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Additional Information

Competing Interests

Dr Gary J Burkholder is an employee of Laureate Inc.

Author Contributions

Grace Gachanja conceived and designed the experiments, performed the experiments, analyzed the data, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.

Gary J Burkholder analyzed the data, reviewed drafts of the paper.

Aimee Ferraro analyzed the data, reviewed drafts of the paper.

Human Ethics

The following information was supplied relating to ethical approvals (i.e., approving body and any reference numbers):

Ethics approval received from the Kenyatta National Hospital Research Standards and Ethics Committee (Approval # P373/10/2010) in Nairobi Kenya, and Walden University Institutional Review Board (Approval # 11-10-10-03904).


No funding was received for this study.

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