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Cost Analysis Of Facility-Based HIV Testing Models In Kenya; A Case Of Riruta Health Centre
No full textHIV testing is the first and essential step in HIV management. Awareness of HIV status is an important step in linking people to prevention, care and treatment services and reducing possible transmission of HIV. Despite this step being key in HIV management, there exist people living with HIV in Kenya who do not know their HIV status. There is need to identify cost effective HIV testing models that target to reach the unreached population and help reduce risk of HIV transmission. The aim of the study was to document HIV testing models and estimate unit cost of facility-based HIV testing. This study was conducted at Riruta Health Centre, Nairobi County. Process maps were used to document HIV testing and to capture all the resources used at the facility. Testing models were established through key informant interviews. Cost for HIV testing was estimated by considering cost of HIV test kits, consumables, space, furniture and cost of human resource. Overhead costs were applied at 10% of the total costs. An abstraction tool was used to collect retrospective data for all children and adults tested for HIV at the facility between July 2017-June 2018. Facility-based HIV testing was predominant at facility. However, it participated in community HIV testing when there was planned outreach by other institutions. A total of 30,665 HIV tests were done at the Voluntary Counselling and Testing Centers (VCT) and 237 at Antenatal Clinic (ANC) of the total tests done 600 were reactive. No data on HIV self-testing was documented for the period under study. Costs of test kits and consumables per a non-reactive test was Ksh189.30 compared with Ksh541.40 for a reactive test for general population. Testing costs at ANC were higher; Ksh.221.26 for a non-reactive test compared to Ksh.573.33 for a reactive test using HIV Syphilis duo test kit. There was a difference in the cost of HIV test based on the cadre of officer that performed the test; Ksh70.44 for HTS counselor compared Ksh104.64 for a registered Nurse. Costing information is useful for resource allocation and carrying out economic evaluations of HIV testing programs.a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny
The Impact Of Public Sector Investment In Human Capital On Economic Growth: A Case Study Of Healthcare And Education In Kenya
No full textThis study sought to explore the impact of public sector investment in human capital on economic growth in Kenya. In order to establish the impact specific components of investment in human capital on economic growth, human capital was disintegrated into two major components of education and healthcare. The dependent variable was economic growth expressed as real GDP while expenditure by the government on the two components human capital formed the independent variables. The study utilized time series secondary data sourced from the different Kenya’s annual Economic Surveys and Statistical Abstracts by KNBS and data from World Bank database.
The study was anchored on Solow’s Swan growth model and used ADF test to check for the presence of unit root and the test found that all study variables were stationary. Johansen (1988) was also utilized in checking for long run correlation between the study variables and it was confirmed that the variables were cointegrated and therefore restricted VAR was estimated. Estimates obtained from restricted VAR were used to derive impulse response functions and variance decomposition analysis and the results used to interpret the impacts of investment in human capital development on education and healthcare on growth of the Kenyan economy. The study found that investment in healthcare and education had a consistently positive impact on the growth of the economy and that such positive impact was felt both in the short-term and long-term. The study therefore recommended that the government through its relevant policy making and budgeting institutions design policies aimed at attracting and improving both public and private sector investments in researched components of human capital to spur growth of the economy and help achieve its development goals as envisioned under Vision 2030 development blue print.
Key Words: Human Capital, Economic Growth, Investments, Solow growth Model, Impulse Response Function, Impact, and Budgeting
A mixed model approach to vegetation condition prediction using artificial neural networks (ANN): case of Kenya’s Operational Drought Monitoring
No full textDroughts, with their increasing frequency of occurrence, especially in the Greater Horn of Africa (GHA), continue to negatively affect lives and livelihoods. For example, the 2011 drought in East Africa caused massive losses, documented to have cost the Kenyan economy over 12 billion US dollars. Consequently, the demand is ever-increasing for ex-ante drought early warning systems with the ability to offer drought forecasts with sufficient lead times The study uses 10 precipitation and vegetation condition indices that are lagged over 1, 2 and 3-month time-steps to predict future values of vegetation condition index aggregated over a 3-month time period (VCI3M) that is a proxy variable for drought monitoring. The study used data covering the period 2001–2015 at a monthly frequency for four arid northern Kenya counties for model training, with data for 2016–2017 used as out-of-sample data for model testing. The study adopted a model space search approach to obtain the most predictive artificial neural network (ANN) model as opposed to the traditional greedy search approach that is based on optimal variable selection at each model building step. The initial large model-space was reduced using the general additive model (GAM) technique together with a set of assumptions. Even though we built a total of 102 GAM models, only 20 had R2 ≥ 0.7, and togetherwith the model with lag of the predicted variable, were subjected to the ANN modelling process. The ANN process itself uses the brute-force approach that automatically partitions the training data into 10 sub-samples, builds the ANN models in these samples and evaluates their performance usingmultiple metrics. The results show the superiority of 1-month lag of the variables as compared tolonger time lags of 2 and 3 months. The best ANN model recorded an R 2 of 0.78 between actual and predicted vegetation conditions 1-month ahead using the out-of-sample data. Investigated as a classifier distinguishing five vegetation deficit classes, the best ANN model had a modest accuracy of 67% and a multi-class area under the receiver operating characteristic curve (AUROC) of 89.99%
Alliance For A Green Revolution In Africa-Agra
No full textProject Implementation ;
PI: Prof. A.W. Mwang’ombe
Management: Prof. F. Olubayo, Dr. Kiarie Njoroge
Dr. D.K. Ndung’u –Project Manager, Florence Kiwunja-Admin. Asst., Rosebena Cherono –Field Asst, Francis Maina, Caroline Ndumi, B. Kirang
Prevalence Of Secondary Medical Complications After Traumatic Spinal Cord Injury During Acute Care In Kenyatta National Hospital
No full textBackground: There is paucity of data in low and middle income countries concerning the burden of traumatic spinal cord injury (tSCI). Despite advanced acute care and better awareness and identification of complications, many complications still occur during acute phase. These complications lengthen hospital stays and adversely affect rehabilitation. Attempt aimed at improving quality of care should be based on comprehensive and reliable data. This data is lacking in our local setting.
Study Design: Hospital based Prospective Cohort Study.
Objectives: To identify the prevalence of selected medical complications after tSCI during acute care and to identify predisposing factors for pressure ulcers.
Study Population: Patients with acute tSCI or traumatic cauda equina syndrome aged 18 years and above at admission.
Methods: Demographic, injury characteristics and neurological severity data were captured using International SCI Core Data Set. The predefined medical complications were screened for and recorded. Risk factors for pressure ulcers were assessed through logistic regression models.
Results: A sample of 63 (92.65%) patients was analyzed. Overall, the most common secondary medical complication was Urinary Tract Infection (UTI) (n= 46 (73.02%)), followed by pulmonary complications (n=38 (60.32)) and pressure ulcers (n=26 (41.27%)). Other complications were neuropathic pain, (n =22 (34.92%)), spasticity (n =18 (28.57%)), autonomic dysreflexia, (n =14 (22.22%)) and venous thromboembolism (n =9 (14.29%)).
Significant risk factors for development of pressure ulcers were development of urinary tract infections and pulmonary complications at risks of 3.5 and 11.7 times of developing PU, respectively (Odds Ratio (OR) =3.52; 95% CI: 1.15-10.75) (OR=11.75; 95% CI: 1.12-123.24). Additionally, those with more than one complication were 6.4 times more likely to develop PU, as compared to those with only one complication (95% CI: 1.05-39.33). Those aged between 46-60 years were 4.7 times more likely to develop PUs, compared with the younger (18-30) age group. This was only significant at 90% confidence interval. (OR = 4.7; 90% CI: 0.98–23.54).
Conclusion: Secondary medical complications are common in traumatic Spinal Cord injury in Kenyatta National Hospital during acute care. Individual risk factors for development of pressure ulcers were urinary tract infections, pulmonary complications and patients having more than 2 complications.
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1.0 INTRODUCTION
Life expectancy for patients with tSCI has increased over the last few decades (1). This is due to medical advances that have led to improved health care (2). In this respect, it is noteworthy that tSCI not only results in paraplegia or tetraplegia but also adverse events (AEs) that have become frequent during acute care in patients with tSCI(3, 4). These complications lengthen hospital stays and affect the rehabilitation process. To prevent complications, more information about the number and nature of complications is needed (1).
Over half of tSCI patients will have at least 1 complication during hospital stay. 75% of these adverse events present within 2 weeks. These adverse events associated with tSCI carry a significant risk of morbidity and mortality. Prompt diagnosis and treatment is critical in care of the tSCI patients (5).
Most published and unpublished studies have reported the common secondary medical complications of traumatic spinal cord injuries to include, pulmonary complications, urinary tract infections, pressure ulcers, autonomic dysreflexia, deep vein thrombosis, pulmonary embolism, spasticity and neuropathic pain (1, 2, 6-9). Age, severity of neurological injury, associated traumatic brain injury, comorbid illnesses and mechanism of injury have all been shown to increase risk of complications (1, 5). There is limited local data regarding the prevalence of these secondary complications. One local study reported prevalence of 48.3% for neuropathic pain, 44.8% for pressure ulcers and 40.8% overall mortality within 3 months.(10) Above findings indicate that these complications are indeed a huge burden in management of traumatic spinal cord injuries in our local setting.
Pressure ulcers are serious and common complications in patients with tSCI. Though an ancient, pressure ulcers are still a problem today. Pressure ulcers commonly occur over bony prominences such as the sacrum, ischial tuberosities, heels, malleoli and greater trochanters. Previous reports have identified reduced activity, insensibility, moisture from urinary or fecal incontinence, atrophy, prolonged time since injury, depression, smoking and malnutrition as
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the main predisposing factors. However, identification of pre disposing factors in the local settings is lacking. Pressure ulcers constitute a huge burden in the management and rehabilitation of tSCI patients especially in resource limited settings in developing countries (11, 12). As well as other complications, pressure ulcers are associated with longer hospital stay with dire financial implications (1, 13).a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Keny
Assessment of farmers' compliance in implementing recommended cow comfort changes and their effects on lying time, stall and cow cleanliness within smallholder dairy farms in Kenya
No full textOur study aimed to evaluate farmers' compliance in implementing recommendations of farm-specific cow comfort changes, and the effects of these changes on lying time, stall cleanliness and cow cleanliness using a randomized controlled trial carried out on 100 smallholder dairy farms in Kenya, with 62 and 11 farms remaining in the intervention and control groups, respectively. On the first farm visit, data loggers were attached on lactating cows to determine lying time and questionnaires utilized to collect baseline data. Three days later, stall design and management recommendations were given to the intervention group of farmers orally and in written form. After an average of 39 ± 7 days, data loggers were re-attached, compliance was assessed, and a post-intervention questionnaire was administered to the intervention group on the third visit. Three days subsequent to the first and third visits, data loggers were removed from all cows. Data were analysed in Stata 14.2® using proportion tests and Kruskal-Wallis rank tests to compare cleanliness scores and lying time, respectively. Interaction effects between treatment groups and visits were assessed using multivariable mixed linear and logistic regression models. While 46 of the 62 intervention farmers (74%) made at least one recommended change to cow comfort, 63% of the 324 overall recommendations were implemented. The odds of a recommendation being implemented were significantly higher when:1) major recommendations were given relative to minor recommendations (OR = 6.28); 2) recommendations were related to floor characteristics (floor softness and flatness) in comparison to recommendations related to stall design (OR = 3.14). The odds of compliance were lower on: 1) farms where the farm-hands received the recommendations compared to farms that had the female principal farmer receive the recommendations (OR = 0.01); 2) farms that had recommended changes related to roof, alley and sharps fixes relative to stall design fixes (OR = 0.13). Post-intervention, stall, udder and upper hind-leg cleanliness scores improved significantly (p < 0.0001, p = 0.021 and p = 0.017, respectively) in the intervention farms but not in the control farms. There was no significant difference in lying times between intervention and control farms, with 0.6 and 0.2 h/day increases being recorded in the intervention and control groups, from the 10.9 and 10.4 h/day at baseline, respectively. Giving farm-specific cow comfort recommendations to smallholder dairy farmers in Kenya, and providing them with a participatory role in the formulation and implementation of improvement recommendations ensured good acceptance and a high degree of implementation, and led to a subsequent improvement in cow comfort and cleanliness
Influence of Teacher Preparedness on Implementation of Competency Based Curriculum in Public Primary Schools in Nyandarua North Sub- County, Kenya.
No full textDespite the key role played by women in social and economic development,
gender differences in education and formal employment have continued to retard
the female potential in favor of their male counterparts. Consequently, this study
sought to investigate the influence of institutional practices on women lecturers’
progression to management positions in Liberia based on the perspectives of the
University of Liberia. The study sought to determine the influence of women
lecturer mentors, administrative support, implementation of internal affirmative
action policy, and promotion criteria on women lecturers’ progression to top
management. The study employed a descriptive research methodology that
incorporated survey techniques in collecting data from target respondents, who
were employees of the University of Liberia using both structured questionnaires
and interview guide. The survey sample consisted of all full time lecturers and
senior administrators at the University of Liberia. Purposive sampling was used as
a guide to selecting women senior administrators of the university while simple
random sampling was used to select male administrators. Stratified random
sampling was used to select lecturers. A total of 168 respondents comprising of 1
president, 5 vice presidents, 10 heads of academic programmes, and 152 lecturers
participated in the survey. The questionnaire return rate was 95.2% Data collected
was coded, input into, and analyzed using SPSS statistical analysis software
Version 20. For qualitative data, content analysis of documentary and verbal
material was used for analysis while quantitative data was analyzed using both
descriptive and inferential statistics to give frequency counts, percentages, and
correlation coefficients between study variables. The findings are presented in
frequency tables and charts. The study revealed that mentorship, administrative
support, internal affirmative action policy and promotion criteria are principal
factors that influence women lecturers’ progression to management positions at
the University of Liberia, and that their expected outcomes can be negated by
marginalization and bureaucracy. Key conclusion of the study is that, academic
qualification, experience, hard work and diligence were necessary for women to
progress to management positions. The study, therefore, recommends that besides
women taking initiative to develop better working and networking relationships
with other women, enforcement mechanisms for more affirmative action of
mentorship and review of promotion criteria with a bias to female leading should
be undertaken by the university
Influence Of Foreign Market Entry Strategies On Export Performance Of Epz Firms In Kenya
No full textThe objective of the study was to determine the influence of foreign market entry
strategies on export performance of EPZ firms in Kenya. The research was conducted
using descriptive cross sectional survey design. The population of interest was all the
EPZ firms in Kenya. There are 113 firms in the three EPZ zones in Kenya. Thus the
target population was 113 EPZ firms in Kenya. The researcher chose a representative
sample of thirty-five (35) firms, which was 30% of the population. The sample was
selected using the stratified sampling technique where the population was divided into
subgroups based on zone and location. The study used an open ended questionnaire as the
main instrument of collecting primary data. The data from the field was checked to
ensure completeness, consistency and accuracy. The data was then coded and tabulated to
facilitate data analysis. The researcher analyzed the data and presented the results in form
of percentages, frequencies, graphs and tables. In addition, the researcher used
descriptive statistics such as the mean and standard deviation to also present the data. The
response rate of 86%. The study found that entry into the foreign market gave the firms a
chance to relaunch themselves after many years of absence. The study found that the firm
has created value for its customers through quality products and services as a results of
foreign market entry strategies. The study further found that the firm’s market share has
improved due to increased marketing activities as a result of foreign market entry
strategies. The study concluded that the firms first used joint ventures or strategic
alliances strategy. The study concluded that the strategy chosen to enter the foreign
market was very effective. The study recommended that the EPZ firms should critically
analyze the various strategies at their disposal in entering a new market before making
decisions on how to enter the selected market. Market entry strategy plays a very
important role in determining the successfulness of the multinational corporations on the
local market
Prevalence and Dental Effects of Infant Oral Mutilation or Ebiino Among 3-5 Year-old Children From a Rural District in Uganda
No full textBackground: Ebiino, a form of Infant Oral Mutilation (IOM), involves the gauging or enucleation of primary canine tooth buds in infants, and is believed to be a form of remedy to a range of childhood diseases. The effects of this practice have ranged from the child experiencing excessive bleeding, opportunistic infections and even death, besides the potential negative dental effects on primary and the developing permanent dentition of the affected child. The purpose of the study was to establish the occurrence of Ebiino and its dental effects in a rural child-population in Uganda.
Methods: This study formed part of a larger descriptive cross-sectional study on dental caries and gingivitis, in which 432 children aged 3-5 years old from Nyakagyeme Sub-county, Rukungiri District, Uganda, participated. All the 432 participants (230 males and 202 females, mean age 4.1 SD = 0.8) who had been recruited through stratified random sampling procedure, and whose caregivers had provided a written informed consent, were included in the study. Initially the past dental history of each participant was obtained, and all the children had an oral examination carried out to establish their dental status.
Results: The data gathered were entered in a computer and analysed using Windows SPSS version 23.0. The results of the analysis showed the prevalence of missing teeth not due to reasons like caries or trauma was 8.1%, with the primary canine being the most commonly missing tooth. These unusual missing teeth were attributed to a traditional practice called Ebiino. Chi-square test showed no statistically significant association of Ebiino with gender and age (p = 0.352 and p = 0.909, respectively). Also found in the study were enamel hypoplasia or damage of some primary canines and/or the primary lateral incisors and first primary molars, as well as displacement of adjacent teeth, a result found to be associated with the practice.
Conclusion: The practice of Ebiino appears to be endemic within the communities in Rukungiri region in spite of the negative impacts in form of hypoplasia, midline shift, trauma, dental displacement and missing adjacent teeth that it had on the primary dentition of the child
Gender Assessment Of Access To Financial Capital For Agri-business Smes: A Case Of Fish Traders In Homa Bay County
No full textThis was a cross-sectional descriptive study on gender assessment of access to financial capital among agribusiness SMEs in the fish trade in Homa Bay County. Specifically, the study set out to: assess the gendered socio-economic determinants of access to financial capital for agribusiness SMEs in fish trade; determine financial institutional factors that affect uptake of financial capital by gender among agribusiness SMEs in fish trade; and to establish the gender differential challenges experienced in the uptake to financial capital for agribusiness SMEs in fish trade in Homa Bay County. The current study employed both quantitative and qualitative approaches and utilized Financial Capital Theory and Harvard Analytical Framework as the theoretical frameworks to guide the inquiry. The study adopted secondary analysis, in-depth interviews and key informant interviews as methods of data collection. Secondary data collection involved extensive content analysis of data from Financial Access (2019). Respondents for in-depth interviews and key informant interviews were selected through multi-stage random sampling and purposive sampling respectively. Quantitative data collected was analyzed using descriptive statistics presented in tables, charts and graphs for easy interpretation. Statistical Packages for Social Sciences (SPSS) was used for quantitative data analysis. Qualitative data was coded and analyzed thematically in line with the study objectives presented in prose and verbatim quotes used to project the voices of the participants. Analysis of qualitative data was analyzed using Nvivo software. Findings of the study show that socio-economic determinants indicated that respondents had access to financial capital with a higher primary level of education, there was a positive and significant relationship between level of education and access to finance, an increase in the level of education had an increase in access to finance. The findings also indicated that access to financial capital is gendered along the socio-economic factors such as land ownership, bank account ownership, level of education, marital status among other factors. Female fish traders also reported human rights violations such as sexual harassment from fishers (fish for sex). In order to address the gaps in financial access, the study recommends that sensitization-targeting women on economic entitlement need to be carried out in the county, financial institutions to review the existing financial laws and policies to improve the flexibility of the services offered and putt up banks or banks agents along the beaches. The study further recommends that there is need to link self-help group and Beach Management Unit with the financial institution to enhance financial access among fish traders, development partners need to support and promote fish farming or aquaculture value chain among female fish traders, to provide enough fish and address sustainable development goal no.14 on life below water