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Short-term Outcomes of Asphyxia in Preterm Neonates Receiving Care at Newborn Unit, Kenyatta National Hospital
No full textBackground: Neonatal resuscitation plays a major role in preventing neonatal death due to
asphyxia. Globally, it is estimated that out of 2.5 million neonatal deaths that occur annually, 28%
of which is attributed to preterm delivery and 24% result from perinatal asphyxia. However,
despite Kenyatta National Hospital being a teaching and referral hospital providing specialty
neonatal care, there is paucity of data on short term outcomes of asphyxia in pre-term neonates
hence the need this study.
Objective: This study aimed at determining short-term outcomes of birth asphyxia in preterm
neonates receiving care at Kenyatta National Hospital Newborn Unit.
Methods: A hospital-based descriptive cross-sectional study was conducted between the month
of June and July 2019 involving mother-infant pair of preterm neonates with asphyxia (n=36)
selected purposively and Nurses working in the newborn unit (n=52) selected via systematic
random technique. Maternal socio-demographic characteristics and nurses‟ characteristics were
collected using semi-structured questionnaire and a separate checklist used to capture daily
neurological assessment for infant in the first seven days of life. Data collected were analyzed
using STATA version 14, descriptive and inferential statistics calculated using Odds Ratio with
bivariate and multinomial logistic regression applied to independent variables with level of
significance set at 95% Confidence Interval and p value = ≤ 0.05.
Results: Out of 34 infant mothers that took part in the study, advanced maternal age (AOR =3.3,
95% CI [-1571.4-1577.9]), distance from medical facility (AOR = -32, 95% CI [-20829.8-
20765.5]), low income status (AOR = -23, 95% CI [-25.8-21,4]) and anemia in pregnancy
(AOR=12.8, 95% CI[-18048.2-18073.7]) was shown to increase the risk for adverse neonatal
outcome. By the end of day seven of life, 55.8% of neonates (n=19) had recovered and got
discharged, 35.2 % (n=12) continued treatment and 9% (n=3) had expired. Neonatal
characteristics such as decreased birth weight (AOR= 0.17, 95% CI [-1054957-1054958]), low
APGAR score (AOR= -91.01, 95% CI [0.23-8.1]) and poor monitoring of vital signs (AOR= -
1.17, 95% CI [-8.04-8.0]) in neonates was found to influence neonatal outcome. There was no
significant statistical association between knowledge of nurses on preterm asphyxia and its
management in relation to neonatal outcome (p=0.635). Similarly, no significant statistical
association was found to exist between nurses‟ practice regarding immediate care of asphyxiated
neonate and neonatal outcome (p=0.512).
Conclusion: In Kenyatta National Hospital, the mortality rate of asphyxia in preterm neonates
was found to be 9 % with morbidity rate of 35% on day seven of life and this was largely
determined by maternal and neonatal risk factors rather nurse‟s knowledge and practice on
management of asphyxia.
Recommendations: There is need to strengthen prevention of anemia in pregnancy and
identification of risk factors associated with preterm asphyxia. Nurses should practice strict
observation of vital signs in high risk neonates to improve outcome. Prompt treatment of
hypoglycemia and sepsis in preterm neonate can help prevent neonatal morbidity and mortality
in early neonatal period.a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny
The colonial aftermath in digitalizing tax
No full textThe impact of colonialism is often discussed from a historical perspective. The influence of colonialism however remains evident in the current global developmental discourses, particularly in the use of technology for development because technology since colonialism has always been viewed as an important catalyst for development. In this paper, I analyze how a tax digitalization project is part of the colonial imperial formations arguing that the current project, tax for development, conforms to colonial rationale and imperatives as it employs notions of western modernity and transformation. In essence, the argument is that the very grounds used to justify colonialism is re-worked - though implicitly- to make digital technologies a cornerstone of development process especially with regards to revenue mobilization
Effect Of Financial Literacy On The Financial Management Practices Of Employees Of Public Primary Schools In Mombasa County
No full textThe istudy iinvestigated ithe ieffect iof ifinancial iliteracy ion ifinancial imanagement ipractice iof iemployees iof ipublic iprimary ischools iin iMombasa iCounty. iSpecifically, ithe istudy ifocused ion; isavings iand iinvestment iliteracy, idebt iliteracy, iretirement iliteracy iand itaxation iand iinsurance iliteracy. iThe istudy iadopted ia idescriptive istudy idesign iand ia ipopulation iof i2101 ifrom iwhich ia isample iof i336 iemployees iwere iengaged iin ithe istudy. iData iwas icollected iby iuse iof iquestionnaires istructured iusing ia i5 ipoint iLikert-scale, iquestionnaires iwere ihand idelivered ito iemployees iin ipublic iprimary ischool ifor ifilling iand icollected ifor ianalysis iafter i14 idays. iData iobtained iwas itested ifor ivalidity iand ireliability iand ianalysed iby iuse iof iStatistical iPackage ifor iSocial iSciences. iRegression ianalysis iwas iconducted ito idetermine ithe icorrelation iand ivariance ico-efficient ito iprove ithe ilevel iof isignificance iand irelationships ibetween ithe istudy ivariables. iThe istudy iestablished ithat; isavings iand iinvestment iliteracy ihas iweak ipositive iand iinsignificant icorrelation of 0.111 ito ifinancial imanagement ipractices; iretirement iliteracy ihas ia istrong ipositive iand isignificant icorrelation of 0.574ito ifinancial imanagement ipractice; idebt iliteracy ihas istrong, ipositive iand isignificant icorrelation of 0.532 ito ifinancial imanagement ipractices iand itaxation i& iinsurance iliteracy ihad ia istrong, ipositive iand isignificant icorrelation of 0.660 ito ifinancial imanagement ipractices iThe ioverall ifinding iwas ithat ifinancial iliteracy ihas ia istrong ipositive icorrelation ito ifinancial imanagement ipractices with a significant significance of 0.00. iTherefore,there iis ia istrong icorrelation ibetween ifinancial iliteracy iand ithe ifinancial imanagement ipractices iof iemployees iof ipublic iprimary ischools iin iMombasa iCounty. iThe istudy irecommends; iadoption iof ifinancial iliteracy iprograms ifor Ithe teaching istaff iof ipublic iprimary ischools; iteacher’s iservice icommission ito ilobby ifor trade iassociations ito isensitize itheir imembers ion isound ifinancial imanagement imatters and ialso iseek ipartnerships iwith iinterested iparties, ifor iinstance, iuniversities iand icolleges, iin iprovision iof ifinance iliteracy icourses ifor iits iemployees
A Multi-dimensional Model for Determining Susceptibility to Unintentional Insider Threats: the Case of Social Engineering Through Phishing
No full textMany of the information security incidents that make headlines around the
world are perpetrated by authorized users of the information systems. These users are
commonly referred to as insiders. The Unintentional Insider Threat is posed by insiders
who inadvertently compromise information systems. Literature shows that the
Unintentional Insider Threat is under researched and should be the focus of current
insider threat research. One predominant case of Unintentional Insider Threat is social
engineering particularly through phishing. There is need for a unified multidimensional
theoretical model that facilitates an understanding of the Unintentional
Insider Threat phenomenon. This research is a response to this gap.
The presented multi-dimensional theoretical model is grounded on the
Elaboration Likelihood Model and Protection Motivation Theory. In addition, it is
developed after evaluating 62 research articles on the Unintentional Insider Threat. The
model presents: 1 dependent variable, 22 independent variables and 12 control
variables. This model is then validated using data from an empirical study that is guided
by the realist, positivist and objective ontological and epistemological views; using a
deductive research approach. Quantitative data is collected by staging a naturalistic
experiment which presents a real-life social engineering phishing attack. This is after
gaining approvals for the research from an institution’s research board (IRB) and its
administration. This allows study participants to be observed without alerting them on
the ongoing research, therefore, providing data with high ecological and external
validity. Participants are then requested to fill in a cross-sectional survey in order to
measure latent constructs and variables that were not directly observed. Data is
analyzed using Structural Equation Modeling (SEM) because the technique allows for
all the variables and relationships to be tested in their entirety; and accommodates latent
constructs in the model analysis. A total of 192 cases are analyzed from an effective
sample size of 241 persons who participated in the experiment giving a 79.67%
response rate. A total of 22 hypotheses are tested. Of these, 10 are supported while 12
are not supported by the provided model specification and sample dataset. The model
is able to explain 41.4% of the Elaboration variance, 43.1% of Threat Detection
variance, 19.1% of Threat Avoidance variance and more importantly 28.7% of
Unintentional Insider Threat outcome variance and performs better than models
presented in other studies.
This study makes several contributions to theory, knowledge, policy and
practice. It presents a unified theoretical model that gives a multi-dimensional
understanding of the Unintentional Insider Threat phenomenon from demographic,
organizational, insider and attack factors. This model can be used to provide a
theoretical grounding in the study of various unintentional insider threats and can also
be comparatively applied by other researches in different contexts. The body of
knowledge is extended in the testing and analysis of 22 hypotheses and discussion of
the findings. The various factors presented in the multi-dimensional model encourage
policy makers to address the Unintentional Insider Threat not only using technology
but also through addressing psychological and sociological imperatives.
Recommendations for policy and practice show that organizations should invest in
measures that equip users with the ability to detect threats; particularly through their
knowledge on detection cues and high determinants of trust. In addition, efforts must
be taken to increase cognitive elaboration so as to intentionally counter factors that try
to diminish insider’s ability to examine deceptive scenarios
Empyema necessitans due to aspergillus in a 3-year-old paediatric patient at a referral hospital in Nairobi, Kenya
No full textWe present a case of empyema necessitans due to aspergillus in a young child. The incidence of deep fungal mycoses in children, especially in
developing countries is not known. There is paucity of data and access to diagnostics is usually limited. Our patient had received treatment for
pulmonary tuberculosis which is endemic in Kenya for four months before diagnosis was made. We present this case to highlight the importance of
considering alternative diagnosis when there is non-response to anti-tuberculous therapy
Factors Affecting Financial Performance in the Kenyan Non-Life Insurance Sector
No full textDespite premium growth over the years, Kenyan non-life insurance penetration has continued
on the downward trend from 2.28% in 2013 to 1.63% in 2017; Pro tability has also been
on the negative side since 2015; recording an underwriting loss of Kenyan shilling 0.02
Billion in 2015; 2.1 Billion in 2016 and 1.013 Billion in 2017. Against this background, the
present study establishes the internal factors a ecting Kenyan non-life insurers nancial
performance, Return on Asset (ROA) being the proxy indicator. The study was mainly
based on secondary data collected from audited nancial statements of all the 37 non-life
insurance companies in Kenya for the period 2013 to 2017 (5 years). For this purpose,
xed e ects panel data regression analysis was used to assess the relationship of insurance
companies speci c characteristics such as expense ratio, retention ratio, liquidity, company’s
size, loss ratio and shareholders equity ratio against return on assets. The statistical
ndings revealed that liquidity has a signi cant positive e ect on Kenyan non-life insurers
nancial performance; company size and loss ratio have a signi cant negative e ect; and
no signi cant relationship with expense ratio, shareholders equity ratio, and retention
ratio. The study recommends that for non-life insurers in Kenya to enhance their nancial
performance in terms of their return on assets, they should embrace technological
disruptive innovations by leveraging on new technologies that boosts their operational
e ciency and meets the evolving customer demands
Microbial Pattern in Amniotic Fluid and Histology of the Smooth Chorion in Women With Premature Rupture of Membranes and Preterm Premature Rupture of Membranes at the Kenyatta National Hospital
No full textPreterm premature rupture of membranes (PPROM) is rupture of membranes at 37 weeks gestation (1)....a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny
Factors Affecting Implementation of Strategic E-procurement of Construction Materials for Maintenance Works A Study of Private Hospitals in Nairobi City County
No full textBuilding maintenance is usually a requirement due to the use of the structure. Hospitals are not
an exception in this, as there is a requirement to ensure comfort and ambience for those in such
premises. There is a strong feeling that at the moment, there is a researchable gap to address the
situation on ground regarding the optimum management of procurement of materials for
maintenance purposes in private hospitals in Nairobi City County.
The old ways of procurement have been practiced for long, but the world is fast moving out of
this form of procurement and embracing new trends such as E-Procurement. This is in a bid to
achieve timeliness, Quality, and Cost effectiveness.
Hospitals have not fully embraced E-procurement practices and this makes them fail to benefit
from the advantages it offers, resulting into long turnaround times in correcting maintenance
related problems and eventually having customers disgruntled, due to uncomfortable hospital
conditions.
The intention of this study was to find out the procurement methods that are in use in
procurement of Materials for Maintenance Work in Private Hospitals located within Nairobi City
County. It explored the most preferred method(s) of procurement of materials for Maintenance
works and investigated the challenges facing the implementation of E-Procurement of materials
for Maintenance works in private hospitals in Nairobi City County. Study research proposition
was “E- Procurement is the most preferred system of procurement of materials for Maintenance
works in Private Hospitals within Nairobi City County”. Use of questionnaires emailed, emailed
to these hospitals, was the main method for data collection, out of which only 39 responded.
It was clear that there are several methods of procurement for construction materials in the
Nairobi City County, and most of them most procuring based on needs and not pre-planned. The
study also found that there were several challenges that faced the strategic implementation of Eprocurement
of construction materials for maintenance works such as lack of training, awareness
about e-procurement especially within the hospital suppliers was also wanting. It also found out
that most private hospitals do not implement E-Procurement especially for maintenance
construction materials procurement. The study therefore recommends continuous review of
procurement management policies, enhancement of internet connectivity, awareness of E-Procurement to
be enhanced, training, and employment of the right professionals in procurement and maintenance
departments. Levels of awareness of maintenance programming among facilities managers in these.
It identifies several areas for further study such as research on available computer-based
maintenance systems in use for maintenance in institutions, the Level of Maintenance
Programming Training in Private Hospitals in Kenya in Kenya, the Level of internet connectivity
among construction materials suppliers and its relationship with the type of methods adopted for
procurement of materials from these suppliers in Nairob
Strategic Responses Adopted By Bata Shoe Kenya Plc To Changes In The External Environment
No full textThe external environment is increasingly turbulent calling on all organizations to continuously re-think and re-focus their strategies, aligning each strategy to the macro-environment. Every organization is an open system with critical interaction with the environment. The aim of the study was to establish the strategic responses adopted by Bata Shoe Kenya Plc to changes in the external environment. The study adopted a case study design with primary data being used. The researcher collected data by use of an interview guide which was administered through face-to-face interviews during scheduled onsite visits. The respondents included the Managing Director and seven Departmental Heads, being selected through purposive sampling technique. This group was critical to the study having a role to play in strategically responding to macro-environmental changes. The collected data was scrutinized through thematic analysis. The results revealed that Bata Kenya faces political-legal, economic, social-cultural, technological, industry-level, competitor and physical environmental changes. To counter the macro-environmental changes, the findings showed that Bata Kenya has put in place various strategic responses. These are- modernization, diversification, innovation, market positioning, market segmentation, partnership, total quality management, vertical integration, outsourcing, marketing and advertising, frugality, training and restructuring strategies. The study made significant contributions to theory, policy and strategic management practice. On the theoretical front, there was a deviation from the philosophy that the external environment is non-controllable as modern organizations are powerful tools in the society with an ability to influence the direction of the macro-environment. The study offered helpful information to various administrative bodies with a stake in the footwear manufacturing business. This enables a better understanding of the challenges and opportunities faced for enactment of improvement measures. Industrialization policymakers can for instance identify and address gaps such as exportation of high quality leather, creating scarcity in the domestic market as well as increased competition driven by footwear importation. Finance policymakers can make better budgetary decisions to support footwear manufacturing businesses in Kenya. On strategic management practice, the study can be of value to the management of Bata Kenya and footwear manufacturing businesses in Kenya at large. The findings can enable them assess the adequacy of major response strategies. The research was limited to Bata Shoe Kenya Plc and in terms of the period it covered, being the past five years. The study concluded that Bata Shoe Kenya Plc deploys a combination of strategies to counter challenges emanating from the external environment. In doing so, the company adopts a proactive stance by forecasting the macro-environmental changes and deploying precautionary measures. This helps the organization overcome many challenges faced in strategic response and exert influence on the macro-environment. The study suggests to future researchers to consider conducting a comparative study of the strategic responses adopted by formal footwear manufacturers in Kenya versus the informal footwear manufacturers to changes in the external environment
Prevalence of Iron Deficiency and Iron Deficiency Anaemia in Low Birth Weight Infants on Follow-up at Kenyatta National Hospital
No full textBackground
Iron deficiency anaemia (IDA) is a common micronutrient deficiency that contributes to morbidity and mortality among low birth weight infants; with significant, long-term effects on memory, cognition and auditory brain responses. Prevention is achieved by early initiation of iron supplementation as prophylaxis against IDA. Kenyan national guidelines recommend supplementation of elemental iron for infants born weighing less than 2000 grams, starting at 4 weeks of age.
Objectives
The aim of this study was to determine the prevalence of iron deficiency anaemia among low birth weight infants aged 12 months and below following discharge from the New Born Unit. It also sought to identify factors influencing the uptake of iron supplements among LBW infants as prophylaxis against IDA.
Methodology
A cross-sectional study was conducted among babies born weighing 2000 grams and below aged less than one year, on follow-up at various newborn, outpatient clinics at Kenyatta National Hospital. 110 infants were recruited into the study. Socio-demographic and clinical details of the infant-mother dyads were obtained and blood samples collected for analysis of Hemoglobin, MCV and Transferrin receptor levels as measures of levels of deficiencies of iron.
Prevalence of ID and IDA was calculated as a percentage of normal levels of hemoglobin, MCV and estimated iron levels. Bivariate and Multivariate analyses were done to find out the various factors associated with the uptake of iron supplements.
Results
The prevalence of ID and IDA among LBW infants on follow-up at KNH was at 3.6% {95% Confidence Interval (CI) 0%-7%} and 14.5% (95% CI 8%-21%) respectively. However, the total prevalence of anaemia was at 26.4% (95% CI 18%-35%) with most infants receiving iron prophylaxis at high dosages. The factors that positively influenced the uptake of iron supplementation were maternal factors which included; >4 ANC visits(AOR=2.9; 95% CI 1.74-4.77), gestation at 1st visit at <18 weeks(AOR 8.12; 95%CI 4.59-14.38), and prior history of pregnancy losses (AOR=3.91; 95%CI 1.40-10.89); infant factors (age<3 months {AOR 3.77; 95%CI 1.81-7.92}, birth weight <1800g {AOR 5.03 95%CI 1.13-22.40} and provision of health education (AOR 20.28, 95% CI 9.163-41.883).
Conclusion and Recommendation
While the prevalence of ID and IDA among low birth weight infants on follow-up at KNH was low, the use of iron supplements till the age of one year should be emphasized in line with the national guidelines, as this is crucial in the prevention of ID and IDA in LBW infants.a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny