Kenyan Population Research Articles

Anthropometric measures and their association with risk factors for cardio-metabolic diseases in Kenyan adults

Background: The prevalence of cardio-metabolic diseases (CMD) is drastically increasing worldwide. Anthropometric measures of fat accumulation are correlated with CMD and Metabolic Syndrome (MS), but few studies have addressed this association in sub-Saharan African populations.Aim: To investigate the association between anthropometric features, MS and other CMD risk factors in a population from Kenya.Subjects and methods: In this cross-sectional study including 1405 Kenyans, anthropometric measurements including visceral adipose tissue (VAT) and abdominal subcutaneous adipose tissue (SAT) were carried out. Fasting blood glucose and standard oral glucose tolerance test, fasting serum insulin and plasma lipids were analysed. Homeostatic model assessment of insulin resistance was calculated. Systolic and diastolic blood pressures were measured.Results: CMD risk factors and MS were associated with all anthropometric features, except for high-density lipoprotein cholesterol levels (p < 0.05). The strongest association between MS and anthropometrics was seen with SAT (β = 1.45 ± 0.32 in men and 0.88 ± 0.14 in women, both p < 0.05).Conclusions: Anthropometric measures, especially features of central obesity such as VAT and SAT, are relevant indicators of cardio-metabolic health in Kenyan populations. SAT is the strongest predictor of MS. These results highlight the need for further research on the pathological implication of VAT and SAT, in order to understand patterns of fat distribution and cardio-metabolic health among different ethnic groups.

Energy Poverty and Its Implication on Standard of Living in Kirinyaga, Kenya

Energy poverty affects physical health, well-being, and ability to prosper. A large proportion of Kenyan population lack access to electricity because they are located far from the national grid where it is uneconomical to extend electricity. This paper assesses energy poverty situation in Kirinyaga and reviews its implication on standard of living. Kirinyaga is a rural county with the main economic activity being agriculture and a few agroprocessing factories. Most rural households in Kirinyaga rely on fuel wood to meet their basic energy requirements and lack access to electricity. Tea factories and educational institutions rely on fuel wood to minimize cost of electricity. Kirinyaga residents, therefore, experience energy poverty as indicated by low electricity access and reliance on traditional cooking fuels. Energy poverty in Kirinyaga has negative impact on indicators of standards of living, calorific intake, life expectancy, and literacy levels.

Patterns of non-communicable disease and injury risk factors in Kenyan adult population: a cluster analysis

BackgroundNon-communicable diseases and unintentional injuries are emerging public health problems in sub-Saharan Africa. These threats have multiple risk factors with complex interactions. Though some studies have explored the magnitude and distribution of those risk factors in many populations in Kenya, an exploration of segmentation of population at a national level by risk profile, which is crucial for a differentiated approach, is currently lacking. The aim of this study was to examine patterns of non-communicable disease and injury risk through the identification of clusters and investigation of correlates of those clusters among Kenyan adult population.MethodsWe used data from the 2015 STEPs survey of non-communicable disease risk factors conducted among 4484 adults aged between 18 and 69 years in Kenya. A total of 12 risk factors for NCDs and 9 factors for injury were used as clustering variables. A K-medians Cluster Analysis was applied. We used matching as the measure of the similarity/dissimilarity among the clustering variables. While clusters were described using the risk factors, the predictors of the clustering were investigated using multinomial logistic regression.ResultsWe have identified five clusters for NCDs and four clusters for injury based on the risk profile of the population. The NCD risk clusters were labelled as cluster hypertensives, harmful users, the hopefuls, the obese, and the fat lovers. The injury risk clusters were labelled as helmet users, jaywalkers, the defiant and the compliant. Among the possible predictors of clustering, age, gender, education and wealth index came out as strong predictors of the cluster variables.ConclusionThis cluster analysis has identified important clusters of adult Kenyan population for non-communicable disease and injury risk profiles. Risk reduction interventions could consider these clusters as potential target in the development and segmentation of a differentiated approach.

Modelling Diabetes Mellitus among Adult Kenyan Population Using Artificial Neural Network

Artificial Neural Network (ANN) is a parallel connection of a set of nodes called neurons which mimic biological neural system. Statistically, ANN represents a class of non-parametric models which is capable of approximating a non-linear function by a composition of low dimensional ridge functions. This study aimed at modeling diabetes mellitus among adult Kenyan population using 2015 stepwise survey data from Kenya National Bureau of Statistics. Data analysis was carried out using R statistical software version 3.5.0. Among the input variables Age, Sex, Alcoholic status, Sugar consumption, Physical Inactivity, Obesity status, Systolic and Diastolic blood pressure had a significant relationship with diabetic status at 5% level of significance. A multi layered feed-forward neural network with a back propagation algorithm and a logistic activation function was used. Considering a parsimonious model, the model selected had the eight input variables with two neurons in the hidden layer since it gave a minimum MSE of 0.0580 reported. 75% of data was used for training while 25% was used for testing. The sensitivity of the trained network was reported as 75% while specificity was 94.29%. The overall accuracy of the model was 84.64% . This implied that the model could correctly classify an individual as either diabetic or not with an accuracy rate of 84.64%. A 10-fold cross validation was carried out and an average MSE of 0.0686 reported. Kolmogorov-Smirnov test of normality was carried out and at 5% level of significance, for most parameter estimates, we failed to reject the null hypothesis and concluded that the network parameter estimates were asymptotically normal and consistent. With a good choice of risk factors for diabetes, neural network structures could be successfully used to accurately model diabetes melitus among Kenyan adult population.

Complex Contagions and the Diffusion of Innovations: Evidence from a Small-N Study

The recent literature on “complex contagions” challenges Granovetter’s classic hypothesis on the strength of weak ties and argues that, when the actors’ choice requires reinforcement from several sources, it is the structure of strong ties that really matters to sustain rapid and wide diffusion. The paper contributes to this debate by reporting on a small-N study that relies on a unique combination of ethnographic data, social network analysis, and computational models. In particular, we investigate two rural populations of Indian and Kenyan potters who have to decide whether to adopt new, objectively more efficient and economically more attractive, technical/stylistic options. Qualitative field data show that religious sub-communities within the Indian and Kenyan populations exhibit markedly different diffusion rates and speed over the last thirty years. To account for these differences, we first analyze empirically observed kinship networks and advice networks, and, then, we recreate the actual aggregate diffusion curves through a series of empirically calibrated agent-based simulations. Combining the two methods, we show that, while single exposure through heterophilious weak ties were sufficient to initiate the diffusion process, large bridges made of strong ties can in fact lead to faster or slower diffusion depending on the type of signals circulating in the network. We conclude that, even in presence of “complex contagions,” dense local ties cannot be regarded as a sufficient condition for faster diffusion.

Kenya National Hospital Insurance Fund Reforms: Implications and Lessons for Universal Health Coverage

This article identifies and describes the reforms undertaken by the National Hospital Insurance Fund (NHIF) and examines their implications for Kenya’s quest to achieve universal health coverage (UHC). We undertook a review of published and grey literature to identify key reforms that had been implemented by the NHIF since 2010. We examined the reforms undertaken by the NHIF using a health financing evaluation framework that considers the feasibility, equity, efficiency, and sustainability of health financing mechanisms. We found the following NHIF reforms: (1) the introduction of the Civil Servants Scheme (CSS), (2) the introduction of a stepwise quality improvement system, (3) the health insurance subsidy for the poor (HISP), (4) revision of monthly contribution rates and expansion of the benefit package, and (5) the upward revision of provider reimbursement rates. Though there are improvements in several areas, these reforms raise equity, efficiency, feasibility, and sustainability concerns. The article concludes that though NHIF reforms in Kenya are well intentioned and there has been improvement in several areas, design attributes could compromise the extent to which they achieve their intended goal of providing universal financing risk protection to the Kenyan population.

Factor analysis of the Clinical Outcomes in Routine Evaluation \u2013 Outcome Measures (CORE-OM) in a Kenyan sample

BackgroundThere is no generic psychotherapy outcome measure validated for Kenyan populations. The objective of this study was to test the acceptability and factor structure of the Clinical Outcomes in Routine Evaluation – Outcome Measure in patients attending psychiatric clinics at two state-owned hospitals in Nairobi.MethodsThree hundred and forty-five patients filled out the CORE-OM after their initial therapy session. Confirmatory and Exploratory Factor Analysis (CFA/EFA) were used to study the factor structure of the CORE-OM.ResultsThe English version of the CORE-OM seemed acceptable and understandable to psychiatric patients seeking treatment at the state-owned hospitals in Nairobi. Factor analyses showed that a model with a general distress factor, a risk factor, and a method factor for positively framed items fit the data best according to both CFA and EFA analysis. Coefficient Omega Hierarchical showed that the general distress factor was reliably measured even if differential responding to positively framed items was regarded as error variance.ConclusionsThe English language version of the CORE-OM can be used with psychiatric patients attending psychiatric treatment in Nairobi. The factor structure was more or less the same as has been shown in previous studies. The most important limitation is the relatively small sample size.

Prevalence of aortic arch anatomical branching variants in Kenyan population as shown on contrast enhanced chest multidetector computed tomography

Background: The objective of the study was to determine the prevalence of aortic arch(AA) anatomical branching variants present in Kenyan population as shown on a chest contrast-enhanced multidetector computed tomography (MDCT). Methods: The study design was a prospective cross-sectional study carried out in 6 months (between May and November 2016) at the Kenyatta National Hospital(KNH) department of Radiology. Participants were recruited amongst patients referred for a chest contrast enhanced MDCT. Acquired data was subjected to volume rendering technique (VRT) and multiplanar reconstruction (MPR) software to define the anatomy of the AA. The type of AA branching classification used was one derived by Natsis et al. Data analysis involved calculating frequency distributions of AA variations using Statistical Package for Social Sciences version 21 software. Results: One hundred and eighty-five subjects (86 males and 99 females) were recruited. Ninety-five participants had classical AA Natsis type I. Ninety participants had non-classical variant AA of which 83 participants had Natsis type II while 2 patients had Natsis type III. The remaining 3 had a variant AA not found in the Natsis study. Conclusions: Variations in the branching pattern of AA are very common in Kenya with the most common being Natsis type II. Keywords: aortic arch; anatomical variants; branching variation; chest multidetector computed tomography

Fusion of the Medial Clavicular Epiphysis in the South African and Kenyan Populations

Fusion of the Medial Clavicular Epiphysis in the South African and Kenyan Populations

Seroprevalence of Equine Herpesviruses 1 and 9 (EHV-1 and EHV-9) in Wild Grévy's Zebra ( Equus grevyi) in Kenya.

Equid herpesviruses types 1 (EHV-1) and 9 (EHV-9) are unusual among herpesviruses in that they lack strong host specificity, and the full extent of their host range remains unclear. The virus establishes latency for long periods and can be reactivated and shed, resulting in clinical disease in susceptible species. A sensitive and specific peptide-based enzyme-linked immunosorbent assay was developed to study the seroprevalence of both viruses in a broad range of species among both wild and captive populations. We used this assay to study the seroprevalences of EHV-1 and EHV-9 in a natural population of the highly endangered Grévy's zebra ( Equus grevyi) in Kenya, sampled during a 4-yr period (2012-15). The results were compared with those obtained from captive Grévy's zebras from a previous study. The wild population had a significantly higher seroprevalence of EHV-9 compared with the captive population, suggesting that captivity might reduce exposure to this serotype. In contrast, the seroprevalences of EHV-1 between captive and wild groups was not significantly different. The seroprevalence of EHV-9 was not significantly higher than EHV-1 in zebras within the wild Kenyan population.

Reference values for body composition and associations with blood pressure in Kenyan adults aged \u226550 years old

Background/objectivesTo develop age- and sex-specific centile reference curves for fat-free mass (FFM) and fat mass (FM) adjusted for height in an adult Kenyan population and to investigate the association between FM, FFM and blood pressure (BP).Subjects/methodsMeasures of body composition from bioimpedance analyses and BP were collected in 1995 participants aged ≥50 years in Nakuru County, Kenya. Reference curves were produced using the LMS method. Multivariable linear regression models were used to test the cross-sectional association between body composition indexes and BP.ResultsThe age- and sex-specific reference curves for body composition (FMI and FFMI) confirmed that FFMI is lower in both men and women with increasing age. FMI declines with age in women while among men the decline starts after 70 years. FFM was higher in men (47.4 ± 7.2 kg) than in women (38.8 ± 5.5 kg), while FM was lower in men (17.3 ± 8.1 kg) than in women (24.4 ± 10.2 kg). FMI, FFMI and BMI were all positively associated with systolic and diastolic BP, and after adjusting for body weight, FFMI remained positively associated with systolic BP and the FMI remained positively associated with diastolic BP. There was no evidence to suggest that FMI and FFMI were superior to measurement of BMI alone.ConclusionsThese body composition reference curves provide normative data on body composition for older adults in Kenya. Further research should consider the prospective associations with health, including frailty-related outcomes.

The Prevalence of Hepatitis C Virus Antibody in HIV-Negative Persons in Kenya, 2007.

The prevalence of hepatitis C virus (HCV) infection in the Kenyan population has not been previously determined. We estimated the Kenyan HCV prevalence in HIV-negative persons aged 15-64 years. This is a retrospective cross-sectional study using data from the 2007 Kenya AIDS Indicator Survey-a nationally representative sample of 15,853 persons aged 15-64 years who completed a health interview and provided a blood specimen. Of the 1,091 randomly selected participants, 50 tested positive for HCV antibody using the automated chemiluminescence immunoassay, corresponding to a weighted HCV antibody positivity rate of 4.4% (95% confidence interval: 3.3-5.9%) or 848,000 (range: 634,000-1,100,000) persons. Hepatitis C virus RNA, a marker for current infection, was not detected in any of the tested antibody-positive specimens. The high HCV antibody prevalence together with no current infection suggests that some HCV antibody serologic testing in Kenya may result in false positives whereas others may be because of spontaneous viral clearance.

Morphology of the Left Atrial Appendage: Prevalence and Gender Difference in a Kenyan Population

Introduction The left atrial appendage is the site of origin of thrombi in 90% of cardioembolic stroke. Although literature reports a higher risk of cardioembolic stroke among blacks and females, it is unclear whether this is due to preponderance of specific left atrial appendage morphologies in these groups since there is paucity of data. This study describes the left atrial appendage morphology in a Black Kenyan population and assesses for existence of gender differences. Materials and Methods Ninety one (91) human hearts (50 male and 41 female) were obtained from autopsy specimens after ethical approval. The morphological types of the left atrial appendage were determined and classified as cauliflower, Windsock, Chickenwing and cactus. Data were analyzed using Statistical Package for Social Sciences. The frequencies of the morphological types was determined and Chi square applied to check for gender differences. A p-value of &lt; 0.05 was considered statistically significant at 95% confidence interval. Results and Conclusion There were 27 cauliflower (29.7%), 26 Windsock (28.6%), 25 Chickenwing (27.4%) and 9 cactus (14.3%) morphological types of left atrial appendage. Cauliflower and cactus types were more prevalent in males, while Windsock and Chickenwing types were more prevalent in females (p = 0.537). There are no statistically significant gender differences in the left atrial appendage morphology types in this sample black Kenyan population. The higher frequency of both the risky cauliflower and the protective Chickenwing morphologies warrants assessment of left atrial appendage morphological types in management of high risk cardioembolic stroke patients in this setting.

Variations in the attachments of the medial meniscal anterior horn: a descriptive cadaveric study.

Meniscal tears are common in Kenya, with prevalence rates ranging from 45 to 78% of intracapsular knee pathology. Diagnosis of these injuries relies on the use of both clinical signs and symptoms as well as radiological investigations. In a few instances, radiological detection could be difficult, partly because of variant attachment patterns of the medial meniscal anterior horn. Some of these unusual attachments of the anterior horn of the medial meniscus could even be mistaken for meniscal tears. There is also evidence that these variations differ from population to population. This study, therefore, aimed to determine the variant bony and ligamentous attachments of the medial meniscal anterior horn in a sample Kenyan population. The study was conducted at the Department of Human Anatomy, University of Nairobi. Thirty-one male and female unpaired medial menisci were obtained from cadaveric specimen. The bony and ligamentous attachments were identified and recorded and photomacrographs taken. The bony attachments different from the classical textbook attachment accounted for 54.8% of the medial meniscal anterior horns. The anterior intermeniscal ligament was present in 62.3% while 16.2% showed attachment to the anterior cruciate ligament. Twenty-nine percent (29%) of the medial menisci studied did not have any ligamentous attachments. The bony and ligamentous attachments of the medial meniscal anterior horn are highly variable presenting unique diagnostic and therapeutic challenges. A new classification of ligamentous attachments is thus proposed.

Validation of spirometry prediction equations in western Kenya.

Community of Eldoret, Kenya. To test the performance of three commonly used spirometry prediction equations in a healthy Kenyan population. Cross-sectional assessment of healthy adults in Eldoret. Of the 331 subjects enrolled in the study, 282 subjects aged 18-85 years (45% males, 55% females) produced high-quality spirograms. Lung function predictions were made using the Global Lung Initiative 2012 (GLI 2012) prediction equations for African Americans, the National Health and Nutrition Examination Survey III (NHANES III) prediction equations for African Americans, and the Crapo prediction equation. Bland-Altman analyses were performed to measure the agreement between observed and predicted spirometry parameters. Overall, the GLI 2012 and NHANES equations for African Americans performed similarly for forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), significantly overestimating FVC while accurately predicting observed FEV1 values. The study brings into question the utility of three major spirometry prediction equations in a Kenyan population. The significant overestimation of FVC by the best-performing equations despite accurate prediction of FEV1 suggests poor performance of these equations in our population.

An Anatomic Study of the Facial Nerve Trunk and Branching Pattern in an African Population

There are known racial variations in the branching and furcation pattern and the length of the facial nerve (FN) trunk and hardly any studies from the black African population. Surgeries around the FN predispose it to trauma and warrant a detailed anatomy of its branching pattern. Using a descriptive cross-sectional study, a total of 40 FN (20 fresh cadavers) were dissected to record the pattern and length of the FN. The frequency of various patterns of FN using the Davis et al classification was as follows: type I: 10 (25%), type II: 9 (22.5%), type III: 7 (17.5%), type IV: 6 (15%), type V: 2 (5%), and type VI: 6 (15%). The nerve bifurcated in 32(80%) and trifurcated in 8(20%) of the cadavers. There was no statistical difference in the branching patterns ( p = 0.509) and furcation types ( p = 0.414) between the sides and gender. The length of the trunk of the FN measured from the stylomastoid foramen to the bifurcation point was 16.14(−/+ 3.28 mm). The results from this data established a variation in the anatomical branching pattern of the FN in a black Kenyan population.

Efficacy of nutrition counselling on energy and micronutrient intake of pregnant women in Migori County, Kenya

A large number of pregnant women in many parts of the world enter pregnancy at sub-optimal weight. More than 60% of Kenyan population suffers from food insecurity.&nbsp; The result is malnutrition which primarily affects pregnant women and children and significantly contributes to their morbidity and mortality.&nbsp; Maternal nutrition is critical for both mother and child as it lays fundamental foundation for the successful outcome of pregnancy. This study sought to assess changes in energy and selected micronutrient intakes after nutrition counselling among pregnant women in Migori County.&nbsp; A Prospective Cohort study design was used and simple random sampling was used to recruit a sample of 150 pregnant women who were enrolled into a nutrition counselling programme.&nbsp; Data was collected by 24 hour recall and food frequency and analyzed by Nutri-Survey computer package and SPSS Analysis Software. Relationships between variables were tested by t-tests.&nbsp; Generally, there was improved dietary intake of all nutrients after counselling although some did not meet the RDA even after counselling. 4.4% and 20.9% of the women had intakes above RDA for energy, at baseline and after counselling respectively, 62.5% and 84.3% had intakes above RDA for protein at baseline and after counselling respectively.&nbsp; Carbohydrate intake had 93.9% within or above RDA at baseline while all met the RDA after counselling. 61.2% and 77.4% were able to meet the RDA for vitamin A at baseline and after counselling respectively. Only 13.5% met the RDA for folic acid and iron each at baseline but after counselling all had intakes below RDA. The finding is important to central and local governments, civil society, intergovernmental agencies, research groups, business enterprises and community under study.&nbsp; The study fills the knowledge gap and therefore contributes to the advancement of knowledge.

Prevalence and anatomical pattern of the median artery among adult black Kenyans

Knowledge of the anatomy of median arteries is important in the diagnosis and management of carpal tunnel and pronator teres syndromes, reconstructive surgery in the forearm, minimizing inadvertent vascular injury as well as in limiting operative complications due to unexpected bleeding. The anatomical pattern displays ethnic differences but there are few studies on black Africans. This study therefore sought to describe the anatomy of median arteries in an adult black Kenyan population. A total of sixty two (62) upper limbs from thirty one (31) formalin-fixed cadavers were studied at the Department of Human Anatomy, University of Nairobi, Kenya. The prevalence, origin, types, relationship with median nerves and termination were determined. Median arteries were observed in 37 (59.7%) cases. Of these, the palmar type comprised 12 (32.4%) and antebrachial type 25 (67.6%) cases. It occurred bilaterally in 14 (45.2%) cases. The most common origin was the common interosseous artery (21; 56.8%) followed by anterior interosseous (13; 35.1%) and ulnar 3 (8.1%) arteries. The artery pierced the median nerve in 7 (18.9%) cases. The palmar type terminated by uniting with the ulnar artery to form a median-ulnar type of superficial palmar arterial arch in 8 (21.6%) cases and directly gave rise to the first, second and third common digital arteries in 4 (10.8%). In conclusion, the median artery occurs in nearly 60% of the population, much higher than in prevailing literature reports. Prevalence of the palmar type of median arteries and that of median arteries piercing median nerves are also higher than in other populations. Accordingly, presence of median artery and consequently other vascular and median nerve variations should be considered in the differential diagnosis of forearm entrapment neuropathies and due caution taken during forearm surgical procedures. We recommend preoperative ultrasound evaluation of the forearm and hand vascular system.Keywords: Median artery, origin, prevalence, median nerve, Kenyan

Abstract A12: Ethnic differences in the clinical and pathological characteristics of breast cancer among Kenyan women

Abstract Background: Breast cancer is the most common female malignancy worldwide. The effect of race and ethnicity on breast cancer has been the subject of much investigation. However, there are no published data from specific regions of sub-Saharan Africa with regards to the ethnic distribution of breast cancer and its subtypes. Objective: To investigate the differences in clinical and pathological characteristics of breast cancer in three major ethno-cultural groupings (Bantus, Nilotes and Cushites) in Kenya. Methods: A nationwide prospective study involving 15 public, faith-based and private institutions, which recruited patients with pathologically confirmed breast cancer between March 2012 and May 2015, was conducted. Relevant socio-demographic, clinical, reproductive and known breast cancer risk factor data were collected using a standardized questionnaire. Central pathology review and immunohistochemistry of all breast cancer tissue were done at Aga Khan University Hospital Nairobi. Proportions, chi-square tests, and logistic regression were used in the analysis of data. Results: Among the 867 female study participants with malignant breast tumor, 675 (77.8%) were Bantus, 148 (17.0%) were Nilotes, 20 (2.4%) were Cushites, and 24 (2.8%) were patients of mixed ethnicity. Bantus were more likely than the other three ethnic groups to fall within the 40-49 year age group (32 vs 19, 15, and 25% respectively, p=0.002), more likely to have at most secondary education (27.6 vs 17.6, 0, and 16.7%, p=0.0003), and more likely to be farmers (33.9 vs 19.6, 0.0, and 16.7%, p&amp;lt;0.0001). The majority of the study population overall was overweight or obese. When limited to Bantus and Nilotes only, Bantus were significantly more likely to be overweight than Nilotes (42.0 vs 29.9%, p=0.04). After adjusting for age, Nilotes seemed more likely to present with larger tumors and less likely to present with lymph node metastasis (OR: 0.39, 95% CI: 0.24-0.65), extra nodal extension (OR: 0.42, 95% CI: 0.23-0.75), and lymphovascular invasion (OR: 0.67, 95% CI: 0.47-0.97). The data suggest that Nilotes may be less likely to have ER positive cancers and more likely to have HER2+ cancers, though these associations were not statistically significant. Conclusion: The differences observed for some of the clinical and pathologic features of Breast Cancer among the three distinct ethnic groups in Kenya could be multifactorial and attributable to socio economic indicators, lifestyle factors and probable genetic variations. The association of specific measurements and biomarkers of obesity from Breast cancer patients among the ethnic Kenyan population and the association of serum estradiol concentrations with ethnicity and breast cancer subtypes are areas of future research. Further research to explore the BC incidence among the ethnic groups may provide insight into yet unexplored risk factors and etiology of breast cancer. Citation Format: Shahin Sayed, Zahir Moloo, Ronald Wasike, Asim Jamal, Peter Bird, Maya Palakal, Gretchen Gierach, Dhiren Govender, Mansoor Saleh. Ethnic differences in the clinical and pathological characteristics of breast cancer among Kenyan women [abstract]. In: Proceedings of the AACR International Conference: New Frontiers in Cancer Research; 2017 Jan 18-22; Cape Town, South Africa. Philadelphia (PA): AACR; Cancer Res 2017;77(22 Suppl):Abstract nr A12.

Kamari M. Clarke, Abel S. Knottnerus and Eefje de Volder (eds), Africa and the ICC: Perceptions of Justice

The International Criminal Court (ICC) is ‘going through turbulent times’.1 Most recently with claims of a mass withdrawal of African states proposed during the African Union’s January 2017 Summit and the separate withdrawal processes started by South Africa and Burundi.2 The Gambia’s withdrawal was reversed following the election of President Adama Barrow.3 Coupled with claims of an African bias held by the ICC and legitimacy criticisms, Kamari Clarke, Abel Knottnerus and Eefje de Vodler’s publication is timely.4 This edited collection brings together a selection of conference papers and specially commissioned essays from various disciplines. The editors seek to move beyond the two paradigms predominant in the debate on the relationship of the ICC with African states: the legal or pragmatic approach; and a normative assessment.5 To achieve this, perceptions are categorized into three distinct groups: state actors; impacted communities; and individuals directly affected by the crimes before the ICC. Justification for the approach is based upon the inaccuracy of treating Africa as a monolithic group with a united stance on the ICC. The chapter authored by Thomas Wolf points this out by contrasting the general Kenyan population’s support for the ICC as opposed to that of the political elite’s.6