Summary: of lens, micro cornea, ill-defined limbus, variable

Summary:
Congenital primary aphakia (CPA) is rare developmental abnormality presents with an absence of lens, micro cornea, ill-defined limbus, variable corneal thinning, distorted anterior segment architecture and atypical silvery white corneal sheen. Embryonic lens plays a crucial role in the anterior segment development in turn maintaining their structural integrity and normal corneal architecture. The efficacy of corneal transplantation in the setting of a diffusely thinned corneal bed, hypoplastic ciliary body and immature vitreous is abysmally poor. Most patients lose vision owing to irreversible hypotony and consequent retinal detachment. This is a short case report on a child with a CPA, who presented with a secondary glaucoma in both eyes, who underwent glaucoma filtering surgery (GFS) in right eye and trans-scleral cyclophotocoagulation (TSPC) in the left eye, and the successful outcomes of the same. This entity was clinically confirmed by ultrasound imaging and prompt corrective measures were instituted.
Introduction:
Congenital primary aphakia (CPA; OMIM 610256) is a rare autosomal recessive developmental abnormality of the lens. CPA can have some associated ocular co-morbidities comprising microphthalmia, absence of the iris, anterior segment aplasia, and/or sclerocornea (when the cornea blends with the sclera). This condition is thought to result from an aberration during the 4th or 5th week of fetal development, which prevents the formation of crystalline lens structure in the eye. This original failure leads, in turn, to complete aplasia of the anterior segment of the eye, which is the diagnostic histological criterion for CPAADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “DOI” : “10.1006/dbio.2000.9638”, “author” : { “dropping-particle” : “”, “family” : “Beebe”, “given” : “David C”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Coats”, “given” : “J Michael”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “id” : “ITEM-1”, “issued” : { “date-parts” : “2000” }, “page” : “424-431”, “title” : “The Lens Organizes the Anterior Segment : Specification of Neural Crest Cell Differentiation in the Avian Eye”, “type” : “article-journal”, “volume” : “431” }, “uris” : “http://www.mendeley.com/documents/?uuid=69cd78d9-60ac-40c8-88b6-0bc4285fa88a” } , “mendeley” : { “formattedCitation” : “<sup>1</sup>”, “plainTextFormattedCitation” : “1”, “previouslyFormattedCitation” : “(1)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }1. Mutations in the FOXE3 gene have been implicated with this condition.ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Valleix, S Niel, F Nedelec, B Algros, MP Schwartz, C Delbosc”, “given” : “B”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Al”, “given” : “Et”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “American Journal of Human Genetics”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2006” }, “page” : “358-64”, “title” : “Homozygous nonsense mutation in the FOXE3 gene as a cause of congenital primary aphakia in humans.”, “type” : “article-journal”, “volume” : “79” }, “uris” : “http://www.mendeley.com/documents/?uuid=da149f2a-2f97-4388-b5bc-d20060c771a6” } , “mendeley” : { “formattedCitation” : “<sup>2</sup>”, “plainTextFormattedCitation” : “2”, “previouslyFormattedCitation” : “(2)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }2
In disparity, congenital secondary aphakia (CSA); where in lens induction ensues and the lens vesicle develops to some degree but is progressively reabsorbed perinatally, leading to less severe ocular defects. Valleix et alADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Valleix, S Niel, F Nedelec, B Algros, MP Schwartz, C Delbosc”, “given” : “B”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Al”, “given” : “Et”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “American Journal of Human Genetics”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2006” }, “page” : “358-64”, “title” : “Homozygous nonsense mutation in the FOXE3 gene as a cause of congenital primary aphakia in humans.”, “type” : “article-journal”, “volume” : “79” }, “uris” : “http://www.mendeley.com/documents/?uuid=da149f2a-2f97-4388-b5bc-d20060c771a6” } , “mendeley” : { “formattedCitation” : “<sup>2</sup>”, “plainTextFormattedCitation” : “2”, “previouslyFormattedCitation” : “(2)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }2 analyzed a consanguineous family in which 3 siblings had bilateral aphakia, microphthalmia, and complete agenesis of the ocular anterior segment. Two siblings exhibited sclerocornea, and one had megalocornea with secondary glaucoma.

Posterior segment involvement is also inevitable in these eyes. There is presence of hypoplastic ciliary processes and abnormal vitreous as reported Maschot ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Manschot”, “given” : “W A”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Archives of Ophthalmology”, “id” : “ITEM-1”, “issue” : “5”, “issued” : { “date-parts” : “1963” }, “page” : “571-577”, “title” : “Congenital Aphakia”, “type” : “article-journal”, “volume” : “69” }, “uris” : “http://www.mendeley.com/documents/?uuid=ae455bf4-d97a-4aa0-92c8-97b17971ad2d” } , “mendeley” : { “formattedCitation” : “<sup>3</sup>”, “plainTextFormattedCitation” : “3”, “previouslyFormattedCitation” : “(3)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }3. Thus these eyes are prone to develop complications, either spontaneously or following a surgical intervention. Mainstay of management include the prevention of gouging by providing protective polycarbonate goggles, watchful monitoring of visual function, and assessment for complications such as hypotony, retinal detachment and or rarely secondary glaucoma. Herein, we describe a child who presented with a CPA with a secondary developmental glaucoma which was managed appropriately.
Methods: A retrospective chart review was conducted of a child diagnosed with CPA at our institute. The clinical history, systemic and ocular findings were assessed.
Case description:
A 5-year-old male child was brought to us by his parents with complaints of whitish discoloration of the eye and subnormal vision since birth. This child was a product of an uncomplicated full term cesarean delivery. Family history was negative for known genetic disorders. There was no history of parental consanguinity.

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On examination in the clinic, visual acuity in both eyes was recorded as fixing and following objects close to face. The corneas were obviously prominent with a significant greyish white corneal discoloration (Fig 1 A-C). Ocular movements were full. On finger tension test, the intraocular pressure was found to be high.
The anterior segment examination under general anesthesia revealed marked corneal opacification, with distorted anterior segment architecture, ill-defined limbus, steeper corneal contour, and both corneas had a typical silvery white sheen. A 3×3 mm of ciliary staphyloma was noted at 2 o’ clock in the right eye. The sclera was thinned out with underlying uveal show from 11 to 1 o’ clock in the left eye. The tangential illumination reveled absence of lens which was corroborated using ultrasound sound imaging (Fig 1 D-E). The intraocular pressure measured by Perkins tonometer was 22 mm Hg in the right eye and 20 mm Hg in the left eye. Fundus was hazily seen and retina appeared attached though disc details were indiscernible. Corneal pachymetry was 250 and 348 microns in right and left eyes respectively. B scan of both eyes confirmed the absence of crystalline lens and did not show any disc excavation. Based on the corroborative evidence a diagnosis of bilateral primary congenital aphakia with a secondary developmental glaucoma was made. A trabeculectomy with trabeculotomy was performed in the right eye and a trans-scleral photocoagulation was performed in the left eye owing to the superior scleral show. The post-operative course was uneventful. At post-operative 6 weeks, an examination under anesthesia was repeated. The right eye showed a diffuse bleb. The rest of the findings were as before. Using Perkin’s tonometer IOP was recorded as 14 and 26 mmHg in right and left eye respectively. In view of the consistently raised IOP in the left eye, Dorzolamide 2% eye drops thrice daily was started.

The parents were counseled about the child’s eye condition and encouraged to get the other healthy siblings for a genetic analysis. They were also referred for visual rehabilitation where the vision was assessed and child was able to point out 16M Lea symbols from 30cm distance. Parents were taught visual stimulation exercises to be done at home. In the next follow up, the child was stable with good navigational vision. The elder siblings were also examined and ocular examination was within normal limits.
Re-examination occurred in April 2018. Developmental milestones were normal and child had decent navigational visual functions. Slit lamp examination under general anesthesia showed dense corneal opacification as compared to previous visit. The remainder of the anterior segment and posterior segment was hazily seen. Parents were advised to continue the protective goggles and the importance of the eye protection was re-emphasized. Parents were advised that there is a 1/4th risk of having another affected child and a 2/3rd risk of subsequent children being a carrier for either point mutation or the gene deletion.

DISCUSSION:
CPA is rare autosomal recessive condition associated with severe anterior segment dysgenesis. Frequently, absence of lens is overlooked in these cases. Invariably surgical intervention such as full thickening corneal grafting carries abysmal outcomes. Therefore, it is crucial to recognize this distinct clinical entity to undertake the necessary preventive measures to reduce the risk of consequent complications of spontaneous phthisis bulbi and retinal detachment and thus reduce the rate of irreversible morbidity associated with this disease. Features that differentiate CPA from primary congenital glaucoma (PCG) are the presence of discernible and characteristic ocular signs in children with CPA namely the typical silvery white corneal sheen, alongside absence of crystalline lens as revealed on imaging.
Development of the lens begins at 4 weeks of gestation after the lens placode forms at surface ectoderm adjacent to the developing optic vesicle. Sequentially the lens placode invaginates and forms the lens vesicle after separation from the surface ectoderm. The lens vesicle gets surrounded by the optic cup. The space between the lens vesicle and the surface ectoderm is filled with migrating neural crest cells and give rise to structures of the anterior segment namely the corneal endothelium, corneal stroma, iris stroma, trabecular meshwork.ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Beebe, DC, Coats”, “given” : “JM”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Developmental Biology”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2000” }, “page” : “424-31”, “title” : “The lens organizes the anterior segment: specification of neural crest cell differentiation in the avian eye”, “type” : “article-journal”, “volume” : “220” }, “uris” : “http://www.mendeley.com/documents/?uuid=426aeea4-8703-4a37-a6c5-bd6a787bc676” } , “mendeley” : { “formattedCitation” : “<sup>4</sup>”, “plainTextFormattedCitation” : “4”, “previouslyFormattedCitation” : “(4)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }4 Several studies have shown that absence of the lens leads to aplasia of the anterior segment, abnormal ciliary bodyADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “al”, “family” : “Trabucchi, G Piantanida, A Bandello, F Freschi, M Nucci, P Brancato”, “given” : “R et”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Acta Ophthalmologica”, “id” : “ITEM-1”, “issued” : { “date-parts” : “1997” }, “page” : “595-597”, “title” : “Congenital aphakia in Peters u2019 anomaly syndrome”, “type” : “article-journal” }, “uris” : “http://www.mendeley.com/documents/?uuid=1f8bbe13-76a8-4b2f-a3a8-ebc9a4a0a7e9” } , “mendeley” : { “formattedCitation” : “<sup>5</sup>”, “plainTextFormattedCitation” : “5”, “previouslyFormattedCitation” : “(5)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }5. Not only does the developing lens effect anterior segment development, but also differentiation of the optic vesicle into the optic cup, which will give rise to the future posterior segment. Absence of secondary and tertiary vitreous is evident, and choroidal and optic disc coloboma has also been reported in literatureADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Johnson, BL Cheng”, “given” : “KP”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Journal of Pediatric Ophthalmology and Strabismus”, “id” : “ITEM-1”, “issued” : { “date-parts” : “1997” }, “page” : “35-39”, “title” : “Congenital aphakia: a clinicopathologic report of three cases”, “type” : “article-journal”, “volume” : “34” }, “uris” : “http://www.mendeley.com/documents/?uuid=daea7cad-e48e-4dfa-89cd-3c3d6e8643d7” } , “mendeley” : { “formattedCitation” : “<sup>6</sup>”, “plainTextFormattedCitation” : “6”, “previouslyFormattedCitation” : “(6)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }6. This kind of affection of the anterior segment and posterior segment is seen in CPA.
Genetic analysis has revealed that mutations in the fork head transcription factor gene, FOXE3, present on chromosome 1p32, is responsible of the phenotype of congenital primary aphakiaADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Valleix, S Niel, F Nedelec, B Algros, MP Schwartz, C Delbosc”, “given” : “B”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” }, { “dropping-particle” : “”, “family” : “Al”, “given” : “Et”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “American Journal of Human Genetics”, “id” : “ITEM-1”, “issued” : { “date-parts” : “2006” }, “page” : “358-64”, “title” : “Homozygous nonsense mutation in the FOXE3 gene as a cause of congenital primary aphakia in humans.”, “type” : “article-journal”, “volume” : “79” }, “uris” : “http://www.mendeley.com/documents/?uuid=da149f2a-2f97-4388-b5bc-d20060c771a6” } , “mendeley” : { “formattedCitation” : “<sup>2</sup>”, “plainTextFormattedCitation” : “2”, “previouslyFormattedCitation” : “(2)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }2. It is expressed in the developing lens, and its absence results in abnormal development of anterior segment structures. Along with features of anterior segment dysgenesis, it is not uncommon to find raised intra ocular pressures in the affected individualsADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Semina, EV, Brownell, I Mintz-Hittner, HA Murray, JC Jamrich”, “given” : “M”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Human Molecular Genetics”, “id” : “ITEM-1”, “issue” : “3”, “issued” : { “date-parts” : “2001” }, “page” : “231-236”, “title” : “Mutations in the human forkhead transcription factor FOXE3 associated with anterior segment ocular dysgenesis and cataracts”, “type” : “article-journal”, “volume” : “10” }, “uris” : “http://www.mendeley.com/documents/?uuid=4f24f34f-719a-412f-abea-741cd6ad422d” } , “mendeley” : { “formattedCitation” : “<sup>7</sup>”, “plainTextFormattedCitation” : “7”, “previouslyFormattedCitation” : “(7)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }7. However, due to the altered anatomy of the cornea, the accuracy of IOP measurement is questionable. The corneal opacity precludes visualization of the posterior segment, though disc excavation can be looked for on B scan as corroborative evidence. Valleix(2) et al have reported 3 siblings with CPA, one of which was developed secondary glaucoma and underwent trabeculectomy. Apart from this, extensive literature search did not reveal other such case reports.

Our case presented with typical ocular findings of CPA, associated with raised IOP and enlarged eyes, suggestive of secondary developmental glaucoma. The child underwent uneventful trabeculectomy with trabeculotomy in the right eye and TSCPC in the left eye. Managing a case of CPA with secondary glaucoma can be very challenging. Firstly, the intraocular pressure measurement may not be accurate owing to the thin, scarred and ectatic cornea. Secondly, performing a successful trabeculotomy technically may be difficult owing to the disorganized anterior segment, unreliable external limbal landmarks, or obscured anatomy of the Schlemm’s canal. Post-operatively the child was doing well with a well-formed bleb and controlled IOP in right eye. There were no signs suggestive of hypotony. The left eye had persistently raised IOP and thus was started on anti glaucoma medication. In contrast to the published reports, secondary developmental glaucoma can be a rare part of CPA.
The management of corneal opacification in setting of CPA is quite challenging. The efficacy of corneal transplantation in the setting of a poorly developed anterior segment is abysmally poor.
Our experience has shown that out of the 71 eyes of primary congenital aphakia seen in our institute, 5 had undergone penetrating keratoplasty and eventually had poor anatomical outcomes. The grafts were clear in the immediate post-operative period, however, the eyes subsequently had persistent low IOP despite intense steroids and cycloplegic medication. Perhaps the ciliary body hypoplasia resulted in low IOP, and eventually phthisis ensued within 3 months in most cases. It was inferred that any penetrating procedures in these eyes would ultimately lead to poor anatomical outcomes ADDIN CSL_CITATION { “citationItems” : { “id” : “ITEM-1”, “itemData” : { “author” : { “dropping-particle” : “”, “family” : “Muralidhar, Ramappa Sunita, Chaurasia Subhadra”, “given” : “Jalali”, “non-dropping-particle” : “”, “parse-names” : false, “suffix” : “” } , “container-title” : “Indian Journal of Ophthalmology2”, “id” : “ITEM-1”, “issue” : “2”, “issued” : { “date-parts” : “2018” }, “page” : “341-342”, “title” : “Keratoplasty in congenital primary aphakia”, “type” : “article-journal”, “volume” : “66” }, “uris” : “http://www.mendeley.com/documents/?uuid=f5fce400-299d-4fb7-a250-c8d612f33e03” } , “mendeley” : { “formattedCitation” : “<sup>8</sup>”, “plainTextFormattedCitation” : “8”, “previouslyFormattedCitation” : “(8)” }, “properties” : { “noteIndex” : 0 }, “schema” : “https://github.com/citation-style-language/schema/raw/master/csl-citation.json” }8. .In this context, the key challenge in the management of CPA is the prevention of ocular hypotony, which relies on early diagnosis to allow for targeted measures aimed at preventing ocular trauma or inadvertent surgical intervention. Therefore, in context of poor penetrating keratoplasty outcomes, no further intervention was advised for the child, and regular follow up, along with visual rehabilitation was advised.

In conclusion: We believe it possible that CPA remains an under-diagnosed rare genetic condition of the anterior segment. Timely recognition of the secondary developmental glaucoma is crucial in minimizing the sight threatening sequelae. A multidisciplinary approach is necessary, with prompt IOP control, visual stimulation, avoiding eye poking, and close monitoring to pick up post-operative complications. Definitive molecular diagnosis allows for appropriate preventive management strategy including advice and aids to preclude future ocular complications.BIBLIOGRAPHY
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Beebe DC, Coats JM. The Lens Organizes the Anterior Segment?: Specification of Neural Crest Cell Differentiation in the Avian Eye. 2000;431:424-431. doi:10.1006/dbio.2000.9638.

2. Valleix, S Niel, F Nedelec, B Algros, MP Schwartz, C Delbosc B, Al E. Homozygous nonsense mutation in the FOXE3 gene as a cause of congenital primary aphakia in humans. Am J Hum Genet. 2006;79:358-364.

3. Manschot WA. Congenital Aphakia. Arch Ophthalmol. 1963;69(5):571-577.

4. Beebe, DC, Coats J. The lens organizes the anterior segment: specification of neural crest cell differentiation in the avian eye. Dev Biol. 2000;220:424-431.

5. Trabucchi, G Piantanida, A Bandello, F Freschi, M Nucci, P Brancato R et al. Congenital aphakia in Peters ‘ anomaly syndrome. Acta Ophthalmol. 1997:595-597.

6. Johnson, BL Cheng K. Congenital aphakia: a clinicopathologic report of three cases. J Pediatr Ophthalmol Strabismus. 1997;34:35-39.

7. Semina, EV, Brownell, I Mintz-Hittner, HA Murray, JC Jamrich M. Mutations in the human forkhead transcription factor FOXE3 associated with anterior segment ocular dysgenesis and cataracts. Hum Mol Genet. 2001;10(3):231-236.

8. Muralidhar, Ramappa Sunita, Chaurasia Subhadra J. Keratoplasty in congenital primary aphakia. Indian J Ophthalmol. 2018;66(2):341-342.

Legends:
Fig 1. Digital images depicting phenotype and B scan. A: Frontal view of face showing bilateral corneal opacification. B-C: Grayish white corneal discoloration with classic silvery white corneal sheen. D-E: B Scan images showing absent lens echo (star) and normal posterior segment and optic nerve shadow in both eyes. Inset showing A scan with absent lens spike.

SUMMARY, and journalism in Kenya, statement of

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS5.6 IntroductionThis chapter presented the discussion of key data findings, discussion of the findings, conclusion drawn from the findings highlighted and recommendations made there-to. The conclusions and recommendations drawn were focussed on addressing the purpose of this study which was to: establish the effects of digitalization on the mainstream media in Kenya, to determine the effects of social media on the journalism practice in Kenya, and to find out the effects of digitalization on consumption of media services in Kenya.

The study was organized into five chapters. The first chapter was the Introduction which gave the background on the effects of digitalization on mainstream media and journalism in Kenya, statement of the problem which sought to establish the effects of digitalization on mainstream media and journalism in Kenya (2006-2018). The objectives were to establish the effects of digitalization on mainstream media in Kenya; to determine the effects of social media on the journalism practice in Kenya; and to find out the effects of digitalization on consumption of media services in Kenya. Justification of the study provided the significance for the study for future scholars and academicians as it was to serve as a guide for future research in providing material on the subject of digitalization’s effects on mainstream media and journalism. Furthermore, the findings from the study were to suggest areas where future researchers and academicians may research on. The scope and limitations of the study was limited to the analysis of the effects of digitalization on mainstream media and journalism in Kenya (2006-2018). The study targeted various players in the media industry in Kenya which included Media Owners Association officials, Kenya Union of Journalists officials, Bloggers Association of Kenya writers and heads of media training institutions.Chapter two presented an analysis of literature as carried out by other scholars on the concept of digitalization and its effects on mainstream media.

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The study extensively reviewed the impact of digitalization on mainstream media and the journalism practice as the world embraces globalization. The theoretical framework was guided by the research objectives. Uses and gratifications theory of mass media was used in this study as it explains why and how people actively seek out specific media to satisfy specific needs.

This is because mainstream media still remains relevant despite social media being available and accessible to audiences. Chapter three was about research methodology. It covered research design, population, sampling and sample size, data collection and data collection instrument and finally data analysis.

Chapter four presented the findings of the study, analysis of data and presentation of major findings. For the purpose of demonstrating the relationship among the variables, the data was presented in the form of tables and percentages.5.7 Summary of Findings 5.7.1 Effects of Digitalization on Mainstream MediaOn the effects of digital technologies, 87.

5% of the respondents indicated that digital technologies had enhanced the collection, dissemination and consumption of information and news while 12.5% indicated that digital technologies had not enhanced the collection, dissemination and consumption of information and news by the mainstream media in Kenya. On the question of the effects of digitalization on media ethics, 75% of the respondents indicated that digitalization affected media ethics in Kenya, 18.8% indicated that it did not, while 6.

2% of the respondents were not sure of whether or not it did.Regarding the extent to which the integration of social media by mainstream media had widened audience reach, 93.8% of the respondents indicated that it did to a very great extent, 3.1% of the respondents indicated that it did to a great extent while 3.1% of the respondents indicated that it did to a moderate extent. On whether media training institutions were taking social media as a serious field of study, 81.

2% of the respondents indicated that media training institutions in Kenya did not take social media as a serious field of study, while 18.8% of the respondents indicated that media institutions in Kenya took social media as a serious field of study. 5.7.2 Effects of Social Media on the Journalism PracticeOn whether journalists needed to know how to use social media effectively in this digital era, 100% of the respondents said that journalists indeed needed to know how to use social media effectively.On the extent to which citizen journalism affected traditional journalism, 68.

8% of the respondents indicated that citizen journalism affected the traditional journalism practice to a very great extent, 18.8% indicated that citizen journalism affected the traditional journalism practice to a great extent while 12.5% of the respondents indicated that citizen journalism affected the traditional journalism practice to a moderate extent.

On whether or not social media increased the propagation of fake news 93.8% of the respondents indicated that social media increased the propagation of fake news while 6.2% of the respondents indicated that social media did not increase the propagation of fake news.5.

7.3 Effects of Digitalization on Consumption of Media Services On the extent to which social media platforms are used to access information and news, 90.6% of the respondents indicated that social media platforms are used to access information and news to a very great extent. 6.3% indicated that social media platforms were used to a great extent to access information and news, while 3.1% indicated that social media platforms were used to a moderate extent to access information and news.

As to whether or not social media enhanced the speed and immediacy of breaking news, the study established that all the respondents (100%) indicated that it did.The study also established that 87.5% of the respondents indicated that mainstream media audiences use social media to produce and consume information and news to a very great extent, while 12.5% of the respondents indicated that mainstream media audiences use social media to produce and consume information and news to a great extent.5.8 Conclusions:The study makes the following conclusions:5.8.1 Digitalization on Mainstream MediaThe study found out that digital technologies have indeed aided the gathering, production, dissemination and consumption of information and news.

According to Bakker, P. ; Sadaba, C. (2008), the collection, packaging, analysis and dissemination of media products are becoming increasingly participatory. The active participation of users or consumers is seen not only as a common feature of modern productions but desirable as part of increasing cultivation of symbiotic relationships and discipleship, and loyalty which is important as competition for audiences intensifies. Ordinary people are now increasingly involved in media business by contributing stories, pictures and audio-visual material for publication by mainstream media.The study also revealed that digitalization affected media ethics. Unlike in mainstream media, the digital space hardly has gatekeepers. This lack of regulation makes it easy for citizen journalists to produce content that is too permissive by legal and even cultural standards.

According to Witschge ; T. Nygren, media ethics such as truth, impartiality, fairness and objectivity in reporting are not adhered to by citizen journalists as they are not bound by any code of conduct. Often times mobile phones have been used to send pornographic content indiscriminately. Given that pornography is illegal is Kenya, the digital space easily becomes a brooding ground for immoral and unlawful content. The study also noted that integration of social media by mainstream media helped in widening audience reach. Obijiofor (2015) observed that the youth in Africa have embraced social media for the purposes of connecting and interacting. Seeing as social media has transformed the way youths learn, communicate, collect information, collaborate with their peers and entertain themselves, mainstream media have found it necessary to embrace social media in a bid to widen their audience reach.The study observed that media training institutions had not taken social media as a serious field of study.

It therefore concludes that these institutions should take social media as a serious field of study in order to equip media students for the industry where social media has been embraced.5.8.2 Social Media on the Journalism PracticeThe study established that social media had affected the journalism practice considerably. It found out that journalists are expected to know how to use social media effectively in his digital era.

Knight and Cook (2015) describe social media as a form of media whose prime role is interaction rather than just dissemination of information. Social media have been described as powerful tools in guiding journalists in new ways of telling stories because they have tools that enable convergence of audio, video and text.The study revealed that citizen journalism affected the journalism practice to a very great extent. Apart from the challenge on media ethics, there is also loss of revenue for mainstream media organizations. This is majorly because the audience for offline media seems to be diminishing while the younger generation tends to be more social media-oriented. The problem is that the online audience prefer to get the content free and is yet to embrace the concept of subscription.

This means that media organizations are still grappling with ways to generate money from their online platforms besides what they make from advertising.The study also confirmed that social media increased the propagation of fake news. This was seen as a major challenge that necessitated legal action to deter perpetrators. The President Mr. Uhuru Kenyatta assented to law the Computer and Cyber Crimes Bill passed in Parliament in May 2018, that stipulates stiff penalties on cyber espionage, false publications, child pornography, computer forgery, cyberstalking and cyber bullying.

According to a 16th May publication by the Standard newspaper, sharing fake news and propagating hate speech will attract a fine of five million Kenya Shillings or to imprisonment not exceeding two years, or both.5.8.3 Digitalization on Consumption of Media ServicesThe study revealed that social media have become popular sources of news and information. Convergence of mobile technology coupled with access to the internet have made it easy for media consumers to access content through online platforms.

In a bid to maximize on available resources of manpower and money, media houses now have converged newsrooms. For example, from its converged newsroom, SG is able to use fewer resources to generate news content from a pool of reporters and correspondents with skills to report for print, radio, and television. This has made social media popular sources of news and information.The study noted that social media had enhanced the speed and immediacy of breaking news. Though this was seen as being positive, urgency to ‘scoop’ or be the first to tell a story by citizen and traditional journalists led some to post information that was unverified or unconfirmed. The study also found that mainstream media audiences were involved in the production and consumption of media content to a very great extent. The study observed that there were young people who had taken blogging as a career and were writing on issues that were not given coverage on mainstream media.

It also observed that twitter was a popular platform where users set agenda and actively discussed issues affecting them in one way or another.The study concluded that despite social media being popular sources of information especially among the youth, mainstream media were still the most credible sources of news. This is owing to the gatekeeping measures taken to ensure that what is reported conforms to the set legal and cultural standards while also observing media ethics. The study asked respondents to briefly comment on the effects of digital broadcasting.

It was observed that though the transition had hiccups in its inception, the move bore positive results. Variety of channels for consumers, improved signal quality and increased job opportunities for artists, content producers and journalists were among the responses obtained. On the flip side, loss of revenue for mainstream media was cited as a major challenge as the media marketplace had become increasingly competitive.

5.9 RecommendationsFrom the findings and conclusions, the study recommends that mainstream media and journalists fully embrace and take advantage of digitalization because of its numerous opportunities. Participation by audience in discussions and debates on mainstream media through social media platforms was seen to be a major benefit of digitalization. The study recommends that mainstream media embraces citizen journalism. Citizen journalists could be useful in telling stories where there are no reporters on the ground. Mainstream media can therefore verify the information and use it if it adheres to the set standards.

The study also recommends that mainstream media improve on the quality of their content as it was noted that not much research was being carried out resulting to shallow reporting. Mainstream media would do better if they would do follow up stories to what they report, or what is popularly known as Day Two journalism.The study further recommends that media training institution take social media as a serious field of study in order to equip future journalists for the industry dynamics.

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