ambient Tair. Results: Using any tent resulted in higher daytime in-tent Tair than ambient Tair. Further, compared to a control tent, the Tair within tents shaded with sunbrella, tarp, and white bedsheet had significantly higher Tair at all times (2.36 °C, 2.46 °C, and 1.11 °C higher Tair, respectively), controlling for Tair and day/night. Conclusion: Adding cover materials over tents may increase heat risk to an already vulnerable population at certain times of the day. Higher in-tent Tair is attributable to the reduced ability for heat and vapor to escape, largely due to reduced ventilation (mixing). Local authorities and welfare associations should reconsider using unventilated tents for shading and promote more widespread, ventilated tents and shade to ensure that prevention efforts do not further marginalize the most vulnerable. Future work should incorporate more comprehensive measurements of solar radiation to quantify overall heat stress for exposure reduction techniques.

Resilience of routine childhood immunization services in two counties in Kenya in the face of the COVID-19 pandemic.

The recently emerged coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide and disrupted health services. We describe the effect of the COVID-19 pandemic on utilization of childhood vaccination services during the pandemic. Using a mixed methods approach combining retrospective data review, a cross-sectional survey, focus group discussions among care givers and key informant interviews among nurses, we collected data between May and September 2021 in Mombasa and Nakuru counties. Overall, there was a <2 % decline in the number of vaccine doses administered during the pandemic period compared to the pre-pandemic period but this was statistically insignificant, both for the pentavalent-1 vaccine (ß = -0.013, p = 0.505) and the pentavalent-3 vaccine (ß = -0.012, p = 0.440). In government health facilities, there was 7.7 % reduction in the number of pentavalent-1 (ß = -0.08, p = 0.010) and 10.4 % reduction in the number of pentavalent-3 (ß = -0.11, p < 0.001) vaccine doses that were administered during the pandemic period. In non-government facilities, there was a 25.8 % increase in the number of pentavalent-1 (ß=0.23, p < 0.001) and 31.0 % increase in the number of pentavalent-3 (ß = -0.27, p < 0.001) vaccine doses that were administered facilities during the pandemic period. The strategies implemented to maintain immunization services during the pandemic period included providing messaging on the availability and importance of staying current with routine vaccination and conducting catch-up vaccinations and vaccination outreaches. Our findings suggest that the COVID-19 pandemic did not impact childhood vaccination services in Mombasa and Nakuru counties in Kenya. The private health facilities cushioned vaccination services against the effects of the pandemic and the strategies that were put in place by the ministry of health ensured continuation of vaccination services and encouraged uptake of the services during the pandemic period in the two counties in Kenya. These findings provide useful information to safeguard vaccination services during future pandemics.

Rhizosheath: An adaptive root trait to improve plant tolerance to phosphorus and water deficits?

Drought and nutrient limitations adversely affect crop yields, with below-ground traits enhancing crop production in these resource-poor environments. This review explores the interacting biological, chemical and physical factors that determine rhizosheath (soil adhering to the root system) development, and its influence on plant water uptake and phosphorus acquisition in dry soils. Identification of quantitative trait loci for rhizosheath development indicate it is genetically determined, but the microbial community also directly (polysaccharide exudation) and indirectly (altered root hair development) affect its extent. Plants with longer and denser root hairs had greater rhizosheath development and increased P uptake efficiency. Moreover, enhanced rhizosheath formation maintains contact at the root-soil interface thereby assisting water uptake from drying soil, consequently improving plant survival in droughted environments. Nevertheless, it can be difficult to determine if rhizosheath development is a cause or consequence of improved plant adaptation to dry and nutrient-depleted soils. Does rhizosheath development directly enhance plant water and phosphorus use, or do other tolerance mechanisms allow plants to invest more resources in rhizosheath development? Much more work is required on the interacting genetic, physical, biochemical and microbial mechanisms that determine rhizosheath development, to demonstrate that selection for rhizosheath development is a viable crop improvement strategy.

Metabolic properties, gene functions, and biosafety analysis reveal the action of three rhizospheric plant growth-promoting bacteria of Jujuncao (Pennisetum giganteum).

This study aimed to identify the specific genes associated with plant growth promotion and cadmium tolerance in three bacteria strains associated with Pennisetum giganteum as well as to determine their biosafety levels in their potential use as biofertilizers for promoting plant growth and phytoremediation activities. The plant growth-promoting (PGP) abilities of Enterobacter cloacae strain RCB980 (A3), Klebsiella pneumonia strain kpa (A4), and Klebsiella sp. strain XT-2 (A7) were determined by a growth promotion trial and through testing for PGP traits such as 1-aminocyclopropane-1-carboxylic acid (ACC) deaminase enzyme production, phosphorus solubilization, siderophore synthesis, and indole-3 acetic acid (IAA) production. The genes that potentially contribute to the beneficial activities of these three strains were identified through an analysis of their genomes. To establish the biosafety of the candidate PGPB, a pathological study was undertaken whereby 20 Kunming mice were injected intraperitoneally to study and analyze the effects of the strains on growth and lung paraffin sections of the mice. The strains had no obvious toxicity effect on the tested mice and were therefore not considered as highly virulent strains. These strains are thus considered non-toxic, safe, and highly recommended for use in environmental remediation strategies and agricultural production.

Weighting mechanics and the spatial pattern of composite metrics of heat vulnerability in Atlanta, Georgia, USA.

This study constructs two biophysical metrics; one based on Land Surface Temperatures (LST) and an integrated spectral index. The latter is an aggregate of Normalized Difference Vegetation Index (NDVI), Normalized Difference Bareness Index (NDBaI), Normalized Difference Water Index (NDWI), and Normalized Difference Built-up Index (NDBI). The goal is to determine how disparate weighting techniques, data transformation approaches, and spatial visualization pathways influence the computation of composite heat metrics. Using composite images made of aggregated images from late May to Early September within Google Earth Engine, we generated four composites by combining biophysical metrics with SoVI using equal and Eigen-based weightings informed by Principal Component Analysis (PCA). We compared equal interval classification, global and local Moran's as pathways for spatial visualization of hotspots. We utilized several data transformation techniques in a Geographic Information System (GIS), including rescaling, reclassification, zonal statistics, and spatial weighting. Mann Kendall and Sen's Slope detected and quantified monotonic trends in each spectral index. The results show that the LST biophysical metric and its composites indicate increased heat susceptibility over time, with disproportionately exposed core metro counties. The integrated spectral index and its proxies showed reduced vulnerability hence not a good proxy for LST. At the same time, the Mann Kendall and Sen's Slope found persistent increases in NDVI and NDWI and decreases in NDBI and NDBaI. However, opposite trends were evident in core city counties. The LST-based composites and spectral indices-based composites varied in the spatial-temporal distribution of hotspots. Disparate weighting mechanics, data transformation techniques, and visualization alternatives influence the magnitude and spatial-temporal distribution of heat hotspots.

Abscisic Acid Mediates Drought-Enhanced Rhizosheath Formation in Tomato.

The rhizosheath, commonly defined as soil adhering to the root surface, may confer drought tolerance in various crop species by enhancing access to water and nutrients under drying stress conditions. Since the role of phytohormones in establishing this trait remains largely unexplored, we investigated the role of ABA in rhizosheath formation of wild-type (WT) and ABA-deficient (notabilis, not) tomatoes. Both genotypes had similar rhizosheath weight, root length, and root ABA concentration in well-watered soil. Drying stress treatment decreased root length similarly in both genotypes, but substantially increased root ABA concentration and rhizosheath weight of WT plants, indicating an important role for ABA in rhizosheath formation. Neither genotype nor drying stress treatment affected root hair length, but drying stress treatment decreased root hair density of not. Under drying stress conditions, root hair length was positively correlated with rhizosheath weight in both genotypes, while root hair density was positively correlated with rhizosheath weight in well-watered not plants. Root transcriptome analysis revealed that drought stress increased the expression of ABA-responsive transcription factors, such as AP2-like ER TF, alongside other drought-regulatory genes associated with ABA (ABA 8'-hydroxylase and protein phosphatase 2C). Thus, root ABA status modulated the expression of specific gene expression pathways. Taken together, drought-induced rhizosheath enhancement was ABA-dependent, but independent of root hair length.

Phosphorus uptake is associated with the rhizosheath formation of mature cluster roots in white lupin under soil drying and phosphorus deficiency.

Phosphorus (P) deficiency largely restricts plant growth and lead to severe yield losses. Therefore, identification of novel root traits to improve P uptake is needed to circumvent yield losses. White lupin (Lupinus albus) is a legume crop that develops cluster roots and has the high phosphorus use efficiency in low P soils. We aimed to investigate the association between cluster roots (CR) rhizosheath formation and P uptake in white lupin. Rhizosheath formation and P concentration were evaluated under four soil treatments. CR increased up to 2.5-fold of overall plant dry weight under SD-P compared to WW + P (control), partly attributable to variations in CR development. Our data showed that SD-P significantly increase rhizosheath weight in white lupin. Among the root segments, MCR showed improved P accumulation in the root which is associated with increased MCR rhizosheath weight. Additionally, a positive correlation was observed between MCR rhizosheath weight and P uptake. Moreover, high sucrose content was recorded in MCR, which may contribute in CR growth under SD-P. Expression analysis of genes related to sucrose accumulation (LaSUC1, LaSUC5, and LaSUC9) and phosphorus uptake (LaSPX3, LaPHO1, and LaPHT1) exhibited peaked expression in MCR under SD-P. This indicate that root sucrose status may facilitate P uptake under P starvation. Together, the ability to enhance P uptake of white lupin is largely associated with MCR rhizosheath under SD-P. Our results showed that gene expression modulation of CR forming plant species, demonstrating that these novel root structures may play crucial role in P acquisition from the soil. Our findings could be implicated for developing P and water efficient crop via CR development in sustainable agriculture.

Mini review: Advances in understanding regulation of cellulase enzyme in white-rot basidiomycetes.

White-rot basidiomycetic fungi have gained a lot of scientific attention in recent years owing to their ability to produce cellulase enzymes that are of great importance in numerous industrial applications. This has seen a rise in number of studies seeking to comprehend both physical and molecular mechanisms that regulate the production of cellulase enzymes in these fungi. Cellulase has several applications in production of food and beverages, biofuel, biological detergents, pharmaceuticals, and deinking in paper and pulp industry. Enhanced understanding of genetic mechanisms that regulate cellulase production would have utility for optimal cellulase production in white-rot basidiomycetes using biotechnology approaches. Carbon catabolite repression and various transcriptional factors such as XlnR, Cre, Clr, Ace, and gna1 control expression of genes encoding cellobiohydrolase (CBH), endoglucanase (EGL) and ß-glucosidase (BGL). In this review, we have consolidated and summarised some of recent findings on genetic regulation of cellulase with an aim of highlighting the general regulatory mechanisms that underlie cellulase expressions in white-rot fungi. This review further outlines some of important transcription factors that regulate cellulase genes, and key research gaps that may need to be addressed by future research.

In Vitro Regeneration Potential of White Lupin (Lupinus albus) from Cotyledonary Nodes.

The tissue culture regeneration system of Lupinus albus has always been considered as recalcitrant material due to its genotype-dependent response and low regeneration efficiency that hamper the use of genetic engineering. Establishment of repeatable plant regeneration protocol is a prerequisite tool for successful application of genetic engineering. This aim of this study was to develop standardized, efficient protocol for successful shoot induction from cotyledonary node of white lupin. In this study, 5 day old aseptically cultured seedlings were used to prepare three explants (half cotyledonary node, HCN; whole cotyledonary node, WCN; and traditional cotyledonary node, TCN), cultured on four concentrations of M519 medium (M519, ½ M519, 1/3 M519, and » M519), containing four carbohydrate sources (sucrose, fructose, maltose, and glucose), and stimulated with various combinations of KT (kinetin), and NAA (naphthalene acetic acid) for direct shoot regeneration. High frequency of 80% shoot regeneration was obtained on ½ M519 medium (KT 4.0 mg L-1 + NAA 0.1 mg L-1) by using HCN as an explant. Interestingly, combinations of (KT 4.0 mg L-1 + NAA 0.1 mg L-1 + BAP 1.67 mg L-1), and (KT 2.0 mg L-1 + NAA 0.1 mg L-1) showed similar shoot regeneration frequency of 60%. Augmentation of 0.25 g L-1 activated charcoal (AC) not only reduced browning effect but also improved shoot elongation. Among the all carbohydrate sources, sucrose showed the highest regeneration frequency with HCN. Additionally, 80% rooting frequency was recorded on ½ M519 containing IAA 1.0 mg L-1 + KT 0.1 mg L-1 (indole acetic acid) after 28 days of culturing. The present study describes establishment of an efficient and successful protocol for direct plant regeneration of white lupin from different cotyledonary nodes.

Female Genital Mutilation/Cutting: Innovative Training Approach for Nurse-Midwives in High Prevalent Settings.

BACKGROUND: Female genital mutilation/cutting (FGM/C) has no medical benefits and is associated with serious health complications. FGM/C including medicalization is illegal in Kenya. Capacity building for nurse-midwives to manage and prevent FGM/C is therefore critical. OBJECTIVE: Determine the current FGM/C knowledge and effect of training among nurse-midwives using an electronic tool derived from a paper-based quiz on FGM/C among nurse-midwives. METHODS: Nurse-midwives (n=26) were assessed pre- and post-FGM/C training using a quiz comprising 12 questions. The quiz assessed the following factors: definition, classification, determining factors, epidemiology, medicalization, prevention, health consequences, and nurse-midwives' roles in FGM/C prevention themes. The scores for individuals and all the questions were computed and compared using SPSS V22. RESULTS: The mean scores for the quiz were 64.8%, improving to 96.2% p < 0.05 after training. Before the training, the following proportions of participants correctly answered questions demonstrating their knowledge of types of cutting (84.6%), link with health problems (96.2%), FGM/C-related complications (96.2%), communities that practice FGM/C (61.5%), medicalization (43.6%), reinfibulation (46.2%), dissociation from religion (46.2%), and the law as it relates to FGM/C (46.2%). The participants demonstrated knowledge of FGM/C-related complications with the proportion of nurse-midwives correctly answering questions relating to physical impact (69.2%), psychological impact (69.2%), sexual impact (57.7%), and social impact (38.5%). Additionally, participant awareness of NM roles in managing FGM/C included the following: knowledge of the nurse-midwife as counselor (69.2%), advocate (80.8%), leader (26.9%), role model (42.3%), and caregiver (34.6%). These scores improved significantly after training. CONCLUSION: Substantial FGM/C-related knowledge was demonstrated by nurse-midwives. They, however, showed challenges in preventing/rejecting medicalization of FGM/C, and there were knowledge gaps concerning sexual and social complications, as well as the specific roles of NM. This underscores the need to implement innovative FGM/C training interventions to empower health professionals to better respond to its management and prevention.

Microstructured FBG hydrogen sensor based on Pt-loaded WO3.

Hydrogen gas sensing properties of Pt-WO3 films on spiral microstructured fiber Bragg grating (FBG) has been demonstrated. Pt-WO3 film was prepared by hydrothermal method. The spiral microsturctured FBG was fabricated using femtosecond laser. Spiral microstructure FBG hydrogen sensor can detect hydrogen concentration from 0.02% H2 to 4% H2 at room temperature, and the response time is shortened from a few minutes to 10~30 s. Double spiral microstructure at pitch 60 µm and sputtered with 2 µm Pt-WO3 film recorded hydrogen sensitivity of 522 pm/%(v/v) H2 responding to hydrogen gas in air. This translated to approximately 2~4 times higher than the unprocessed standard FBG. The humidity has little effect on the sensing property. The sensor has fast response time, good stability, large detection range and has the good prospect of practical application for hydrogen leak detection.

A Low Frequency FBG Accelerometer with Symmetrical Bended Spring Plates.

To meet the requirements for low-frequency vibration monitoring, a new type of FBG (fiber Bragg grating) accelerometer with a bended spring plate is proposed. Two symmetrical bended spring plates are used as elastic elements, which drive the FBG to produce axial strains equal in magnitude but opposite in direction when exciting vibrations exist, leading to doubling the wavelength shift of the FBG. The mechanics model and a numerical method are presented in this paper, with which the influence of the structural parameters on the sensitivity and the eigenfrequency are discussed. The test results show that the sensitivity of the accelerometer is more than 1000 pm/g when the frequency is within the 0.7-20 Hz range.

Micro-structured femtosecond laser assisted FBG hydrogen sensor.

We discuss hydrogen sensors based on fiber Bragg gratings (FBGs) micro-machined by femtosecond laser to form microgrooves and sputtered with Pd/Ag composite film. The atomic ratio of the two metals is controlled at Pd:Ag = 3:1. At room temperature, the hydrogen sensitivity of the sensor probe micro-machined by 75 mW laser power and sputtered with 520 nm of Pd/Ag film is 16.5 pm/%H. Comparably, the standard FBG hydrogen sensitivity becomes 2.5 pm/%H towards the same 4% hydrogen concentration. At an ambient temperature of 35°C, the processed sensor head has a dramatic rise in hydrogen sensitivity. Besides, the sensor shows good response and repeatability during hydrogen concentration test.

Factors influencing uptake of contraceptive implants in the immediate postpartum period among HIV infected and uninfected women at two Kenyan District Hospitals.

BACKGROUND: Family planning is a cost effective strategy for prevention of mother to child transmission of HIV and reduction of maternal/infant morbidity and mortality. Contraceptive implants are a safe, effective, long term and reversible family planning method whose use remains low in Kenya. We therefore set out to determine and compare the uptake, and factors influencing uptake of immediate postpartum contraceptive implants among HIV infected and uninfected women at two hospitals in Kenya. METHODS: This cross sectional study targeted postpartum mothers at two Kenyan district hospitals (one urban and one rural). All participants received general family planning and method specific (Implant) counseling followed by immediate insertion of contraceptive implants to those who consented. The data was analyzed by descriptive analysis, T-test, Chi square tests and logistic regression. RESULTS: One hundred eighty-five participants were enrolled (91 HIV positive and 94 HIV negative) with a mean age of 26 years. HIV positive mothers were significantly older (27.5 years) than their HIV negative counterparts (24.5 years), P = 0.001. The two groups were comparable in education, employment, marital status and religious affiliation. Overall, the uptake of contraceptive implants in the immediate postpartum period was 50.3% and higher among HIV negative than HIV positive participants (57% vs. 43%, P = 0.046). Multivariate analysis revealed that a negative HIV status (P = 0.017) and prior knowledge of contraceptive implants (P = 0.001) were independently associated with increased uptake of contraceptive implants. CONCLUSION: There was a high uptake of immediate postpartum contraceptive implants among both HIV infected and un-infected women; efforts therefore need to be made in promoting this method of family planning in Kenya and providing this method to women in the immediate postpartum period so as to utilize this critical opportunity to increase uptake and reduce the high unmet need for family planning.

Medium-high frequency FBG accelerometer with integrative matrix structure.

To meet the requirements for medium-high frequency vibration monitoring, a new type fiber Bragg grating (FBG) accelerometer with an integrative matrix structure is proposed. Two symmetrical flexible gemels are used as elastic elements, which drive respective inertial mass moving reversely when exciting vibration exists, leading to doubling the wavelength shift of the FBG. The mechanics model and a numerical method are presented in this paper, by which the influence of the structural parameters on the sensitivity and eigenfrequency is discussed. Sensitivity higher than 200 pm/g and an eigenfrequency larger than 3000 Hz can be realized separately, but both cannot be achieved simultaneously. Aiming for a broader measuring frequency range, a prototype accelerometer with an eigenfrequency near 3000 Hz is designed, and results from a shake table test are also demonstrated.

Study protocol for promoting respectful maternity care initiative to assess, measure and design interventions to reduce disrespect and abuse during childbirth in Kenya.

BACKGROUND: Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population. METHODS/DESIGN: A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors. DISCUSSION: This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale.

Goals and activities proposed by countries in seven regions of the world toward prevention of unsafe abortion.

This article describes the goals and activities included in the national plans of action for the prevention of unsafe abortion. With broad variability, all were in line with the initiative's purpose of contributing to reduce the number of women who have unplanned pregnancies and induced abortions, as well as the maternal mortality and morbidity associated with unsafe abortion. The interventions proposed can be classified in 5 groups: (1) to work toward better national policies through obtaining and disseminating accurate evidence-based data on abortion and to sensitize policy makers and health professionals on issues pertaining to unsafe abortion; (2) to reduce the number of unplanned/unwanted pregnancies by increasing the use of modern contraceptive methods, introducing or improving sex education, and improving adolescent-friendly reproductive health services; (3) to make induced abortion safer by making adequate abortion services available, within the full extent of the national laws, and promoting access to safe abortion; (4) to improve postabortion care, including postabortion contraception; and (5) to reduce the need to resort to abortion by working on facilitating the process of adoption. The proportions of plans that include each of these interventions are described, as well as some regional differences.

Comparative acceptability of combined and progestin-only injectable contraceptives in Kenya.

OBJECTIVE: We compared 12-month continuation rates, menstrual bleeding patterns and other aspects of acceptability between users of Cyclofem and users of Depo-Provera. METHODS: The life-table method was used to calculate quarterly continuation rates. In all, 360 Kenyan women were randomly assigned to one of the two contraceptives. User-satisfaction questionnaires were administered at 6 and 12 months or at discontinuation, whichever occurred first. RESULTS: The 1-year continuation rate was 75.4% for Depo-Provera users versus 56.5% for Cyclofem users (p<.001). Main reasons for discontinuation included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for Depo-Provera), menstrual changes (14.1% vs. 12.5%) and nonmenstrual problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of the Cyclofem users claimed frequency of visits as the main reason for discontinuation. In all, 70.6% of the Depo-Provera users were amenorrheic after 12 months, as were 20.8% of the Cyclofem users. CONCLUSIONS: The 1-year continuation rate was higher for Depo-Provera than for Cyclofem. There was no important difference in discontinuation rates because of menstrual problems; the difference mainly reflected the frequency of visits required.