EANSO East African Nature and Science Organization Journals
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Quality and Effect of Maternal Death Reviews on Annual Trends of Maternal Mortality Ratio at a Tertiary Referral Hospital in Western Kenya
Get PDFIntroduction: The Global maternal mortality ratio remains high despite various strategies to lower it. More than two-thirds of global maternal deaths occur in Sub-Saharan Africa. Kenya’s maternal mortality ratio estimate is 355 deaths per 100,000 live births. To achieve below 70 deaths per 100,000 live births by 2030, Kenya’s Ministry of Health recommended the use of maternal death reviews as a mortality reduction strategy. The quality of MDR is an area of concern as to whether it achieves its desired goal. We sought to assess the quality and effect of maternal death reviews on annual trends of maternal mortality ratio at a tertiary hospital in Western Kenya between 2019 and 2023. Methods: A five-year retrospective chart review of 111 maternal death review forms was done, with variables being completeness of the forms, timeliness of review, and notification of maternal deaths. Statistical analyses were done using R version 4.4.1. To assess for quality, variables were dichotomised into either a yes or a no. Completeness sought to review if all sections of the review form were filled, while timeliness aimed to establish if a death was either notified within 24hours or not, and also reviewed by at least 40 percent of the relevant committee. Results: Median (Interquartile range) age of the parturients who had maternal death was 26 (22,33) with gestational age median of 33(30,37) weeks. Only 7% of the forms were complete, with 57.6% notified and 16.2% reviewed within seven days as per Ministry of Health guidelines. Across the five years, the average quality score was 1.89 (47.3%) with no effect on either decline or increase of maternal mortality ratio (P=0.482). Conclusion: The Quality of Maternal death reviews didn’t meet the set standards. As a result, no impact was observed on the maternal mortality trends as a result of the reviews over the period of evaluation. Recommendation: We recommend electronic notification of all maternal deaths and filling of all the forms, as this will ensure compliance with timeliness and completeness of filling of maternal death review forms
Capacity Building as a Predictor of Service Provision among Community Health Promoters in Nandi County, Kenya
Get PDFCapacity building is increasingly recognised as a cornerstone for strengthening community health systems, particularly in underserved regions where Community Health Promoters (CHPs) play a vital role in bridging the gap between households and formal healthcare services. This study examined the role of capacity building in enhancing the effectiveness of CHPs’ service provision in Nandi County, Kenya. The research adopted a descriptive design and targeted 1,567 CHPs across six sub-counties, from which a stratified random sample of 306 was drawn. Data were collected using a structured five-point Likert scale questionnaire that was pretested in Uasin Gishu County to ensure reliability and validity. A total of 287 responses were obtained, yielding a 93.8 percent response rate. Descriptive statistics indicated that although many CHPs had received some form of training, gaps persisted in the consistency, adequacy, and relevance of these capacity-building initiatives, which in turn affected their ability to deliver services effectively. Inferential analysis using Pearson correlation showed that capacity building had a statistically significant positive relationship with service provision (r = 0.518, p < 0.01), while regression analysis confirmed that capacity building was the strongest predictor among all facilitators, explaining a substantial portion of the variance in CHP performance outcomes. CHPs who accessed regular training, mentorship, and learning resources demonstrated greater confidence, improved efficiency, and stronger engagement with their communities. The findings underscore that beyond financial incentives, supplies, and job security, sustained investment in capacity building remains the most critical enabler of community health service delivery. The study concludes that institutionalising structured and continuous professional development programs for CHPs is essential for equipping them with the skills to respond to evolving health challenges, foster innovation, and build trust between communities and health systems. Policymakers and stakeholders are therefore urged to prioritise capacity building as a strategic pathway toward achieving universal health coverage in Kenya and similar contexts
Assessing Prevalence of Vaccination, Awareness, and Exposure to Risk Factors of Hepatitis B in Wa Municipality: A Descriptive Cross-Sectional Study
Get PDFBackground: Hepatitis B (HBV) in the Wa Municipality has increased over the past several years in Ghana, calling for urgent prevention and education interventions. This study evaluated awareness, vaccination coverage, and risk factors for HBV exposure in Wa Municipality, Ghana, to guide public health interventions. Methods: A cross-sectional study was conducted among 300 adults aged 18 years and above residing in Wa Municipality. A pre-tested questionnaire was used to collect information on demographic profile, knowledge about HBV, vaccination status, and history of exposure to major risk factors from January 1 to February 20, 2022. Statistical Package for Social Sciences (SPSS) version 22 was used to compute descriptive statistics and Pearson's correlation analysis. Results: The prevalence of full vaccination against HBV among respondents was 42%. The overall exposure to hepatitis B risk factors was 14.2%. Awareness of HBV was generally high, with about 81% exhibiting adequate awareness of risk factors, 92.6% of preventive measures and 80.6% of signs and symptoms of Hepatitis B. Statistically significant negative correlations were found between awareness of Hepatitis B exposure to risk factors (r = -0.282, p < 0.01), risk factors, (r = -0.251, p < 0.01) and preventive measures (r = -0.222, p < 0.01) and exposure to risk factors, and this increased awareness was linked with reduced risk exposure. Conclusion: Although Hepatitis B awareness is high in Wa Municipality, HBV vaccination is suboptimal. Targeted interventions must be implemented to optimise vaccination coverage and decrease HBV transmission in the Municipality. Future research must examine barriers to Hepatitis B vaccination, migration impact on HBV transmission, and the impact of interventions in progress
Exploring Task-Shifting Approaches in Addressing Specialist Shortages to Enhance Access to Healthcare Services in Rural Kenya: A Systematic Review
Get PDFAccess to healthcare services in rural Kenya remains significantly constrained due to a chronic shortage of medical specialists, uneven distribution of resources, and weak health system structures. Task-shifting, the delegation of specific clinical responsibilities to non-specialist health workers, has emerged as a promising strategy to address these gaps. This systematic review aimed to evaluate how task-shifting influences access to healthcare services in rural Kenya by examining individual, systemic, and policy-level determinants. A total of 28 empirical studies published between 2020 and 2025 were systematically analysed using the PRISMA framework. The findings revealed that individual factors such as adequate training, clinical experience, positive attitudes, and self-efficacy significantly enhance the effectiveness of task-shifting. Human resource capacity, particularly the availability of trained non-specialists and consistent supervision, played a crucial role in ensuring service quality. Health system readiness, including functional infrastructure, referral systems, and medical supplies, emerged as critical enablers of successful task-shifting, while deficiencies in these areas limited intervention effectiveness. Furthermore, policy and governance frameworks influenced scalability and sustainability, with weak enforcement and ambiguous role definitions identified as major barriers in Kenya. Overall, the review found that task-shifting can significantly improve healthcare access in rural settings, but only when supported by comprehensive training, adequate system capacity, and strong regulatory frameworks. The study concludes that task-shifting is a viable solution to mitigate specialist shortages, but its success requires a holistic approach that addresses training, supervision, infrastructure, and policy enforcement. It recommends the development of standardised training programs, robust mentorship systems, investments in rural healthcare infrastructure, and the creation and enforcement of clear, context-specific task-shifting policies. These findings are critical for health policymakers and practitioners seeking to enhance equitable healthcare delivery in underserved regions of Kenya
Validating Measures of Technological Acceptance Model in the Context of Lecturers at Kyambogo University
Get PDFThe study validated the measures of the Technological Acceptance Model (TAM) in the context of lecturers at Kyambogo University. Based on Davis (1986), the TAM was studied in terms of perceived usefulness, perceived ease of use and behavioural intention. In this correlational study that involved a sample of 195 lecturers at Kyambogo University, data were collected using a self-administered questionnaire. Descriptive statistics and structural equation modelling (SEM) using Smart PLS for partial least square structural equation modelling (PLS-SEM) were used to determine the presence of the three constructs of the TAM, namely perceived usefulness, perceived ease of use and behavioural intention. Descriptive results indicated that the above three constructs of the TAM were highly practised by lecturers at Kyambogo University. PLS-SEM showed that the indicators that were used to measure the above three constructs of TAM were appropriate measures. The study concluded that the indicators assessed in this article to measure the three constructs of TAM, namely, perceived usefulness, perceived ease of use and behavioural intention, are valid and reliable. It was recommended that researchers use the indicators assessed in this article to measure the three constructs of TA
Quantum-resistant SSL/TLS: Preparing for Post-quantum Cryptography
Get PDFThe rise of quantum computing presents a significant threat to current cryptographic protocols, including SSL/TLS, which are fundamental to secure communication over the internet. This paper provides a comprehensive review of quantum-resistant SSL/TLS implementations to address the looming risks posed by quantum attacks. Using the PRISMA methodology, 766 articles were screened, with 27 meeting the inclusion criteria for in-depth analysis. The study evaluates the design, testing, and validation processes of quantum-resistant algorithms such as SPHINCS+, CRYSTALS-Kyber, and Dilithium, emphasising their integration into TLS 1.3. Key findings highlight advancements in algorithmic choices, protocol modifications, and security assurances while addressing challenges like computational overhead and compatibility issues. By offering a thorough assessment of current developments, this paper aims to guide future research and practical deployment of quantum-resistant cryptography to safeguard digital communications in the post-quantum er
Development of Cost Minimisation Model for Improvement of Road Maintenance Management
Get PDFThis study aimed to develop a maintenance cost minimisation model for the improvement of road maintenance management under TARURA in Songea District, Tanzania. Recognising road maintenance as a cornerstone of socio-economic development in urbanising regions, the research identifies key cost drivers and proposes a data-driven framework for financial sustainability and operational improvement. A quantitative approach was employed, using structured questionnaires administered to 82 respondents from TARURA and civil contracting firms. Descriptive statistics and the Relative Importance Index (RII) ranked critical cost factors, while multiple linear regression analysis was used to construct and validate the model. Five major cost determinants were identified: project management, resource availability, material usage, institutional frameworks, and environmental conditions—with project management emerging as the most influential. The model demonstrated strong explanatory power (R² = 0.766) and high predictive accuracy (97.83%), further optimised through a linear programming objective function. The study recommends structured project management, technological investment, institutional strengthening, and local sourcing strategies to reduce maintenance costs. These findings offer an actionable roadmap for policy reform and operational planning in road infrastructure managemen
Comparative Life Cycle Cost Analysis of Selected Maintenance Strategies for Low-Volume Roads: A Case Study of Ubungo District, Tanzania
Get PDFLow-volume roads in developing countries face significant maintenance challenges due to resource constraints and inadequate strategic planning frameworks. This study conducted a comparative life cycle cost analysis of maintenance strategies for low-volume roads in Ubungo District, Tanzania, to optimise resource allocation and improve infrastructure sustainability. Using a mixed-methods research design, data were collected through structured questionnaires from 67 qualified professionals across various stakeholder categories. The study employed the Relative Importance Index (RII) analysis to identify critical life cycle cost components and developed a multiple regression model to predict strategic maintenance costs. Results revealed seven high-importance cost factors with RII values ≥ 0.88: Periodic Maintenance Costs (RII = 0.892), Emergency Repair Costs (RII = 0.886), User Delay and Disruption Costs (RII = 0.883), Initial Construction Costs (RII = 0.880), Environmental Impact Costs (RII = 0.874), Spot Maintenance Costs (RII = 0.871), and Routine Maintenance Costs (RII = 0.866). A robust predictive model was developed with exceptional performance (R² = 0.98, F = 387.45, p < 0.001). The model equation: Strategic Maintenance Cost = 0.04 + 0.02(PMC) + 0.04(ERC) + 0.02(UDC) + 0.03(ICC) + 0.02(EIC) + 0.02(SMC) + 0.01(RMC) demonstrated statistical significance across all variables. Validation testing across five road scenarios showed model confidence ranging from 20% (very severe conditions) to 84% (very good conditions), confirming the model's discriminatory capability. The findings demonstrate that proactive maintenance strategies significantly enhance cost predictability and infrastructure performance compared to reactive approaches. This research provides evidence-based recommendations for Tanzania Rural and Urban Roads Agency (TARURA) and similar organisations to optimise maintenance planning, improve resource allocation efficiency, and achieve sustainable road infrastructure management in low-volume road networks
Development of Maintenance Management Model to Enhance Reliability Performance of Kurasini Oil Jetty
Get PDFThe Kurasini Oil Jetty (KOJ) in Dar es Salaam, a critical hub for Tanzania’s petroleum imports and exports, faces declining reliability due to ageing infrastructure and reactive maintenance practices. This study aimed to develop a proactive maintenance management model to enhance KOJ reliability performance. A mixed-methods case study combined quantitative data from field observations and expert consultations. The analysis identified twelve (12) factors affecting reliability that are structural failure, quality construction and design, material durability, corrosion of steel components, inadequate maintenance practices, absence of scheduled preventive maintenance, dependence on reactive maintenance, lack of condition monitoring system, inadequate spare parts availability, and absence of protective coatings. From twelve (12) identified factors, seven (7) factors that are most significant and significant were identified which are; enhancing reliability performance was identified that include a recurring vessel impact during vessel docking at the jetty, a lack of cathodic protection systems, a lack of protective coatings, material durability, frequent vessel impacts, quality construction, and progressive structural failures. A multiple linear regression model demonstrated strong explanatory (R2=0.711) and high predictive accuracy, validated by a mean absolute error under 10%, indicating that 71.1% of the reliability performance was enhanced by the selected independent variables from the prediction equation: RP=8.503+2.227QD+0.366MD-1.122PC-0.34RV-0.806CP-0.217SF-1.585RM. ANOVA tests have further validated the model with (F=10.201, p<0.001), showing the statistical significance. The proposed model advocates condition monitoring, corrosion protection, quality construction standards, and preventive maintenance as critical strategies. This framework offers a scalable solution for improving the reliability of KOJ and similar maritime infrastructures, bridging a gap in existing maintenance management research for oil jetties in marine environments
The Right to Bail as a Human Right: Analysing Its Protection Under Mainland Tanzanian Laws and Practices
Get PDFThis study explores the right to bail in Mainland Tanzania as a fundamental human right embedded in both domestic and international legal frameworks. It examines the constitutional foundation of bail, primarily under Articles 13(6)(b) and 15 of the Constitution of the United Republic of Tanzania, which guarantee the presumption of innocence and personal liberty. The research highlights the statutory provisions of the Criminal Procedure Act [Cap 20 R.E 2023], especially Section 151, which categorises offences into bailable and non-bailable, and identifies restrictive conditions that often conflict with constitutional guarantees. Through analysis of landmark case law and scholarly commentary, the paper critiques the discretionary and often inconsistent application of bail by law enforcement and the judiciary. It reveals that pre-trial detention is frequently overused, leading to prison overcrowding and the infringement of individual rights. The study highlights the need for legal reforms to align bail laws with constitutional mandates and international human rights standards, advocating for a clearer recognition of bail as a right rather than a privilege. It concludes by recommending constitutional and legislative amendments to ensure fair and equitable access to bail for all accused persons in Tanzani