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Determinants of the outcome on traumatic brain injurypatients at Kenyatta National Hospital
No full textINTRODUCTION
Traumatic brain injury (TBI) is among the leading causes of admissions in hospitals
globally. TBI has been attributed with significant morbidity, mortality and disability. Most
injuries have mainly been attributed to motor accidents and falls from heights.
Traumatic brain injuries represent a significant and growing disease burden in the
developing world, and one of the leading causes of death in economically active adults in many
low- and middle-income countries.
In Kenya, motor vehicle accidents, assaults and motorcycle are significant causes. Per
vehicle mile travelled, motorcycle riders have a 34-fold higher risk of death in a crash than people
driving vehicles and 8 times more likely to be injured. neurological injury progresses over hours and
days, resulting in a secondary injury. Inflammatory and neurotoxic processes result in vasogenic
fluid accumulation within the brain, contributing to raised intracranial pressure, hypoperfusion,
and cerebral ischaemia a secondary injury may be amenable to intervention. Almost one-third of
patients who die after a TBI will talk or obey commands before their death.
Physiological insults, Hypoxia, hypotension, hyper - or hypocapnia, hyper - or hypoglycaemia
have all been shown to increase the risk of secondary brain injury
OBJECTIVES:
To determine the patients’ factor, clinical care and systems factor affecting outcome of
Traumatic Brain Injury (TBI) patients at Kenyatta National Hospital. Which led to a poor outcome
of above 40 years, casual laborers, Polytrauma and time lapse from trauma to hospitalization
experienced. The clinical care factors indicating good outcome which included; diagnosis and
medication, Nursing care and clinical setting A&E, CCU. Length of hospitalization >10 days.
Protocols factors; Patients in surgical wards recording poor outcome.
DESIGN
The rationale for using purposive sampling was to be able to distinguish between traumatic
brain injury patients, who did not have any neurological problems before the injury, and those
who had suffered neurological problems prior to trauma. A descriptive cross-sectional design,
Purposive sampling and Quantitative approach to data collection, analysis and presentation was
adopted.
SETTING
The study was carried out at the Accident and Emergency department (A&E), Critical
care unit (CCU) and surgical wards of Kenyatta National Hospital (KNH).
SUBJECTS
Patients with TBI within 72 hours of injury, aged between 18- 65 years and should have
had no previous neurological problem.
RESULTS
Patient factors; that led to poor outcome; above 40 years (p=0.042), casual laborers (p=0.043),
Polytrauma (p=0.042) and time lapse from trauma to hospitalization (p=0.051). The clinical care
factors indicated good outcome which included; diagnosis and medication (p=0.001), Nursing care
(p=0.055) and clinical setting A&E (p=0.051), CCU (p=0.032). Length of hospitalization >10 days
(p=0.050). Protocols factors; Patients in surgical wards had poor outcome (p=0.051).
CONCLUSION
Patient factor's influenced outcome of TBI, Intensive care and longer time of hospitalization
is paramount for better outcome.
RECOMMENDATION
Setup of a Trauma Neuro Ward and training of Neuro Teams to facilitate professional and
quality care to improve outcome of Traumatic Brain Injury patients
Resettlement Of Internally Displaced Persons In Kenya: A Case Of Rongai, Nakuru County 2008 – 2016.
No full textThe end of 20th century witnessed a dramatic increase in the number of intractable civil wars leading to massive displacement of persons. Internally Displaced Persons (IDPs) in camps lack access to adequate shelter, food, healthcare and means of livelihoods enduring a life of bleakness and hopelessness. Resettlement of IDPs is an exercise that seeks to alleviate both the short term humanitarian needs of IDPs and provide long term durable solutions. It is expected that after resettlement, IDPs are able to re-establish their livelihoods and are able to sustainably attain their basic needs. However, challenges faced during and after resettlement often times renders such processes inadequate and ineffective.
This study is an evaluation of one such resettlement program in Rongai, Nakuru County in Kenya. The study was guided by two objectives. One, to examine the resettlement of IDPs in Rongai Sub-County and two, to examine the challenges facing the resettlement and the coping mechanism adopted by the resettled IDPs. The study tested two hypotheses. One, that the government of Kenya resettled IDPs in Rongai Sub-County and two, that there are challenges that faced the resettlement of IDPs in Rongai Sub-County.
The study was grounded on the Basic Human Needs Theory. The theory argues that conflicts are inevitable when human needs are not met and that individuals and groups revert to conflict when they don’t have any other way to meet their needs. The study utilized both primary and secondary sources of data. The researcher used purposive sampling method and snowballing technique to identify respondents interviewed with a question guide. The data collected was analyzed qualitatively and presented in narrative a form.
The study argues that while the government of Kenya designed and implemented several initiatives aimed at addressing the plight of IDPs, the resettlement process was hampered by a myriad of challenges that impacted negatively on the overall sufficiency and effectiveness of the process. The study also found out that the resettled IDPs have developed several coping strategies to deal with the challenges that they face after their resettlement
The Influence Of Immigration Policies On The East African Integration Process
No full textRegional integration is a worldwide concept that is built on the objectives of member countries whose main aim is experience positive terms of trade due to free trade. The East African Regional integration has been demonstrated to increase investments in member countries. Despite the EAC’s vision to establish a Customs Union, a Common Market, a Monetary Union, and ultimately a Political Federation of the East African States, progress made throughout the years has been hampered by a myriad of challenges, among them the region’s immigration policies that are different among the EAC partner states. This study therefore set out to investigate role of EAC’s immigration policies in promoting regional integration by focusing on three specific study objectives; to investigate how EAC’s immigration policies promote the EAC integration, the strategies that the EAC member states are applying to harmonize immigration policies with aspirations of the EAC integration process and the challenges faced by EAC member states in the implementation of migration policies to boost integration in the EAC. A descriptive research design was employed to carry out the study with a questionnaire and interview schedule used to collect the primary data from respondents. The study was further guided by Liberal intergovernmentalism Theory and the Regional Integration Theory. The results of the study show that majority of travelers who are EAC citizens do so for business. This means that citizens in the EAC region are brought together mostly by trade related activities. All East African member states including Kenya, have each an immigration policy framework with aspirations for EAC regional integration. Most of the of the EAC member country immigration policies promote movement of people, capital, goods and services. The immigration policies to a large extent promote residence in any EAC state. Member countries’ immigration policies are also formulated to promote healthy business competition among EAC citizens and Cultural integration and religious freedom. The same immigration policies also promote access to markets within the EAC and peaceful coexistence among EAC citizens, EAC customs union and common market. The volume of trade between the EAC member states had increased due to the influence of the immigration policies for countries in the region in the recent past. Majority of EAC countries are working towards greater integration of the region and have done this through formulation of strategies to achieve the same. The policy challenges which pose the greatest challenge to integration in the EAC region are internal and external tariff barriers to trade as well as long business registration process time in the different countries. The political challenges and social challenges on the other constitute a small impact on integration of EAC member countries. Under economic challenges, different taxation regimes in EAC member countries pose a more pronounced challenge to integration. The other economic challenges that affect integration are the different currency systems and the high cost of doing business in East Africa. Pursuant to these findings, the study recommends the following; abolishing passports for EAC citizen travelers, harmonization of crossborder policies, abolish the Visa requirements for short-time visits by members of the EAC, harmonization of taxation regimes, establishment of a common currency system, reduce the high cost of doing business, improve infrastructure and formation of a common political federation
An Assessment Of Heat Stress Status In Pigs And Adaptation Options In Lira District Uganda
No full textThere is limited attention to impacts of climate change on pigs in Uganda by stakeholders
despite the potential vulnerability of pigs to climate change, especially heat stress. Pigs are
very sensitive to heat stress as they do not have functioning sweat glands (as other livestock
species do) and have small lungs which reduces their ability to disseminate heat by panting.
The objectives of the study were to determine the heat stress status in pigs, factors
influencing heat stress and explore the heat-stress adaptation options towards better pig
production in Lira District, Uganda. Lira was selected because of high poverty level, presence
of both rural & urban areas and expected heat stress throughout the year in the district. The
data including management systems, age, color, breeds, body/skin temperature, rectal
temperature and others were collected from 104 households and 259 pigs during the hot
months in Ojwina and Barr sub-counties- Lira district. More data on adaptation options were
collected during the four gender disaggregated focus group discussions. 63.46 % of the
respondents were female and 36.54% of respondents were male. Majority of the respondents
during the household survey were from Barr sub-county (56%) and the remainder (44%)
were from Ojwina sub-county, which were the rural area and urban area respectively. Rectal
temperature (RT=39.06°C ±0.83°C) and body/skin temperature (ST=36.32°C ±2 °C) were
the key heat stress indicators (dependent variables) as have been used by other researchers.
According to the farmers, 48.45% of the pigs had no heat stress, 51.55% of the pigs were heat
stressed and both the rectal temperature & skin temperature of these groups were
significantly different (p<0.01). There was a statistically significant correlation between heat
stress status and heat stress action (p<0.01 The results showed that rectal temperature is
influenced by the external temperature humidity index, pig management system, pig
category, color, heart girth, water quantity given during day in dry season, pig’s body
condition score, and time of the day. Skin temperature is significantly influenced by external
temperature humidity index, pig category, pig management, time of the day and body
condition score. The preferred adaptation options were analysed using the average preference
rating (using a rating scale of 1 to 5 where 1 was the least preferred option and 5 the highest
preferred). The results showed that the most preferred adaptation options included
constructing a high pig pen roof and allow easy air flow (Average Preference Rating = APR
=4.75); pouring water on the pigs (APR=4.63); and allowing pigs to swim/wallow
(APR=4.48). The least preferred adaptation options to heat stress included giving salt to
replace lost electrolytes (APR=1.25); and addition of fans (APR=1.03). The percentage of the
female members of the household making decisions and providing labour for particular
adaptation options was higher relative to the male household members and non-household
members; except for the adaptation option of constructing the pig houses. To adapt to heat
stress, pig shelters should be designed to minimize overcrowding while incorporating ways to
improve airflow and evaporative cooling by having a high roof, and / or using grass. Availing
water ad lib or even mixing water in the feed is critical to reducing heat stress. Pig
swimming/wallowing and pouring water on the pigskin are some of the interventions farmers
may use. However, there is need for more awareness about the suitable adaptation option to
heat stress while putting the local context into consideration
Pro-Environmental Consumer Behavior: A Critical Review of Literature
No full textThe damage to the environment caused by commercial activities and consumption behaviours has become a reason for concern in recent times. Sustainable consumption and drivers behind it was the main objective of the study. The study is a critical review of literature on pro-environmental behaviours with focus on theory, behavioural drivers and inhibitors. The review covered conceptual and empirical papers selected from peer reviewed articles with high citation index. Behaviour change theories including theory of reasoned action, theory of planned behaviour, norm activation theory and goal framing theory were reviewed. In light of theory, attitude, behavioural intention and perceived consequences are the major variables that cause pro-environmental behaviour. Nevertheless, norm activation theory fails to explain behaviour where people are in denial of responsibility for the consequences of their consumption. The study established that pro-environmental behaviour is caused by both intrinsic and extrinsic factors. Intrinsic factors include environmental awareness and knowledge, attitude, consumer age, education, and concern for the environment. Extrinsic factors including income, social network and culture bridge the gap between attitude and pro-environmental behaviour. Perceived high price and lack of trust for green products were the major barriers to sustainable consumption behaviours. The study concludes that interaction between consumer attitude and favourable contextual factors lead to pro-environmental behaviour
Influence of Strategic Management Practices on Service Delivery by National Museums of Kenya
No full textStrategic management and its implementation has been used for improvement of performance. Strategic management is defined as the science and art of formulation, implementation, and evaluation of cross-functional decisions that enable an organization to achieve its objectives. Strategic management is an enabler for firms for their understanding of their strategic position and identification of the choices which are strategic for the future of the organization and management of strategy in action. Strategic management practices, which are central in the strategic management process, demands that the organization puts in place systems which are efficient to enable the organization to counter events which are unpredictable; and enable the organization in sustenance of their operations, minimization of the risks involved and efficient delivery of services. Service delivery is the process and activities that are undertaken by an organization with the aim of creation of value, and it includes performance to customers. The objective of the study was to determine strategic management practices adopted by the National Museums of Kenya and how adoption of the practices influences service delivery at the organization. This study employed a case study design and it was carried out in National Museums of Kenya, with interview guide used to solicit data on the four elements of strategic management process and service delivery. This study made use of data from primary sources and secondary sources. Collection of primary data was undertaken by having face to face interviews that were conducted by the researcher. The respondents for the study were seven senior managers of the organization involved in implementation of strategy. Data was recorded in form of notes during the interview process which was undertaken by the researcher. Content analysis was used for analysis of the data collected, where coding of the data was then undertaken by identifying categories, trends and themes based on relationships observed. Evaluation of the coding was done as per the study objective. Description of the themes and data patterns was then be undertaken. The study established that National Museums of Kenya has adopted different strategic management practices. These practices have influenced its pursuit of the mandate of provision of heritage and monument services for its consumers. These are in the four elements of strategic management process, which are situation analysis, formulation of strategy, strategy implementation, strategy evaluation and control. Adoption of strategic management practices has contributed to and affects service delivery of this public sector organization. The study found out many challenges and gaps which impacts the process and quality of service delivery. The major challenge was funding, among the resource requirements for implementation of strategy. Inadequate resources have let to compromise of accessibility and availability of services. The study recommends provision of adequate resources for programs and activities undertaken by the organization to enable effective implementation. Funding should be increased for improvement of quality of strategic management practices, which would ultimately impact delivery of services. The organization should endeavor to build the capacity of its employees in undertaking their duties. Continuous professional development is recommended. The organization should undertake training needs assessment to comprehensively determine capacity gaps. This should be followed by proper plan to address the gaps
Effect Of Financial Statement Information On Stock Returns Of Firms Listed At The Nairobi Securities Exchange
No full textAccounting information mitigates information asymmetries which brings about
adverse selection during transactions in the capital market. It also boosts liquidity; this
minimizes discounts that firms are forced to issue capital. Accounting information is
regarded as the most powerful resource utilized by investors, since investment
decisions are made on account of the firm’s stock and price which is reflective of the
firm’s future profit. The study was set out to establish the effect of financial statement
information on stock returns of firms quoted at the NSE. A descriptive research
design was employed to detect the association between variables in all listed firms
that had been operational between the years 2014 and 2018. Data collected was
analyzed using quantitative data analysis methods whereby inferential statistics:
regression and correlation analysis were used. All the study parameters (stock prices,
earnings management, ROE, cashflows and dividends) recorded an upward trend
during the research period. Research concluded of an existence of a significant
connection amid financial statement information and stock prices. Dividends was
significantly associated to stock prices while cashflows, earnings management and
profitability were insignificantly linked to stock prices. Output from correlation
established of an existence of a moderately strong correlation among dividends and
stock prices. Similarly, a weak correlation was realized among cashflows and stock
prices. There was non-existence of a correlation among earnings management and
profits with stock prices. Overall regression model adopted by the researcher was
found to be significant since p-value (0.000) was smaller than 5 per cent. Coefficient
of determination was found to be 48.1%, which signaled that the regression equation
was an adequate fit for the data. Research recommends the need for the government to
strengthen its supervision of listed firms to ensure a true disclosure of financial
statement. The main shortcoming of this study is that, the researcher has solely relied
on secondary data which is historical in nature, and prone to manipulation, this could
easily have impacted negatively on the quality of the research findings because this
kind of data is easily manipulatable. Another limitation for this study is the time
frame. Five years is not adequate to establish a clear relationship between variables. A
longer duration of time like 15-20 years can enable the researcher to establish more
accurate and reliable research findings
Influence Of Teacher Characteristics On Achievement Of Reading Comprehension For Pre-school Children In Public Schools, Limuru Sub-county, Kiambu County
No full textThe thrust of this study was to analyze the influence of teacher characteristics on
reading comprehension achievement of pre-schoolers in public pre-schools of
Limuru Sub-County, Kiambu County. The study was conducted using quantitative
and descriptive analysis of data collected from sampled ECE teachers through
questionnaires. This study confirmed the assumption made by several social
theorists such as Bandura that it is not enough for a teacher to have professional
qualifications and experience. They also need to have requisite skills and the right
mindset to interact with children. According to the research study qualifications,
experience and attitude are complementary and go hand in hand to influence
reading comprehension achievement of pre-schoolers. The study may be helpful to
teacher training institutions and the Ministry of Education in recruiting teacher
trainees. A voluntary programme should be put in place so that those who want to
join the career for financial gains only and have no heart for the children are rooted
out before being trained. From the study, there is a real need to improve teacherlearner
social cohesion through workshops and semina
Implication Of Household Land Size And Land Use On Sustainable Food And Livelihood Security In A Maize Farming System Of Kalongo Sub-Location, Makueni County
No full textThe economy of the country is largely based on agriculture as the sector contributes about 30 percent of the Gross Domestic Product (GDP) and provides livelihoods to about 80 percent of the population (Kenya 2017c). The importance of agriculture to the national economy is also replicated in Makueni County as the sector employs over 78 percent of the population. Despite the importance of agriculture and its contribution to the economy, its productivity is being threatened by among other factors diminishing land sizes especially in the relatively high potential areas of the county. The phenomenon can be attributed to the land subdivision practices mainly for inheritance purposes. From literature, land fragmentation has both positive and negative effects. In addition, with the inheritance tradition still in place, land subdivision may be here to stay. However, the most critical issue would be establishing and maintaining an ideal land size so as to ensure sustainable food and livelihood security in the sub-location amidst all the pressures on land, thus the basis of this study.
The study assessed the current household land size and use and their impact on food and livelihood security, evaluated the factors influencing household land size and use, documented inter-generational transmission of land rights and use and recommended planning interventions for sustainable food and livelihood security in the maize farming system of Kalongo sub-location. Both secondary and primary as well as qualitative and quantitative data was collected for the study. The target population included the households; religious, community, political and opinion leaders; administrators and professionals within the sub-location. A representative sample from each category was selected for the study. A total of 140 households were interviewed, 3 focus group discussions held and 5 key informants interviewed. Data collection methods employed for the study included literature review, extraction of statistical data, conducting of interviews, instrument administration, field observation and photography. In addition, with the use of Arc GIS software, a chronological analysis of 5 years interval images for the area was undertaken to understand the changes that have taken place over time with regard to land size and use. The data was analyzed and presented in a meaningful form to aid in deciding on the necessary measures for ensuring food and livelihood security in the area.
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The study established that though there exists a relationship between land size and agricultural production as land is a factor of production, there was no significant difference in the land size for households who were food secure and those who were food insecure, t = -0.767 and p = 0.445. There however exists a relationship between household land size and livelihood security. The chi-square test presents a p of 0.000 which is less than α = 0.05. In addition, the study established that there is a significant relationship between maize land allocation and production, p = 0.000 is less than α = 0.05. Some of the factors affecting household land size and use include population pressure/big household sizes, brothers at the time of inheritance, education level, off-farm income, settlement patterns, land ownership, fertility of the land and topography among others. Intergenerational transmission of land rights and use was evident in the sub-location as inheritance was the most common form of land acquisition. Some of the recommendations include: land consolidation, re-organization of the settlement, establishment of settlement schemes, curbing the selling of land, sensitize people on the environmental damages, social and economic loss brought about by land subdivision as well as educating children to make them less dependent on the land that belongs to their parents. The recommended ideal land size is 5 acres, which, if properly utilized would produce enough food for household consumption and a surplus for sale in the market