Inflammation may play an important role in the pathophysiology of sickle cell disease (SCD), and recent studies have identified the 70-kDa heat shock protein (Hsp70) as an important mediator of inflammatory responses. Here we demonstrate a significant increase in circulating serum Hsp70 level in SCD during vaso-occlusive crisis (VOC) as compared with baseline steady-state levels (P <0.05) and a significant increase in Hsp70 levels in SCD at baseline compared with normal controls (P <0.05). Taken together, these results indicate that circulating serum Hsp70 might be a marker for VOC in SCD.

Amoxycillin products were evaluated for quality by liquid chromatography at
the Drug Analysis and Research Unit (DARU), University of Nairobi. Thirty
three of these were capsule formulations and 24 were dry suspensions. Three
capsule formulations failed the limits on content. The amoxyciIlin content in one
suspension product was below the limit, while in two other products it dropped
. below 80% on storage at 25°C for 7 days.

The ill vitro antimalarial activity of the root extract in partly supports the
ethnobotanical use of the plant to manage malaria. Clematis brachiata Thunberg
(Ranunculaceae) is used in Kenya for the management of headaches, malaria and
other febrile illnesses, abdominal disorders, yaws and for skin disorders. Old stems
and leaves are chewed for the management of toothaches and sore throats. Extracts
of the plant were subjected to tests for antimalarial, antibacterial and antifungal
activity. The toxicity of the extracts was assessed using the brine shrimp lethality
bioassay. The root extract gave the highest ill vitro antimalarial activity against the
mulitidrug resistant strain, Plasmodium Jalciparum VIIS (ICso=39.24 ug/ml). The
stem and leaf extracts had insignificant antiplasmodial activity. The leaf, stem and
root extracts had no bacterial 01' fungal inhibitory effects even at very high
concentrations of 10 mg/ml. The LDso values of the stem and leaf methanol extracts
against the brine shrimp larvae was 365.60 and 66.5 Ilg/ml, respectively.

OBJECTIVE: To determine the pattern and characteristics of patients admitted with firearm injuries (FAIs) and establish the morbidity and mortality associated with these injuries. DESIGN: Retrospective cross-sectional study. SETTING: Kenyatta National Hospital (KNH), January 2004 to December 2005. SUBJECTS: All patients admitted with physically evident firearm injury. RESULTS: There were a total of 717 patients recorded with FAIs constituting 0.6% of the total number of patients seen in the casualty. Of these, 421 (58.7%) were admitted and treated as in- patients. A firearm was used in 6.7% of the 6300 assault cases recorded in 2004 and in 9.7% of the 3079 cases recorded in 2005. The increase from 6.7% in 2004 to 9.7% in 2005 was statistically significant (p < 0.05). There were 370 (87.9%) males and 49 (11.6%) females giving a male to female ratio of 7.5:1. The mean age was 29.7 +/- 10.9 years with a range of 3 to 66 years. At least 262 (62.2%) of the 421 admitted FAI casualties were treated under general anaesthesia (GA). The average duration of operation per patient was 2 +/- 1.5 hours. CONCLUSION: FAIs are on the increase and affect all age groups but is largely a disease of a young male adult in the 3rd and 4th decade of life. Mortality is higher with increasing age while female victims are fewer but on average six years younger than males. The lower extremities are the commonest target among the survivors. However, abdominal wounds tend to be the most lethal, accounting for greater mortality.

The principal objective of this study was to identify the factors that the management of verticaly integrated firms consider in making decisions to integrate either backword or forward. In order to meet this objective, the information sought for the study was collected through the use of a questionnaire. The sample consisted of 52 vertically integrated firms. 31 questionnaires were completed and provided the information used in this report. The study found out that he fator that influence a firm's decision to integrate vertically include certainity of demand for the firm's products, availability of adequate manufacturing facilities, investment costs, and the need for high market share. For textile and steel manufacturers, certain factor were important. The factors were: the need for improved co-ordination for a firm's activities, need for synergies, need for greater control over the firm's economic resources, level of competition in the industries and the mining firms, the need to control the firm's economic resources, the need to build new infrastructures, sze of buiness, and the level of competition in the industry are important

Dombeya rotundifolia (Planch) belongs to the Sterculiaceae family and is wide spread in Kenya growing at an altitude of between 900 and 2250m [1]. It is used in traditional medicine in the treatment of rheumatism and diarrhea [2] syphilis [3], heart problems, hemorrhoids, dyspepsia, to regulate the menses and to hasten the onset of labor [4], to manage abdominal pains, intestinal ulceration, headache and haemorrhage, as a tonic and to cause abortion [5-6]
Some general phytochemical and pharmacological studies have been carried out on D. rotundifolia. It has notable anti-bacterial and anti infalammatory activity, and has been found to contain cardiac glycosides, saponins and tannins. It does not contain cyanogenic glycosides and alkaloids [6] the ethanol leaf extract are bacteriostatic against staphylococcus aureus. Ethanol and water extraxt and antibacterial activity against Bacillus subtilis and S. aureus [6-7]. There is no report on previous isolation of compounds from this plant

Ampicillin products, 20 capsules, 2 tablets and 23 dry suspensions were evaluated
for quality by liquid chromatography at the' Drug Analysis Research Unit
University of Nairobi. Four capsule fonnulations failed limits on content. The
Ampicillin content in 5 suspensions dropped below 80% on storage at 25°C for 7
days. The pH of most suspensions dropped on storage, but had no correlation to
decrease in chemical content.

Three steroidal indoxyls, 3-oxo-16,17-seco-16-nor-l,4-androstadien-15-(7'methoxy-2-indoxyIiden)17-oic
acid, 1-(2' -indoxyJiden )-2-nor-l ,2-secocholestan-3oic
acid and 1-(5'- chloro-2-indoxyliden)-2-nor-l,2-secocholestan-3-oic acid were
synthesized and screened for anti-inflammatory activity. Their pK. values were
also determined using a solubility method. The first compound, 3-oxo-16,17seco-16-nor-l,4-androstadien-15-(7'-methoxy-2-indoxyliden)
17-oic acid, had an
EDso value of 15.3 mg/kg and a pK. of 7.09. The cholestane derivative, l-(rindoxyliden)-2-nor-l,2-secocholestan-3-oic
acid, and its chloro analogue 1-(5'chloro-2-indoxyliden)-2-nor-l,2-secocholestan-3-oic
acid had EDso values of 16.2
and 22.8 mgikg, while their pK. values were 6.56 and 7.07, respectively,
suggesting that these compounds are relatively weak acids.

Dombeya rotundifolia (Planch) belongs to the Sterculiaceae family and is wide spread in Kenya growing at an altitude of between 900 and 2250m [1]. It is used in traditional medicine in the treatment of rheumatism and diarrhea [2] syphilis [3], heart problems, hemorrhoids, dyspepsia, to regulate the menses and to hasten the onset of labor [4], to manage abdominal pains, intestinal ulceration, headache and haemorrhage, as a tonic and to cause abortion [5-6]
Some general phytochemical and pharmacological studies have been carried out on D. rotundifolia. It has notable anti-bacterial and anti infalammatory activity, and has been found to contain cardiac glycosides, saponins and tannins. It does not contain cyanogenic glycosides and alkaloids [6] the ethanol leaf extract are bacteriostatic against staphylococcus aureus. Ethanol and water extraxt and antibacterial activity against Bacillus subtilis and S. aureus [6-7]. There is no report on previous isolation of compounds from this plant

KEMRI Centre for Geographic Medicine Research, PO Box 230, Kilifi, Kenya. menglish@wtnairobi.mimcom.net

BACKGROUND: The district hospital is considered essential for delivering basic, cost-effective health care to children in resource poor countries. We aimed to investigate the performance of these facilities in Kenya. METHODS: Government hospitals providing first referral level care were prospectively sampled from 13 Kenyan districts. Workload statistics and data documenting the management and care of admitted children were obtained by specially trained health workers. FINDINGS: Data from 14 hospitals were surveyed with routine statistics showing considerable variation in inpatient paediatric mortality (range 4-15%) and specific case fatality rates (eg, anaemia 3-46%). The value of these routine data is seriously undermined by missing data, apparent avoidance of a diagnosis of HIV/AIDS, and absence of standard definitions. Case management practices are often not in line with national or international guidelines. For malaria, signs defining severity such as the level of consciousness and degree of respiratory distress are often not documented (range per hospital 0-100% and 9-77%, respectively), loading doses of quinine are rarely given (3% of cases) and dose errors are not uncommon. Resource constraints such as a lack of nutritional supplements for malnourished children also restrict the provision of basic, effective care. INTERPRETATION: Even crude performance measures suggest there is a great need to improve care and data quality, and to identify and tackle key health system constraints at the first referral level in Kenya. Appropriate intervention might lead to more effective use of health workers' efforts in such hospitals.

PMID: 15194254 [PubMed - indexed for MEDLINE]

This study intends to realize a novel thin film material for photovoltaic applications. TiO2 that has a large band gap of 3.2eV is sensitized to visible light via the use of dyes in the Gratzel cell. The dye monolayer when excited by light photons, electron-hole pairs are generated, electrons are injected into the conduction band of TiO2, while the holes are transported to the counter electrode by diffusion. The use of dye and wet electrolyte material has associated instability problems which threatens the suitability of this type of solar cell for commercialization purposes.

The objective of this proposed study is to come up with a semiconductor material of a smaller band-gap which can be used to fabricate a solar cell. This is to be achieved by doping the metal oxide (TiO2) with germanium utilizing the property of the semiconductor nanodot band gap variation with the size. The reduction of the band gap is expected to broaden the wavelength range of the incident light that can be absorbed by the material. This involves the use of large band gap materials (TiO2,) in the form of a thin film that acts as the matrix within which atoms of Ge are added by doping. This enables the tailoring of the band gap of the matrix semiconductor (TiO2,) to absorb incident radiation of a wide range of wavelengths. Film deposition will be done using the sputtering method. Substrate temperatures will be varied for deposition in order to vary the phase. Annealing of the deposited films will be done at different temperatures. The films will then be investigated using various techniques to establish their structural, optical, electrical and opto-electrical properties. The results of the investigation will help to optimize the material performance for fabrication of the solar cells of high efficiency and low cost.

A random sample survey using personal interviews was conducted in Machakos and Makueni Districts of Kenya in 1992 to estimate the level of rabies vaccination of the dog population. To substantiate the results of the interviews, a sample of the surveyed dogs 3 months old and above were bled for serum rabies antibody determination using an inhibition enzyme immunoassay (INH EIA). Of the 266 surveyed 3 months old and above, only 29% (77/266) were reportedly vaccinated against rabies. Out of the 197 dog sera titrated for rabies antibody, only 29% (57/197) had detectable antibodies and only 16% (32/197) had antibody tires equal to or greater than the threshold considered protective of 0.5 I.U/ml. There was a strong positive association between a history of previous vaccination and the detection of rabies antibodies. Of 133 dogs with no history of previous vaccination, 20% (26/133) had detectable antibodies. With the rabies incidence in Machakos and Makueni Districts still unacceptably high, the level of vaccination estimated in this survey is clearly inadequate for rabies control and measures designed to increase it are discussed.

.

Mobile banking service, M-Shwari, allows users to save, earn interest and borrow loan over a short period of time using their mobile phones. The service has a potential to spur economic growth if consumers could understand the concept, its' benefits and adopts it. In our study, we investigated factors that influence the adoption of mobile banking services in Kenya. In particular we have shown empirically that the influence of the intervening demographic factors and the consumer perception may have differential impact in emerging market as compared to developed market situations. We extracted and grouped factors that were perceived by the clients as important in adoption of mobile banking. We then tested if the differences in perceptions on some of the factors extracted by exploratory factor analysis significantly differ between gender categories. The results indicated that there was no significant difference in the perception of ease of use and risk of use between genders in the decision to adopt mobile banking service in emerging market. The findings of our study will therefore provide the financial industry with a better understanding of the factors underlying consumer adoption of mobile banking services and help them formulate marketing and promotional strategies for mobile banking services.

This paper reports on a study involving the market environment for artisanal dimension stone in Nairobi, Kenya. Taking the point of view of exchange relationships within a market systems framework it maps out economic interactions involving actors in this market such as suppliers of raw materials, producers, marketers and users of artisanal dimension stone. This strategy enabled the study to understand the enabling environment for the production and use of artisanal dimension stone that is characterized by the following factors: a rising population that sustains the demand for the built environment products, a vibrant construction market, building regulations that favour the use of stone, availability of cheap and abundant unskilled labour and low standards of stone finish involved, availability of natural rock, a regulatory system that can compromise, lack of support by government institutions and an informal system of transaction that is non-compliant with conventional requirements such as labour and environmental laws but ensures ease of entry into the market environment. Such understanding brings potential for rectifying the negative perceptions about this market environment through policy development and change

Macrophytes have been shown to perform important ecological roles in Lake Naivasha. Consequently, various studies regarding the impact of biotic factors on the macrophytes have been advanced but related studies on environmental parameters have lagged behind. In an attempt to address this gap, sampling on floating species and submergents was carried out in eight sampling sites in 2003 to investigate how they were influenced by a set of environmental factors. Soil texture (sandy sediments; P < 0.05, regression coefficient = −0.749) and wind were the most important environmental parameters influencing the distribution and abundance of floating macrophytes. Combination of soil texture and lake-bed slope explained the most (86.3%) variation encountered in the submergents. Continuous translocation of the floating dominant water hyacinth to the western parts by wind has led to displacement of the submergents from those areas. In view of these findings, the maintenance and preservation of the steep Crescent Lake basin whose substratum is dominated by sand thus hosting most submergents remain important, if the whole functional purpose of the macrophytes is to be sustained

Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adolescents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance.

Despite the potential of Learning Management System (LMS) supported asynchronous e-
learning to improve asynchronous e-learning system quality by enhancing learning
effectiveness and academic achievement of HEIs, several challenges are faced in the
process of providing the e-learning mode of study particularly in developing countries. The
study will explore five factors that influence quality of asynchronous e-learning: instructional
design, learner support, contextual factors, student characteristics and instructor
characteristics. The quality factors can be used to evaluate quality so as to monitor and
improve the inputs, processes and outputs of asynchronous e-learning systems. The study
examines existing e-learning literature and then proposes five factors that determine the
quality of e-learning systems.

The purpose of the present study was to identify the influencing factors of asynchronous
elearning system quality particular in developing countries via a review of current literature
and a qualitative pre-study conducted at Jomo Kenyatta University of Agriculture and
Technology (JKUAT). Despite the perceived benefits of these systems to overcome
challenges facing education sector in the region, studies show that the majority of them have
not been successful. After a thorough review of existing literature on developing countries
and a qualitative pre-study conducted at JKUAT University, the study identified the factors
that influence quality of e-learning systems as: Course Design, Content support, social
support, and Student Characteristics, Instructor Characteristics, Technician Characteristics,
Course Assessment and Institutional factors.

Documentation plays a key role in the construction of social reality (Anderson 2006,
Levy2003, Searle 1996). A descriptive cross-section study conducted among nurses
working at Kenyatta national hospital (KNH) main theatre within a period of 9 months,
where both qualitative and quantitative methods used to collect data. The study aimed at
determining factors affecting documentation of intraoperative nursing care given to
patients while undergoing surgery in KNH theaters.
A self-administered structure questionnaire for the respondents, an interview guide for
face-to-face interview of the key informants and an observation guide using the record
files of patients who were ready for discharge from the unit back to the ward to collect
data on intraoperative nursing documentation. A simple random sampling method was
used to select a sample of 83 out of 96 qualified nurses, employed by KNH and working
in the operating theatre, who were willing to participate in the study.
The results showed Results showed that knowledge on hospital policy and perception
which included; lack of time, lack of provision in file to document and perception that no
nursing is done in theatre were statistically significant to intraoperative documentation (p
< 0.05). The study concluded that nurses perception and knowledge on hospital policy
affected intraoperative nursing care documentation.

Description
Revenue collection is a key source of income to all governments. The purpose of this study was to establish factors affecting revenue collection systems at the county governments of Kenya with specific reference to Meru County. The study sought to determine the effect of financial management system on revenue collection systems. The design for the study was cross-sectional mixed method. The target population was 150 respondents comprising employees at county revenue department of Meru County. The sample size was 62 respondents. The instruments for data collection were questionnaires. Data was analyzed Using SPSS version 25 and STATA version 12. From pilot test Cronbach’s alpha tested reliability. While Regression analysis, ANOVA, Correlation, descriptive statistics, presented the data results and findings. It was expected that; the outcome of the study could be used to develop strategies to be used in facilitating efficiency in revenue collection. The study found that ability to make payments using mobile money Platforms and tax payer’s ability to pay rates, fees through different bank accounts were very good. The study found out that revenue collection systems used have achieved expected revenue targets and revenue collection system available have improved taxpayers’ compliance in a greater extent. The study found out that the respondents strongly agreed that they are encouraged to take up responsibility for their personal development, learning and career growth. In addition, the study found out that respondents agreed that they have been trained on revenue collection systems available in the last one year and that …

This paper looks at factors which influence land allocation and crop production patterns in Botswana, across traditional and commercial farmers. It found that, among smallholder traditional farmers, less land is used (on average 5.6 ha) and is subdivided into the growing of three major crops: sorghum, maize and beans, with more land allocated to sorghum, the main staple and more adaptable to the climate. The small amount of cultivated land is attributed to lack of capital, transport and labour. Although large areas of land are owned by commercial farmers a high percentage is left idle due to constraints such as poor marketing systems, poor storage facilities and shortage of labour.

This paper looks at factors which influence land allocation and crop production patterns in Botswana, across traditional and commercial farmers. It found that, among smallholder traditional farmers, less land is used (on average 5.6 ha) and is subdivided into the growing of three major crops: sorghum, maize and beans, with more land allocated to sorghum, the main staple and more adaptable to the climate. The small amount of cultivated land is attributed to lack of capital, transport and labour. Although large areas of land are owned by commercial farmers a high percentage is left idle due to constraints such as poor marketing systems, poor storage facilities and shortage of labour

The purpose of this research was to determine patients' retention and associated factors in the Antiretroviral Therapy (ART) program. Specifically, it establishes factors that contribute to patients' retention and recommends the appropriate strategies that enhance sustainable retention of patients in the ART program. The case studies were carried out at Kibera Community Based Health Care project/clinic - AMREF intervention area in Kibera slum
A descriptive cross-sectional method was employed aimed at collecting information from the patients in the program through random sampling, while stratified sampling was used to pick on defaulters, who were traced by Community Health Workers as well as key informants. A representative sample constituted 357 patients in the ART program, 27 defaulters and 8 Health Care Providers of the total population of patients in the program. Quantitative data was collected using a standardized questionnaire administered to the study participants in the program and defaulters. Qualitative data
was obtained through; focus Group Discussion and Key informants interviews. Ethical consideration and risk to human subjects was put into consideration, through provision of willing consent and confidentiality upheld at all times.
The study reveals that AMREF in Kenya, Kibera project continues to playa leading role in the fight against HIV/AIDS. A majority of the respondents (69%) confirmed to have disclosed their HIV status to someone while 31% were categorical that they have not disclosed their status to anyone. It is imperative to point out that disclosure levels were high (88%) amongst respondents in the 51-55 years age group and closely followed by those in the 41-45 years age group (77%). The study also found out that 49.5% of the respondents were on the affirmative that indeed they find it easy discussing their challenges with their clinicians, while 50.5% noted that they do not find it easy. It is
interesting to observe that the challenges of side effects related to ARV are more pronounced amongst those who skip appointments at the clinic compared to stigma and lack of food. A considerable number (15%) of the respondents noted that they like the clinic as it provides free ARVs while 4% lauded the good counseling services offered at the clinic. Some 3% liked the facility as it was near to their areas of residence. Asked to state the reasons why they would prefer other ART clinics, most of the respondents (63%) pointed to the distance from their areas of residence, 14% made reference to the quality of services while 8% explained that they would prefer other clinics if they offer food supplements as part of the program.
In conclusion psycho-social counseling appeared the most preferred service in the facility, it enforces adherence to medication and also reduces stigma related condition among the patients and those around them. MSF Belgium clinics were most preferred clinic in Kibera slum; AMREF Kibera project management should consider exchange visits to their sites and learn from each other. The study detects that there is a cross cutting call from the study approach that an ideal ART programme should provide comprehensive care and support (37%) and offer free medical care (15%) to enhance
accessibility besides integrating PTC (7%) among others as captured from the interviews with defaulters. Service delivery it was suggested should also be done professionally without unethical and coercive practices such sexual harassment among other malpractices that accentuate default.
AMREF Kibera project should consider to networking and collaborating with other organizations that are working in informal settlement to learn and share best practice to enhance adherence to ART care. Address the attitude of health care providers in the facility through trainings, supervision and assessment of care. The project should also review its approach to ART care and through operation research to boost ART care in marginalized communities in the informal settlements.

This study focuses on the marketing communication tools pursued by selected milk processing firms in Kenya. The theory articulated in this article suggests that marketing communication tools and factors affecting their performance are two important considerations. Taking this as a standpoint, the author predicted the use of similar marketing communication tools whose performances are influenced by the same factors. An empirical test of this theory using data collected from the milk processors operating in Nairobi yields data consistent with the view that the milk processors use similar marketing communication elements and their performance are influenced by similar factors.

Conditions of analyses of copper, lead, cadmium and zinc content in human hair using differential pulse anodic stripping voltammetry (DPASV) and hanging mercury drop electrode (HMDE) have been established. Sample digestion using the mixture HC1; H2O2:HNO3 in the ratio 2:1:40 by volume gave the best wet-ashing procedure. The peak currents and peak potentials of zinc, cadmium and lead, copper were maximum at pH 6-7 and 1-3 respectively, when excess H2O2 was eliminated with subsequent addition of hydroxyamine hydrochloride. Matrix concentration effects were minimized by digesting weights not exceeding 50 mg per sample. The effect of selenium (IV) was negligible and was ignored. The detection limit of 0.0036 ng/cm3 for Cd+2 was obtained while the values for zinc, lead and copper were 0.0230, 0.0287 and 0.0269 ng/cm3 respectively, at the 95% confidence limit. The observed DPASV conditions of analysis of these metals are useful for routine determination of the metals in human hair and should complement the conventional flame atomic absorption spectrophoto-metry methods

The purpose of this study was to investigate contraceptive prevalence in Kisii/Nyamira district in the Republic of Kenya and on the basis of the results obtained develop a policy framework for use in family planning programmes. The study utilized largely survey research design covering married women in two locations of the district bu use of questionnaires. The major questions covered included the knowledge of contraception by the despondents, the religious affiliation of the respondents, the number and gender of the children they had, the distance to the clinic/delivery points and their education level.

The results indicate that knowledge of family planning methods among the respondents is high although the actual use of the methods is relatively low. A majority of the respondents had at least four years of formal education, and the more education a respondent had the more likely they were to use contraceptives. Husbands played a major role in deciding whether their wives should practise family planning with religious affiliation and the distance to the service delivery points played a substantial role too. The gender composition of living children was found a determining factor in use of contraception. Those respondents without a living son (s) were willing to continue beyond the desired family size until they got a son.

Tuberculosis (TB) is the most common opportunistic infection and the leading cause of death in people living with HIV (PLHIV). HIV-infected children are at a higher risk of TB infection and disease compared to those without HIV. Isoniazid preventive therapy (IPT) is an effective intervention in preventing progression of latent TB infection to active TB. The World Health Organization (WHO) currently recommends that all children aged > 12 months and adults living with HIV in whom active TB has been excluded should receive a 6-months course of IPT as part of a comprehensive package of HIV care. Despite this recommendation, the uptake of IPT among PLHIV has been suboptimal globally. This study sought to determine the factors affecting IPT uptake and completion among HIV-infected children in a large HIV care centre in Nairobi, Kenya.

Ground Flowers of Matricaria Recutita (German Chamomile) Banat Variety grown in Kenya, were subjected to Clevenger distillation under varying temperature, distillation, pressure conditions and the yields assessed. An inert solvent being present in the collecting column of the Clevenger apparatus increases the yield of the oil by reducing dispersion of the blue oil; its presence however, in the distillation flask inhibits the production of the essential oil. Distillation under reduced pressure leads to a decrease in the yield of the oil produced. A break in distillation time especially during the first three hours of distillation also leads to a decrease in the yield of the oil produced.

Introduction: Adherence to dietary prescriptions among patients with chronic kidney disease is known to prevent
deterioration of kidney functions and slow down the risk for morbidity and mortality. This study determined factors
associated with adherence to dietary prescription among adult patients with chronic kidney disease on hemodialysis.
Methods: A mixed-methods study, using parallel mixed design, was conducted at the renal clinics and dialysis units at
the national teaching and referral hospitals in Kenya from September 2018 to January 2019. The study followed a
QUAN + qual paradigm, with quantitative survey as the primary method. Adult patients with chronic kidney disease on
hemodialysis without kidney transplant were purposively sampled for the quantitative survey. A sub-sample of
adult patients and their caregivers were purposively sampled for the qualitative survey. Numeric data were collected
using a structured, self-reported questionnaire using Open Data Kit “Collect software” while qualitative data were
collected using in-depth interview guides and voice recording. Analysis on STATA software for quantitative and
NVIV0 12 for qualitative data was conducted. The dependent variable, “adherence to diet prescription” was analyzed as a
binary variable. P values < 0.1 and < 0.05 were considered as statistically significant in univariate and multivariate logistic
regression models respectively. Qualitative data were thematically analyzed.
Results: Only 36.3% of the study population adhered to their dietary prescriptions. Factors that were independently
associated with adherence to diet prescriptions were “flexibility in the diets” (AOR 2.65, 95% CI 1.11–6.30, P
0.028), “difficulties in following diet recommendations” (AOR 0.24, 95% CI 0.13–0.46, P < 001), and “adherence
to limiting fluid intake” (AOR 9.74, 95% CI 4.90–19.38, P < 0.001).
Conclusions: For patients with chronic kidney disease on hemodialysis, diet prescriptions with less restrictions
and requiring minimal extra efforts and resources are more likely to be adhered to than the restrictive ones.
Patients who adhere to their fluid intake restrictions easily follow their diet prescriptions. Prescribed diets should be based
on the individual patient’s usual dietary habits and assessed levels of challenges in using such diets. Additionally, diet
adherence messages should be integrated with fluid limitation messages. Further research on understanding patients’
adherence to fluid restriction is also suggested.

A study of factors associated with outbreaks of Newcastle disease (ND) in indigenous free - range chickens was carried out in five agro - ecological zones in t wo districts of Eastern province of Kenya. Seventy five households keeping chickens were randomly selected. Data on management practices, incidence of diseases and factors associated with ND outbreaks were collected using interviewer - administered questionn aire. The prevalence rate of Newcastle disease was highest (93.8%) in the dry zone (Low midland 5) and lowest (50%) in cool wet zone (Lower highland 1). The ND outbreaks were significantly associated with stress inducing factors, namely: confinement of bir ds, lack of supplementation of feed and seasons. It was found to be more prevalent in wet seasons than dry seasons in all agro - ecological zones, except the Lower midland 5, where it occurred during the hot season. Other important factors for the outbreaks were: mode of disposal of infected birds, carcasses and fecal matter, windy conditions and the restocking of farms with chickens from the markets. Mixing of chickens with other poultry, green vegetation on the farm, dust storms, gift birds to farms, short intermittent temperature changes and flowering of the crops had minimal association with these outbreaks. The study also revealed that only 17.3% of the farmers were controlling ND through vaccination. It was concluded that besides using vaccination as a c ontrol measure for ND in rural free - range poultry, the flock owners should be educated on the modes of transmission of ND virus, in addition to being discouraged from purchasing restocking chickens from the market

A study of factors associated with outbreaks of Newcastle disease (ND) in indigenous free - range chickens was carried out in five agro - ecological zones in t wo districts of Eastern province of Kenya. Seventy five households keeping chickens were randomly selected. Data on management practices, incidence of diseases and factors associated with ND outbreaks were collected using interviewer - administered questionn aire. The prevalence rate of Newcastle disease was highest (93.8%) in the dry zone (Low midland 5) and lowest (50%) in cool wet zone (Lower highland 1). The ND outbreaks were significantly associated with stress inducing factors, namely: confinement of bir ds, lack of supplementation of feed and seasons. It was found to be more prevalent in wet seasons than dry seasons in all agro - ecological zones, except the Lower midland 5, where it occurred during the hot season. Other important factors for the outbreaks were: mode of disposal of infected birds, carcasses and fecal matter, windy conditions and the restocking of farms with chickens from the markets. Mixing of chickens with other poultry, green vegetation on the farm, dust storms, gift birds to farms, short intermittent temperature changes and flowering of the crops had minimal association with these outbreaks. The study also revealed that only 17.3% of the farmers were controlling ND through vaccination. It was concluded that besides using vaccination as a c ontrol measure for ND in rural free - range poultry, the flock owners should be educated on the modes of transmission of ND virus, in addition to being discouraged from purchasing restocking chickens from the market

Several countries scaling-up adult medical male circumcision (MMC) for HIV prevention intend to introduce early infant male circumcision (EIMC). To assess preference for EIMC in a community with a mature adult MMC program, we conducted a cross-sectional survey of a representative sample of mothers (n = 613) and fathers (n = 430) of baby boys ("index son") at 16 health facilities in western Kenya. Most (59 %) were for EIMC, generally. Just 29 % were for circumcising the index son. Pain and protection from HIV were the most frequently cited barrier and facilitator to EIMC, respectively. In multivariable logistic regression, ever talking with the partner about EIMC and positive serostatus were associated with preference for EIMC for the index son. Attitudes towards EIMC are favorable. Willingness to circumcise an infant son is modest. To facilitate EIMC uptake, education about EIMC pain management and encouraging discussion between parents about EIMC during pregnancy should be integrated into programs.

East African Medical Journal Vol. 91 No. 2 January 2017
FACTORS ASSOCIATED WITH SEVERITY OF NEONATAL SEPSIS DURING ADMISSION IN KENYATTA NATIONAL HOSPITAL PAEDIATRIC WARDS, KENYA: A DESCRIPTIVE CROSS-SECTIONAL STUDY
F. Muthwii, M.Chege, M.Muiva,University of Nairobi, College of Health Sciences, School of Nursing Sciences, P.O. Box 19676-00202 Nairobi, Kenya and M.Habtu, Mount Kenya University, College of Health Sciences, Department of Public Health, P.O. Box P.O.Box 5826 Kigali, Rwanda, Jomo Kenyatta University of Agriculture and Technology, College of Health Sciences, Department of Public Health, P.O. Box 19676-00202 Kigali, Rwanda Request for reprints to: F. Muthwii , University of Nairobi, College of Health Sciences, School of Nursing Sciences, P.O. Box 19676-00202 Nairobi, Kenya. fkaluu77@gmail.com
FACTORS ASSOCIATED WITH SEVERITY OF NEONATAL SEPSIS DURING ADMISSION IN KENYATTA NATIONAL HOSPITAL PAEDIATRIC WARDS, KENYA: A DESCRIPTIVE CROSS-SECTIONAL STUDY F. MUTHWII, M.CHEGE, M.MUIVA and M.HABTU, ABSTRACT Background: Neonatal sepsis is a major cause of neonatal mortality. In the year of 2012, it accounted for 44% of all deaths of underfive years old children globally. Statistics indicate that 98% of the global, one million deaths as a result of neonatal sepsis occur in Africa. Neonatal sepsis contributes to 69% of neonatal mortality in Nigeria and 28% of neonatal mortality in Kenya. Objective: To establish factors associated with severity of neonatal sepsis among patients admitted in Kenyatta National Hospital Paediatric Wards. Design: The study adopted a descriptive cross-sectional design. Setting: The study was carried out in paediatric wards of Kenyatta National Hospital (KNH), Kenya. Subjects: Data was obtained from consenting mothers whose neonates had been admitted with neonatal sepsis and healthcare workers who worked within the paediatric wards. A total of 107 respondents were selected by systematic sampling method in which every alternate participant was selected. A semi-structured questionnaire was used to gather data on maternal and neonatal characteristics and environmental factors. In addition, three focused group discussions comprising nurses, doctors and clinical officers were conducted. Chi-square test was used to determine the factors associated with severity of neonatal sepsis (NNS) during admission. Results: Binary logistic regression analysis was performed to determine predictors of severe NNS. Of the 107 patients with neonatal sepsis, 37.4% had severe neonatal sepsis during admission.After multiple logistic regression analysis, the following factors were found to be independently associated with severe NNS: Neonates aged 8 to 28 days [AOR=2.89; 95%CI=1.07-7.99; P=0.047]compared to those neonates aged less than 8 days; Mothers with primary level of education [AOR=4.57; 95%CI=1.18-17.67; P=0.028]compared to those with tertiary education; primipara mothers [AOR=4.64; 95%CI=1.74-12.37; P=0.002]than multipara mothers and greenish amniotic fluid during labor [AOR=3.11; 95%CI=1.05-9.24; P=0.041]compared to clear amniotic fluid. Conclusion: The study found that severity of NNS was still high. The factors associated with severe NNS were; primiparity, maternal low economic status and poor antenatal clinic attendance. The study thus recommends that newborns at risk of developing severe neonatal sepsis should get prophylactic treatment and mothers be included in specialized programs geared towards reduction of the severity of NNS.

ABSTRACT
Background: Neonatal sepsis is a major cause of neonatal mortality. In the year of 2012,
it accounted for 44% of all deaths of underfive years old children globally. Statistics
indicate that 98% of the global, one million deaths as a result of neonatal sepsis occur
in Africa. Neonatal sepsis contributes to 69% of neonatal mortality in Nigeria and 28%
of neonatal mortality in Kenya.
Objective: To establish factors associated with severity of neonatal sepsis among
patients admitted in Kenyatta National Hospital Paediatric Wards.
Design: The study adopted a descriptive cross-sectional design.
Setting: The study was carried out in paediatric wards of Kenyatta National Hospital
(KNH), Kenya.
Subjects: Data was obtained from consenting mothers whose neonates had been admitted
with neonatal sepsis and healthcare workers who worked within the paediatric wards.
A total of 107 respondents were selected by systematic sampling method in which
every alternate participant was selected. A semi-structured questionnaire was used
to gather data on maternal and neonatal characteristics and environmental factors.
In addition, three focused group discussions comprising nurses, doctors and clinical
officers were conducted. Chi-square test was used to determine the factors associated
with severity of neonatal sepsis (NNS) during admission.
Results: Binary logistic regression analysis was performed to determine predictors
of severe NNS. Of the 107 patients with neonatal sepsis, 37.4% had severe neonatal
sepsis during admission.After multiple logistic regression analysis, the following
factors were found to be independently associated with severe NNS: Neonates aged 8
to 28 days [AOR=2.89; 95%CI=1.07-7.99; P=0.047]compared to those neonates aged less
than 8 days; Mothers with primary level of education [AOR=4.57; 95%CI=1.18-17.67;
P=0.028]compared to those with tertiary education; primipara mothers [AOR=4.64;
95%CI=1.74-12.37; P=0.002]than multipara mothers and greenish amniotic fluid during
labor [AOR=3.11; 95%CI=1.05-9.24; P=0.041]compared to clear amniotic fluid.
Conclusion: The study found that severity of NNS was still high. The factors associated
with severe NNS were; primiparity, maternal low economic status and poor antenatal
clinic attendance. The study thus recommends that newborns at risk of developing
severe neonatal sepsis should get prophylactic treatment and mothers be included in
specialized programs geared towards reduction of the severity of NNS.

Abstract
Background:Neonatal sepsis is a major cause of neonatal mortality. In the year of 2012, it accounted for 44% of all deaths of underfive years old children globally. Statistics indicate that 98% of the global, one million deaths as a result of neonatal sepsis occur in Africa. Neonatal sepsis contributes to 69% of neonatal mortality in Nigeria and 28% of neonatal mortality in Kenya.
Objective:To establish factors associated with severity of neonatal sepsis among patients admitted in Kenyatta National Hospital Paediatric Wards.
Design:The study adopted a descriptive cross-sectional design.
Setting:The study was carried out in paediatric wards of Kenyatta National Hospital (KNH), Kenya.
Subjects:Data was obtained from consenting mothers whose neonates had been admitted with neonatal sepsis and healthcare workers who worked within the paediatric wards. A total of 107 respondents were selected by systematic sampling method in which every alternate participant was selected. A semi-structured questionnaire was used to gather data on maternal and neonatal characteristics and environmental factors. In addition, three focused group discussions comprising nurses, doctors and clinical officers were conducted. Chi-square test was used to determine the factors associated with severity of neonatal sepsis (NNS) during admission.
Results:Binary logistic regression analysis was performed to determine predictors of severe NNS. Of the 107 patients with neonatal sepsis, 37.4% had severe neonatal sepsis during admission.After multiple logistic regression analysis, the following factors were found to be independently associated with severe NNS: Neonates aged 8 to 28 days [AOR=2.89; 95%CI=1.07-7.99; P=0.047]compared to those neonates aged less than 8 days; Mothers with primary level of education [AOR=4.57; 95%CI=1.18-17.67; P=0.028]compared to those with tertiary education; primipara mothers [AOR=4.64; 95%CI=1.74-12.37; P=0.002]than multipara mothers and greenish amniotic fluid during labor [AOR=3.11; 95%CI=1.05-9.24; P=0.041]compared to clear amniotic fluid.
Conclusion:The study found that severity of NNS was still high. The factors associated with severe NNS were;primiparity, maternal low economic status and poor antenatal clinic attendance. The study thus recommends that newborns at risk of developing severe neonatal sepsis should get prophylactic treatment and mothers be included in specialized programs geared towards reduction of the severity of NNS.

Highly active antiretroviral therapy is effective in reducing viral load and increasing survival in HIV-1-infected patients. It consists of two nucleoside reverse transcriptase inhibitors and a protease inhibitor or two nucleoside reverse transcriptase inhibitors and a non-nucleoside reverse transcriptase inhibitor. The efficacy of Highly active anti-retroviral therapy (HAART) is however compromised by adverse events such as lipodystrophy in patients on long-term HAART. This study was carried out in 265 HIV-1 seropositive patients treated with HAART for 6 months and longer, in order to correlate patients’ age, gender, CD4 counts, WHO stage at initiation of HAART, duration and type of anti-retroviral therapy with development of lipodystrophy. A longer duration of therapy was found to be significantly associated with the development of lipodystrophy with 19 patients (24.7%), 73 patients (60.8%) (OR 2.06; CI 1.21 to 3.51, p value 0.004) and 39 patients (67.2%) (OR 2.34; CI 1.21 to 1.46, p value 0.006) having lipodystrophy at 6 to 18, 18 to 36 and 36 to 72 months of treatment, respectively. The odds of lipodystrophy after HAART for 18 to 36 months and 36 to 72 months was 4.14 (p < 0.0001) and 6.179 (p < 0.0001) times, respectively, higher than after HAART for 6 to 18 months. There was no association between age, gender, CD4 counts, WHO stage and the development of lipodystrophy.

Key words: Lipodystrophy, immune reconstitution, protease inhibitors, WHO clinical stage, duration of highly active anti-retroviral therapy (HAART).

A cross-sectional study was carried out between December 2005 and June 2006 in smallholder dairy farms
within and around Nairobi, Kenya to determine risk factors associated with the occurrence of claw disorders in
dairy cows. Farm-and cow-level factors were evaluated in 32 farms and 300 cows respectively. The occurrence
of claw disorders was determined. Chronic laminitis was significantly (P<0.05) associated with three or higher
parities (χ2 = 11.57, P = 0.009), lactation period between 90 to 180 days (χ2 = 9.75, P = 0.021), overstocking
(O.R. = 1.7, χ2 = 24.29, P = 0.0002), absence of cubicle bedding (O.R. = 1.6, χ2 = 29.13, P = 0.003), earthen
floor (O.R. = 1.5, χ2 = 8.98, P = 0.0006) and a curb dividing walk-alleys and cubicles (O.R. = 1.5, χ2 = 5.06, P
= 0.0262). Subclinical laminitis was significantly (P<0.05) associated with lactation period between 1-90 days
(χ2 = 9.06, P = 0.028), and concentrate feeding (O.R. = 2.08, χ2 = 5.5, P = 0.0212). However, lack of mineral
supplementation and leaving manure (slurry) in the walk alleys for a long time seemed to enhance laminitis.
Concentrate feeding had positive (contributor) (β-estimate = 2.187, P<0.05) association with sole bruising,
while mineral supplementation (β-estimate = -4.59, P<0.05) and earthen floor (β-estimate = -1.796, P<0.05)
had negative (protector) association. White line separation was enhanced by concentrate feeding (β-estimate =
3.69, P = 0.002), but reduced by mineral supplementation (β-estimate = -4.07, P<0.05), and frequent manure
(slurry) removal from walk-alleys (β-estimate = -3.58, P<0.05). Non-slip and non-defective concrete floors
were negatively (protectively) (β-estimate = -1.969, P<0.05) associated with heel erosion.
Key words: claw disorders, farm-level factors, dairy cows, smallholder

Abstract

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, ), higher levels of proteinuria (), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, ) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, ) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, ) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

Objective.To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource limited setting.Methods.Across- ectionalstudywascarriedoutonrenaltransplantrecipientsattheKenyattaNationalHospital. Sociodemographicdetails,blood pressure,urine albumin: creatinine ratio,andadherenceusingtheMMAS-8questionnairewere noted.Independentfactorsassociatedwithuncontrolledhypertensionweredeterminedusinglogisticregressionanalysis.Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male:female ratio of 1.9:1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5,

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, p = 0.006), higher levels of proteinuria (p = 0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, p < 0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, p = 0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, p < 0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4-9.5, p = 0.006), higher levels of proteinuria (p = 0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2-65.7, p < 0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1-19.0, p = 0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6-73.0, p < 0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4-9.5, p = 0.006), higher levels of proteinuria (p = 0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2-65.7, p < 0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1-19.0, p = 0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6-73.0, p < 0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population.

Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation.

Subdermal contraceptive implants may be a reasonable option for young women in sub-Saharan Africa; little is known about factors associated with method uptake in this subpopulation.

The study was designed to determine factors which contribute to customer commitment in the mobile telephone service industry. The population of interest comprised of subscribers to mobile telephone companies in Nairobi and Mombasa cities. Two hundred respondents were sampled for purposes of data collection. Data was collected through interviewer administered questionnaires. Factor analysis was used to identify variables which determined customer commitment. It was established that calling habits varied across the two cities. The length of time customers stayed in business relationship had significant influence on their trust for service provider. Commitment to relationship was predominantly determined by level of trust customers had in service providers. Other factors which explained commitment include service quality, reliability and marketing activities by the service provider. Switching costs had significant and positive impact on commitment.
Based on results of analysis, it was concluded that customer commitment to relationship vary across industries and geographic market segments. Commitment in Kenya's mobile telephone industry was determined by customer’s psychological and emotional factors as well as firm related factors. It was also concluded that efforts towards building trust have significant contribution to commitment. In addition, high switching costs increased commitment only when customers had developed trust in the service provider. The study recommends that studies should be carried out to assess the relative contribution of various marketing mix elements to customer commitment.
Key words: commitment, trust, relationship

To offer an increased understanding of the spatial patterns, temporal, social and physical predictors of the conversion and transformations of land use and land cover in Lake Victoria basin, an assessment of proximate and underlying forces is presented. This paper discusses key theoretical underpinnings for the manifold linkages existing between selected drivers and land use and cover change around the basin and their consequences on human wellbeing. Using a meta-analytical research design, the paper analyses ecosystems level cases of the causes ofland use and cover change in the basin, in order to determine any spatio-temporal or institutional patterns and dynam.ics. A suite of recurrent core variables have been identified to influence land use and cover changes in the basin. The most prominent of these at the underlying category are climatic factors, economic factors, institutions, national and regional policies, population growth, and other remote influences. At the proximate level, these factors drive cropland expansion, overgrazing, infrastructure extension and rates of land degradation. These are supported by empirical evidence from the basin. This assessment is crucial for appropriate local and transboundary policy interventions, which have to be fine-tuned to the locale-specific dynamic patterns associated with the inherent land use and land cover changes.

This is a descriptive cross sectional study. A structured questionnaire was used to interview 300 respondents who had infibulation as a form of female genital circumcision.The interviews were conducted at Garissa General Hosptial Gynaecology out-patient clinic. The objective of this study was to establish the factors that enhance the practice of female circumcision.
Female circumcision was performed between 3 to 14 years of age with the peak age of 7 years. In 83% of the respondents the event was arranged by the mother of the respondents. The three leading reasons why the practice was carried out in the community were, religious demand(66.3%), prevention of enlargement of clitoris(51%), and protection of virginity (48.3%).
In conclusion FGM is a harmful traditional practice that is traditionally justified but has no medical support.

As from early 2000s, the Nairobi Securities Exchange (NSE) and the market regulator Capital Markets Authority (CMA) endeavored to reform the market. As part of the market reforms agenda, the Authority initiated market reforms in 2001 which led to the reorganization of the NSE into four distinct segments: the Main Investments Market Segment (MIMS); Alternative Investments Market Segment (AIMS); Fixed Income Securities Market Segment (FISMS); and the Futures and Options Market Segment (FOMS). To date all but the FOMS remain active. The derivatives market in Africa and specifically the NSE remains underdeveloped. One of the major hindrances to the derivatives market development, which is the focus of this paper, is the regulatory and policy environment. There is need to develop these so as to provide a framework within which the market can operate effectively and efficiently. Other disabling factors to the development of the derivatives market discussed in this paper include; low level of investor sophistication and awareness; lack of commodities on large scale; high frictional costs in the market structure; inadequate risk management; inadequate liquidity; and segmented regulation.
The paper further explores the efforts being done by the NSE and the CMA towards the development of the market. This includes the findings of the study undertaken by the CMA on the viability of establishing a futures and options market segment at the NSE. To help understand the factors hindering derivatives market development; in this paper, I have explained key concepts relating to derivatives market development and the various types of derivatives. The benefits and uses of derivatives and their down side/ disadvantages have also been highlighted, drawing from real life experiences across the globe. An overview of studies on derivatives and derivative markets in Latin America, India, South Africa, Asia and Kenya has been discussed.

Factors Hindering Paediatric Ward Nurses from Using Nursing Care Plans at Kenyata
National Hospital (KNH)
BACKGROUND: Documentation is an essential and integral part of quality nursing care.
A nursing care plan best suits this purpose because it combines holistic and scientific
approach to patient care. Further, it communicates and supports continuity of care though
minimally used by nurses.
OBJECTIVE: The aim was to identify factors hindering paediatric nurses from using
nursing care plans.
METHOD: This cross-sectional descriptive study was conducted from June to August 2007
at KNH. It used a random sample of 7 in-charge and 100 non in-charge nurses who filled a
self-administered close-ended questionnaire. Pearson product-moment correlation was used
to assess the association between variables with a P value set at 0.05.
RESULTS: Only 2% nurses were utilizing care plans. The characteristics of the nurse (i.e.
age: r = .026, p= .796 ; qualification: r = .007 , p= .941 and years of service: r = .135 , p=
.181 ), nursing work (i.e. workload: r = .099 ,p = .328 and stress: r = -.027 ,p = .786) and
nursing administration (i.e. staffing: r = .192 ,p = .680 and care plan policy: r = .277 ,p =
.547) had a non significant linear relationship with utilizing care plans. The linear
relationship between familiarity with the care plan content (r=.198, p= .049)) and its use
was statistically significant whereas ease to update a care plantr = .013, p = .897) was not.
CONCLUSION: Further research is indicated to determine hospital-specific factors
predicting non-use of care plans in order to address them with aim of popularizing their
use. This will go a long way to enrich the four main areas of nursing: Research, Education,
Administration and Teaching.

Housing for the low-income group has been and is still a major problem in the developing countries. More attention has been put on this problem by the world in.the recent years. Kenya being one of the developing countries faces this problem like any other developing country. The population growth rates In third world countries' cities is too high as compared to developed countries. This study looked at the factors in the provision of low-income housing and how these factors hinder the process of provision of shelter. The factors included inter alia, National Housing Policy, Land, Financial Resources, Construction costs and Building standards. These factors were analysed independently in the various chapters of this study and then findings we r e drawn. The findings were used as guidelines for the recommendations made. The study was organised in six chapters. Chapter one was an introduction, giving what the study was all about. Chapter two looked at the National Housing Policy of Kenya pointing out the weaknesses of the policy. The study found that the policy has vague, unrealistic and too ambitious

Description
Provision of water services is squarely a devolved function and counties have the bigger role of ensuring their residents have access to clean and safe water. In this regard many strategies have been put in place to ensure water available is adequate. These efforts have faced a myriad of challenges which has greatly affected service delivery. Water is one of the most important natural resource and the availability of safe water is critical not just for health reasons, but also for social and economic development. The purpose of the study was to establish the factors influencing implementation of augmentation of water treatment projects by county government in Kenya; a case of Meru Water and Sewerage Services. The specific objectives of this research project were to determine the influence of financial resources, leadership, staff competency and political factors on the augmentation of water treatment projects by county governments in Kenya. The study adopted a descriptive research design and the target population was 135 management and heads of sections which included county executive committee members (CECM), Chief officers, county directors, MEWASS management/technical staff and Members of County Assemblies (MCA’s). The study adopted a census which allowed all the 135 respondents to participate in the study, however only 109 respondents returned their questionnaires representing an approximate response rate 81%. Data was collected using a questionnaire. To test reliability of this questionnaire Split half method was applied in Isiolo water and Sewerage Company.
Descriptive statistics such as frequencies, percentages and …

The main purpose of the study was to establish the key factors that influence brand loyalty among soft drink
consumers in the Kenyan and Indian markets. The study was carried out between January 2012 and October
2012. The target group was majorly youth consumers who were sampled from local universities in both countries.The study established that in India, peer group are more powerful in influencing potential consumers to take soft drinks while in Kenyan parents play a crucial role. More importantly too, it was established that of the six variables studied, promotion is the strongest influencing factor among Kenyan soft drinks consumers while in India, brand quality matters most.

Key words: Brand loyalty, soft drinks, consumers