This paper reports the detailed results of a study of the impact of the Health Workers for Change (HWFC) workshop series on clients' perceptions of health services, relationships within the health centre and relations between the health facility and the district health system. The study was carried out in three stages: baseline, intervention and evaluation over a period of 20 months. Data, both qualitative and quantitative, were collected at three levels: client, facility and system. Results indicate that relations between health workers and clients improved a great deal after the intervention while those between the facility and the system remained to a large extent unchanged. The paper concludes that, with external support and help, especially from the health system level, health workers can work towards improving health services and their job satisfaction, which can lead to better health worker-client relations.

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{ OBJECTIVES To compare sociodemographic profiles, child care, child feeding practices and growth indices of children born to HIV-1 seropositive and seronegative mothers. METHODS: A cohort study of 234 children (seropositive and seronegative) born to HIV-1 seropositive mothers and 139 children born to seronegative mothers in Pumwani Maternity Hospital which serves a low-income population in Nairobi, Kenya from December 1991 and January 1994. RESULTS: With few exceptions, at the time of their birth children in all three cohorts had parents with similar characteristics, lived in similar housing in similar geographical areas, had their mothers as their primary care givers, had similar feeding practices and similar growth status and patterns. However, the HIV-1 seropositive mothers were slightly younger (23.8 years vs. 25.0 years, P < 0.01), if married they were less likely to be their husband's first wife (79% vs. 91%

AIDS Soc. 1991 Jan-Feb;2(2):7-8.
Social epidemiology in Africa: slowing the heterosexual transmission of AIDS.
Ronald A, Ndinya-achola JO, Ngugi EN, Moses S, Brunham R, Plummer FA.
Abstract
PIP:
Analyzing why the rate of transmission of AIDS varies widely in Africa is the basis for designing strategies for intervention. Promiscuity, i.e. high rates of sex partner change, is not the only reason for rapid transmission, but it is a prerequisite for the explosive spread seen in certain groups. High frequency groups include mobile single men and prostitutes. Research and strategies must focus on sex practices, concepts of personal vulnerability, and possibility of behavioral change. The sexually transmitted diseases that are thought to increase susceptibility to HIV, i.e., genital ulcer diseases, can be controlled with appropriate strategies. Male circumcision is associated with lower HIV seroprevalence. Thus strategies must be concentrate on sustained prevention among high STD transmitters, providing early, effective care for STDs, increasing economic alternatives for women, and offering voluntary circumcision where culturally acceptable.
PMID:
12343101
[PubMed - indexed for MEDLINE]

Analyzing why the rate of transmission of AIDS varies widely in Africa is the basis for designing strategies for intervention. Promiscuity, i.e. high rates of sex partner change, is not the only reason for rapid transmission, but it is a prerequisite for the explosive spread seen in certain groups. High frequency groups include mobile single men and prostitutes. Research and strategies must focus on sex practices, concepts of personal vulnerability, and possibility of behavioral change. The sexually transmitted diseases that are thought to increase susceptibility to HIV, i.e., genital ulcer diseases, can be controlled with appropriate strategies. Male circumcision is associated with lower HIV seroprevalence. Thus strategies must be concentrate on sustained prevention among high STD transmitters, providing early, effective care for STDs, increasing economic alternatives for women, and offering voluntary circumcision where culturally acceptable.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

JASPA Working Paper, ILO, Addis Ababa

Social media for business is the new frontier for deaf Kenyans, due to the information gap they often experience as they navigate a largely speaking and hearing world. This case studyon the use of social media platforms for business by the deaf in Nairobi includes a special emphasis on the convergence of their natural visual language, sign language with video technology. The research is important to boost socio economic livelihoods of deaf Kenyans for equality in development as well as integrate the Kenyan business industry with the innovation and creativity introduced by the signing „genre‟ of business communication. The results of the study indicate that the dialectical gap between the deaf and hearing is significantly reduced as sign language users can informally interact and exchange ideas, information and updates on business. In addition, the general boost in vocabulary originating from deaf people‟ interest in on-line communication in Kenya is highlighted. It is recommended that the recent immersion of the Kenyan deaf community in the use of smartphones and dissemination of instant messaging needs to be enhanced, as it may yield answers to societal inclusion, while also highlighting deaf cultural pride proponents of the deaf business people‟ creativity.
KeyWords:Deaf, social media, business, Kenya

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An instruction manual for teaching Social philosophy to third year students in the department of philosophy.

Although conditions of risk confronting urban youth are most visible in the immediate contexts of family and community, the degree to which specific social policies affect the status of adolescence is less understood. Between 1999 and 2002, with support from the International Development Research Centre, a team of researchers in Canada, Kenya and Nicaragua undertook a comparative inquiry into policy changes designed to influence social services impinging on the welfare of marginalized urban youth. Qualitative case studies focused on three stages of policy: a) the politics and macro-level forces underlying the formulation of social policies that affect urban youth; b) the institutional dynamics of policy implementation within selected urban sites and corresponding relations between units of local government and civil society organizations; and c) the actions and perspectives of groups of individuals who have been engaged in, and affected by, these policy processes. Despite the diversity of contexts and policies examined, case study findings revealed how the formulation of youth-oriented policies are shaped by dominant discourses that rarely accommodate the perspectives of youth themselves. Likewise, the implementation of such policies constitutes a complex set of practices that are subject to negotiation and different forms of appropriation, and therefore often exacerbate the marginalization of urban youth. In keeping with the qualitative and collaborative design of the project, the research helped to generate inter organizational dialogue within the communities that were the sites of inquiry. It also fostered insights regarding the role of collaborative international research as a catalyst for cross-national dialogue and a knowledge base for grassroots rights-oriented social change.

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This paper focuses on social protection programs in Kenya’s agriculture. A case study approach was used where three cases were examined: (a) emergency seed distribution in the arid and semi-arid lands and remote areas which are inadequately served by the formal seed sector, (b) hunger and safety net programme in northern Kenya, and (c) Njaa Marufuku Kenya. The study found that while social protection programs/strategies are necessary to cushion vulnerable groups from covariate risk, these have not been properly domesticated in the Kenyan policy and legal frameworks. In fact, the national response to shocks and stresses among the vulnerable groups has largely been ad hoc. Emergency interventions have been implemented in rather haphazard and knee-jerk approach with minimal strategic policy focus. And even where social safety nets have been implemented, these have largely been untargeted, uncoordinated and humanitarian in nature. Hence, although some efforts have been made in the past to entrench social protection in the Kenyan society (e.g., the Equity Bill, the Affirmative Action Bill and the Constitutional Review), these initiatives have suffered from lack of political goodwill, ethnic and class chauvinism and political patronage. There is therefore need to for the Kenyan society as a whole to re-define its strategic direction with regard to empowering poor households to enable them cope with shocks. The starting point would be to design a comprehensive social protection policy which is now in progress.

The role of pastoralist women in conflict resolution and management (study funded by SIDA though IMPACT)

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PIP: This research report studies several biochemical and histochemical aspects of cervical carcinoma and explores their use in follow-up of patients undergoing radiotherapy. Material came from 19 patients with invasive cervical carcinoma admitted to Kenyatta National Hospital. A control group consisted of 20 women matched for age who attended clinics at the hospital but were not suffering from any malignant disease; control tissue for histological examination was obtained from 3 women who had undergone hysterectomy for uterine fibroids. Biochemical assays for alkaline and acid phosphatases in patients with cervical carcinoma show an increase in alkaline phosphatase in carcinomatous tissue (35.7 umoles/hr/mg) as opposed to normal tissue (7.2). Acid phosphatase values were only moderately raised. Assays of the same enzymes in blood showed a less marked difference between patients and controls (ranges of 7.5-20.8 and 3-14, respectively). When examined histochemically, increased alkaline phosphatase activity was observed in connective tissue, epithelium of the glands and blood capillaries of tumor tissue. 1 section containing normal tissue bordering carcinomatous tissue demonstrated normal alkaline phosphatase activity in the normal tissue and increased activity in the tumor tissue. In summary, there is increased enzyme activity around the tumor areas, but values for serum levels show an overlap of normal and abnormal cases and are therefore not predictive. Results demonstrate a clear difference in activities of these enzymes in carcinomatous tissue and normal tissue, which may be of value in follow-up care.

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No abstract available.

Assesses socio-economic features of smallholder dairy farms in Kiambu district, Kenya. Emphasises input use by farmers and compares average milk production and prices. It is also reported in this study that more detailed analysis of the profitability of milk production on these farms is in progress

Cohen CR, Gichui J, Rukaria R, Sinei SS, Gaur LK, Brunham RC. Departments of Obstetrics and Gynecology, University of Washington, Box 356460, Seattle, WA 98195, USA. crcohen@u.washington.edu OBJECTIVE: To understand immunogenetic mechanisms of Chlamydia trachomatis infection and tubal scarring. METHODS: We measured and compared previously significant human leukocyte antigen (HLA) class II DQ alleles, their linked DRB genes, and polymorphisms in selected cytokine genes (tumor necrosis factor alpha-308 promoter; transforming growth factor beta1-10 and -25 codons; interleukin 10-1082, -819, and -592 promoters; interleukin 6-174 promoter; and interferon gamma+874 codon 1) among Kenyan women with confirmed tubal infertility with and without C trachomatis microimmunofluorescence antibody. RESULTS: Two class II alleles, HLA-DR1*1503 and DRB5*0101, were detected less commonly in C trachomatis microimmunofluorescence seropositive women than in C trachomatis microimmunofluorescence seronegative women with infertility (0% versus 20%; odds ratio [OR] 0.05; 95% confidence interval [CI] 0, 0.7, and 6% versus 26%; OR 0.2; 95% CI 0.02, 1.0, respectively). These alleles are commonly linked as a haplotype at the DRB locus. This finding could not be explained through linkage disequilibrium with the other studied HLA or cytokine genes. CONCLUSION: These alleles may lead to an immunologically mediated mechanism of protection against C trachomatis infection and associated tubal damage, or alternatively increase risk for tubal scarring due to another cause. PMID: 12636945 [PubMed - indexed for MEDLINE]

This chapter attempts to re-evaluate the history of the East African coast and the Comores between the seventh and eleventh centuries. This is being done with a view to correcting the false picture painted by historians and/or archaeologists of the colonial school of thought, who presented rather a history of foreign traders and colonizers credited with the civilization of the coast. The role of outsiders in the early history of the East African coast cannot be denied, but it is one thing to be part of a process of change and completely another to claim responsibility for the process. Recent research, however, is slowly but surely making it very clear that the history of the East African coast is the history of indigenous African populations and their interaction with the environment

Since its introduction in the early 1970s, socially responsible investment (SRI) has gained prominence as both a rival and a complement to conventional investment. SRI is the philosophy and practice of making strategic investment decisions by integrating financial and non-financial considerations, including personal values, societal demands, environmental concerns and corporate governance issues. One of the major concerns in socially responsible investing is whether there is a difference between the performance of socially screened portfolios and that of conventional funds.

This study is a literature review of socially responsible investment and portfolio performance. The objectives of the study are to establish the documented relationship between socially responsible investment (SRI) and portfolio performance; to investigate, from the literature, whether investor demographic characteristics moderate the relationship between socially responsible investment and portfolio performance, to examine whether the relationship between SRI and portfolio performance is intervened by portfolio management process, to identify and document research gaps in socially responsible investment and lastly to establish researchable issues in socially responsible investment. The study presents a conceptual model guided by the modern portfolio theory, the stakeholders’ theory, the institutional theory and the new social movement theory.

Literature reviewed on the performance of SRI mutual funds has been inconclusive with three schools of thought emerging: SRI under-performs, over-performs or performs as well as conventional mutual funds. The paper concludes that the conflicting results are caused by the fact that the relationship between SRI and portfolio performances is not direct but is intervened by other variables such as the portfolio management process. Five factors in the portfolio management process that are affected by SRI have been identified (Havemann and Webster, 1999). These are the portfolio diversification process, the size and structure of the investable universe, concentration and the research costs incurred in monitoring the investee companies. Another explanation into the conflicting results is that the relationship between SRI and portfolio performances may be moderated by the investors’ demographic characteristics such age, gender, level of education and amount of funds under management (Nilsson, 2008; Nilsson, 2009; Junkus and Berry, 2010).

A number of research gaps arise from the analysis of the issues examined in this paper. These include: Firstly, lack of consensus on why SRI occurs even when empirical evidence on the impact of SRI on portfolio performance is inconclusive. Secondly, difficulties in assessment of non-financial risk and return created by SRI especially given the inability to quantify social, ethical, governance, moral and environmental issues. Thirdly, most studies have not controlled for any intervening or moderating variable affecting the relationship between SRI and portfolio performance. Variables such as differences in demographic characteristics of the fund managers and portfolio management process may affect the relationship between SRI and portfolio performance.

Arising from the research gaps identified, several areas of further study have been suggested. These include: Firstly, a research instrument be developed to empirically test the variables that impact on socially responsible investment including the moderating and intervening variables. Secondly, a study can be undertaken to investigate the heterogeneity among investor clienteles and its implications for understanding the effects of social values on asset prices. Thirdly, given that investors have different reasons for investing in SRI profiled mutual funds, future research with regard to this segmentation would be to find out the reasons why investors belong to certain groups. Fourthly, further research can be done focusing on the type of mutual funds that could be marketed to the different investors’ segments and finally, an index can be developed to quantify the non-financial risk and returns existing in SRI mutual funds.

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This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

Although early diagnosis and treatment are key factors in the effective control of human African trypanosomiasis (HAT), many cases of the disease delay taking appropriate action, leading to untold suffering. As a better understanding of treatment-seeking behaviour should help in identifying the obstacles to early diagnosis and effective treatment, the treatment pathways followed by 203 former HAT cases in western Kenya and eastern Uganda have recently been explored. About 86% of the HAT cases had utilized more than two different healthcare options before being correctly diagnosed for HAT, with about 70% each using more than three different health facilities. Only about 8% of the cases reported that they had been correctly diagnosed the first time they sought treatment. Just over half (51%) of the HAT cases had been symptomatic for >2 months before being correctly diagnosed for HAT, and such time lags in diagnosis contributed to 72% of the cases receiving their first appropriate treatment only in the late stage of the disease. The likelihood of a correct diagnosis increased with the time the case had been symptomatic. These observations indicate an urgent need to build the diagnostic capacity of the primary healthcare facilities in the study area, so that all HAT cases can be identified and treated in the early stage of the disease.

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The decision to pay out earnings or retain dividends has been a subject of debate for many scholars. The effect of dividend on the firm value and cost of capital have been covered in attempt to resolve the dividend puzzle. This research paper tests the applicability of constant dividend model by companies listed at the Nairobi stock exchange. Data was collected from annual reports and share price schedules obtained from Nairobi stock exchange and Capital market Authority for a population of 20 companies that paid dividends consistently from 2002 to 2008. The data was then analyzed by re-computing the dividends that should have been paid if the dividend constant model was applied. This recomputed figure was later compared to the dividend as paid out by the companies thought the years of study. Paired sample t-test statistic was also performed to determine whether there is a significant difference between the two dividend figures. The findings of the research established that the dividend model was not employed by the companies listed at the Nairobi stock exchange. Most firms instead adopted stable and predictable policy where a specific amount of dividend per share each year was paid periodically. In some years there was a slight adjustment of the dividend paid after an increase in earnings, but only by a sustainable amount. The study shows that the relationship between the stock market prices and the dividend paid from the constant dividend model is uneven from one year to another and where there was a relationship it was insignificant. Though a share would be highly priced, a high dividend per share was not always declared.

To determine the socio-demographic profiles and some clinical aspects of patients with rheumatoid arthritis (RA). DESIGN: Prospective, cross-sectional study. SETTING: Ambulatory out- patient clinics of Kenyatta National Hospital (KNH), a public national and referral hospital. SUBJECTS: Out of 180 patients interviewed and examined, 60 met American College of Rheumatology (ACR) diagnostic criteria of RA. RESULTS: Of the 60 patients recruited 52 (87%) were females with male: female ratio of 1: 6.5. The mean age of patients was 41.38(+/- 16.8) years. There were two peaks of age of occurrence, 20-29 and 40-49 years. In 75% of the study patients, one or more of metacarpophalangeal joints of the hand were involved in the disease. Other frequently involved sites were--wrists, elbows, knees, ankles and glenohumeral joints of shoulders in a symmetrical manner. Serum rheumatoid factor was positive in 78.9% while rheumatoid nodules were present in 13.3% of the study patients. A large majority of patients (88%) had active disease with 18% having mild disease, 38% moderate activity and 32% having severe disease. Only 12% of patients had disease in remission. Forty six point seven per cent (46.7%) of the study patients were on at least one Disease Modifying anti Rheumatic Drugs (DMARD) from a selection of methotrexate, sulphasalazine, hydroxychloroquine and leflunamide. The most frequent drug combination was methotrexate plus prednisolone at 30% of the study population; while 66.7% were on oral prednisolone with 25% of the study patients taking only Non-Steroidal anti Inflammatory Drugs (NSAIDS). CONCLUSION: A large majority of ambulatory patients with RA had active disease. Most of them were sub-optimally treated, especially the use of DMARDS. About two thirds were on oral steroids. Sub-optimal therapy in relatively young patients, peak 20-29 and 40-49 years is likely to impact negatively on their disease control and quality of life.

To determine the socio-demographic profiles and some clinical aspects of patients with rheumatoid arthritis (RA). DESIGN: Prospective, cross-sectional study. SETTING: Ambulatory out- patient clinics of Kenyatta National Hospital (KNH), a public national and referral hospital. SUBJECTS: Out of 180 patients interviewed and examined, 60 met American College of Rheumatology (ACR) diagnostic criteria of RA. RESULTS: Of the 60 patients recruited 52 (87%) were females with male: female ratio of 1: 6.5. The mean age of patients was 41.38(+/- 16.8) years. There were two peaks of age of occurrence, 20-29 and 40-49 years. In 75% of the study patients, one or more of metacarpophalangeal joints of the hand were involved in the disease. Other frequently involved sites were--wrists, elbows, knees, ankles and glenohumeral joints of shoulders in a symmetrical manner. Serum rheumatoid factor was positive in 78.9% while rheumatoid nodules were present in 13.3% of the study patients. A large majority of patients (88%) had active disease with 18% having mild disease, 38% moderate activity and 32% having severe disease. Only 12% of patients had disease in remission. Forty six point seven per cent (46.7%) of the study patients were on at least one Disease Modifying anti Rheumatic Drugs (DMARD) from a selection of methotrexate, sulphasalazine, hydroxychloroquine and leflunamide. The most frequent drug combination was methotrexate plus prednisolone at 30% of the study population; while 66.7% were on oral prednisolone with 25% of the study patients taking only Non-Steroidal anti Inflammatory Drugs (NSAIDS). CONCLUSION: A large majority of ambulatory patients with RA had active disease. Most of them were sub-optimally treated, especially the use of DMARDS. About two thirds were on oral steroids. Sub-optimal therapy in relatively young patients, peak 20-29 and 40-49 years is likely to impact negatively on their disease control and quality of life.

Low body mass index (BMI) at the time of enrollment into HIV care has been shown to be a strong predictor of mortality independent of CD4 count. This study investigated socio-demographic associations with underweight (BMI < 18.5) among adults in Nyanza Province, Kenya, upon enrollment into HIV care. BMI, socio-demographic, and health data from a cross-sectional sample of 8254 women and 3533 men were gathered upon enrollment in the Family AIDS Care and Education Services (FACES) program in Nyanza Province, Kenya, between January 2005 and March 2010. Overall, 27.4% of adults were underweight upon enrollment in HIV care. Among each women [W] and men [M], being underweight was associated with younger age (W: adjusted odds ratio [AOR], 2.90; 95% confidence interval [CI], 1.85-4.55; M: AOR, 5.87; 95% CI, 2.80-12.32 for those aged 15-19 compared to ≥50 years old), less education (W: AOR, 2.92; 95% CI, 1.83-4.65; M: AOR, 1.55; 95% CI, 1.04-2.31 for primary education compared to some college/university), low CD4 count (W: AOR, 2.13; 95% CI, 1.50-3.03; M: AOR, 1.43; 95% CI, 0.76-2.70 for 0-250 compared to ≥750 cells/mm3), and poor self-reported health status (W: AOR, 1.72; 95% CI, 0.89-3.33; M: AOR, 9.78; 95% CI, 1.26-75.73 for poor compared to excellent). Among all enrollees to HIV care, low BMI was associated with male gender, lower educational attainment, younger age, and poor self-reported health. HIV care and treatment programs should consider using socio-demographic and health risk factors associated with low BMI to target and recruit patients with the goal of preventing late enrollment into care.

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To determine the magnitude of gynaecological emergencies and the socio demographic characteristics of patients admitted at Provincial General Hospital Kakamega (PGHK). DESIGN: Retrospective cross-sectional study. SETTING: Provincial General Hospital Kakamega, the referral hospital for Western Province, Kenya. SUBJECTS: Four hundred patients admitted at the gynaecological wards during the period 1st January 2002 to 31st December 2002. RESULTS: In this study 80% of gynaecological patients admitted at PGH Kakamega were of an emergency nature with 45% being teenagers. The mean age was 17 +/- 3 (mean +/- SD). The majority had primary level of education or below (69%), unemployed (87%) and were rural residents (71%). Patients with abortion formed about 43% of the study group while those with inflammatory disease, pelvic abscess and ectopic pregnancy formed about 24%, 10% and 8% respectively. CONCLUSION: Most gynaecological admissions in PGH Kakamega are of acute nature, with abortion being the most common diagnosis. Hence, trained staff, equipment, supplies and drugs for management of acute gynaecological conditions should be available in hospitals in Western Kenya.

To determine the magnitude of gynaecological emergencies and the socio demographic characteristics of patients admitted at Provincial General Hospital Kakamega (PGHK). DESIGN: Retrospective cross-sectional study. SETTING: Provincial General Hospital Kakamega, the referral hospital for Western Province, Kenya. SUBJECTS: Four hundred patients admitted at the gynaecological wards during the period 1st January 2002 to 31st December 2002. RESULTS: In this study 80% of gynaecological patients admitted at PGH Kakamega were of an emergency nature with 45% being teenagers. The mean age was 17 +/- 3 (mean +/- SD). The majority had primary level of education or below (69%), unemployed (87%) and were rural residents (71%). Patients with abortion formed about 43% of the study group while those with inflammatory disease, pelvic abscess and ectopic pregnancy formed about 24%, 10% and 8% respectively. CONCLUSION: Most gynaecological admissions in PGH Kakamega are of acute nature, with abortion being the most common diagnosis. Hence, trained staff, equipment, supplies and drugs for management of acute gynaecological conditions should be available in hospitals in Western Kenya.

To determine the magnitude of gynaecological emergencies and the socio demographic characteristics of patients admitted at Provincial General Hospital Kakamega (PGHK).

The study was conducted from 30th May 2006 - July 3rd 2006 at Kenyatta and Pumwani hospitals in Kenya. The aim was to determine the socio-economic and cultural factors that influence women's reproductive health decision making. It was cross-sectional and descriptive study on a sample size of 384 subjects. A semi structured questionnaire and focus group discussion on 3 groups of eight mothers each was used.

The study revealed that age, marital status, level of education and employment status influences women's reproductive health decision making. The main cultural factors found to influence women's reproductive health decision making were; FGM, wife inheritance, sex of baby (preference for boys) and dowry.

The conclusions arrived at was that majority of women are participating in their own reproductive health decision making though many need to be given education on different areas of reproductive health to encourage informed decision making. It was recommended that education opportunities for women on reproductive health issues be given more emphasis.

The study was conducted from 30th May 2006 - July 3rd 2006 at Kenyatta and Pumwani hospitals in Kenya. The aim was to determine the socio-economic and cultural factors that influence women's reproductive health decision making. It was cross-sectional and descriptive study on a sample size of 384 subjects. A semi structured questionnaire and focus group discussion on 3 groups of eight mothers each was used. The study revealed that age, marital status, level of education and employment status influences women's reproductive health decision making. The main cultural factors found to influence women's reproductive health decision making were; FGM, wife inheritance, sex of baby (preference for boys) and dowry. The conclusions arrived at was that majority of women are participating in their own reproductive health decision making though many need to be given education on different areas of reproductive health to encourage informed decision making. It was recommended that education opportunities for women on reproductive health issues be given more emphasis.

The study was conducted from 30th May 2006 - July 3rd 2006 at Kenyatta and Pumwani hospitals in Kenya. The aim was to determine the socio-economic and cultural factors that influence women's reproductive health decision making. It was cross-sectional and descriptive study on a sample size of 384 subjects. A semi structured questionnaire and focus group discussion on 3 groups of eight mothers each was used. The study revealed that age, marital status, level of education and employment status influences women's reproductive health decision making. The main cultural factors found to influence women's reproductive health decision making were; FGM, wife inheritance, sex of baby (preference for boys) and dowry. The conclusions arrived at was that majority of women are participating in their own reproductive health decision making though many need to be given education on different areas of reproductive health to encourage informed decision making. It was recommended that education opportunities for women on reproductive health issues be given more emphasis.

The study was conducted from 30th May 2006 - July 3rd 2006 at Kenyatta and Pumwani hospitals in Kenya. The aim was to determine the socio-economic and cultural factors that influence women's reproductive health decision making. It was cross-sectional and descriptive study on a sample size of 384 subjects. A semi structured questionnaire and focus group discussion on 3 groups of eight mothers each was used. The study revealed that age, marital status, level of education and employment status influences women's reproductive health decision making. The main cultural factors found to influence women's reproductive health decision making were; FGM, wife inheritance, sex of baby (preference for boys) and dowry. The conclusions arrived at was that majority of women are participating in their own reproductive health decision making though many need to be given education on different areas of reproductive health to encourage informed decision making. It was recommended that education opportunities for women on reproductive health issues be given more emphasis.

ABSTRACT Northern Kenya, as in other sub-Saharan arid and semi-arid regions, has faced challenges related to the prevailing socio-economy, ecology and polity in the last quarter of last century. In some of these areas, pastoralists have been settled on the peri-urban fringes of towns and have been exposed to flood-retreat cultivation; a culture that has been traditionally practised by the riverine Bantu communities. From the late 1960s these pastoralists started irrigation agriculture with assistance from the government and nongovernmental organisations. The outcome has been the mushrooming of irrigation schemes along rivers. This paper looks at the development of small-scale irrigation schemes and their sustainability. It also analyses their socio-economic and ecological effects on pastoral households and the drylands, taking Garissa District as a case. Interviews, a questionnaire and existing literature on irrigation schemes were used to collect data. Logistic regressions were carried out to assess the socio-economic effects of irrigation on the pastoral households. The results show that irrigation farming plays a supplementary role in pastoral economies, takes away child labour from pastoralism and reduces pastoral mobility. The implication is that irrigation farming in arid areas does not seem to offer a long-term sustainable economic livelihood.

Personal wealth as denoted by accumulated net assets is a key ingredient of a people’s standards of living. This is because wealth facilitates consumption, especially in old age, cushions people against adversities such as illness and unemployment as well as enables further wealth creation through access to bank credit. The assets that comprise wealth include cash and bank balances, properties, shares in cooperatives and listed companies, life assurance policies, accrued pension benefits, corporate bonds, and treasury bills and bonds.
This paper examines the sizes and composition of the wealth portfolios of salaried middle and upper income employees in Kenya in order to find out which personal attributes are key determinants of the portfolios. Primary data was obtained from questionnaires that were administered on a stratified random sample of 1,067 salaried middle and upper income employees in Kenya in mid 2010, the time of survey. The preliminary tests employed the use of Kaiser Mayer-Olkin (KMO) and Bartlett’s Test based on correlation and partial correlation as well as the results of Bartlett’s Test of sphericity to test for the presence of correlations among variables. For this paper, the results KMO measure of sampling adequacy of 0.758 was acceptable, since it was higher than the recommended minimum of 0.50. Additionally, the Bartlett’s Test of sphericity recorded an acceptable p-value of 0.000, which was lower than the test value of 0.05 percent, thereby indicating that there is correlation between the variables To establish the determinants of the wealth portfolios of employees in Kenya, 21variables were used. These variables were analyzed using factor analysis procedure and in order to achieve a simple and meaningful structure, that is, have a nonzero loading of the explained variance for each individual factors, varimax rotation was done. As a result, six critical factors were established as the determinants of wealth portfolios of salaried middle and upper income employees, which include earning capacity, life cycle factors, investment objective, employee’s cultural background, employees’ risk taking behavior and savings. The findings largely conform to theory and corroborate evidence from prior studies.
Key Words: assets, attributes, characteristics, salaried middle and upper income employees, socio-economic, wealth portf

A cross-sectional survey was done in two Districts in Western Kenya to determine the socio-economic characteristics and perceptions of the cattle types kept. This involved socio-economic profiles of households, herd structure, reasons for keeping specific types of cattle and production and marketing constraints together with desired policy interventions to address the constraints. A total of 210 farmers randomly selected were interviewed. The data was analysed using Statistical Analysis System program. The majority of farmers (84%) were males. The households surveyed had an average family size of 8 (± 4.7) members. The mean land holding was 7.8 acres, with 98% of them owning the land. Most of the farmers (64%) in the two districts were literate and were involved in farming (95%) as the primary livelihood. The majority (80%) of the households preferred keeping indigenous zebu cattle over the exotic cattle. The first three reasons for keeping zebu cattle were, in that order, work, especially ploughing (91%), milk (74%) and as a repository for wealth (32%), which accounted for about 62% of the respondents. Diseases (86%), inadequate and low quality feed (12%) and high cost of drugs (2%) were the major constraints to livestock productivity. The farmers also identified lack of market (48%), poor infrastructure (39%) and misuse by the middlemen traders (12%) as main marketing constraints. The survey showed that there is need for the effective implementation of policies on adequate financial aid and regulation of farm input prices to the farmers as well as improved livestock extension services to enhance the production of ruminant livestock.

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The paper describes Kenyan experience with smallholder irrigation, and draws from: (i) an evaluation of socio-economic aspects of smallholder irrigation rice schemes in Nyanza Province; (ii) a survey of the role of irrigation in a smallholder farming system in Baringo District; and (iii) a performance-monitoring survey of some smallholder irrigation schemes, also in Baringo District. Policy implications concerning the need for suitable evaluation before intervening in irrigation development are drawn from examination of the various socio-economic factors which may have led to the success or failure of the selected smallholder irrigation schemes in Kenya. These results could form part of the basis for a checklist of socio-economic factors appropriate to the design of sustainable smallholder irrigation schemes in Sub-Saharan Africa.

Sustainability in agriculture requires a better understanding of interactions within the production syatem. Diverse factors such as social structure, knowledge and information flow all as well as other bio[hyscical afctors interact with each other to determine agricultural productivity and sustainability. Researchers and extension agents find that they need to deal with issues that may be outside their area of specialization. An interdisciplinary approach provides a framework through which such support can be provided.

This paper studies the problem of malaria control in irrigation and non-irrigation areas in Kenya. Empirical results show that in both areas, households' level of awareness of malaria as a health problem, including its cause, was very high. However, attempts to trace the direct effects of malaria upon income or upon agricultural production were not statistically important. This does not imply that malaria has no consequence on household welfare. It is possible that the model equations were mis-specified–aggregate variables (total family size, total family income) and failure to quantify land in the production relationships may have contributed to these results. In addition, poor separation of malaria as a disease, from malaria as an infection, may have underestimated the effect of the disease on production. Thirdly, labour substitution (hiring or within-family substitution) was not measured in this early study, but was taken into account in subsequent research. Finally, labour requirements in the annual crop production schedules and the co-relation between these labour requirements and the pattern of adult morbidity were not longitudinally monitored. Cross-section data would bias the findings, particularly in those areas where the peak transmission season is short, where the crop grown does not require major labour input during this transmission season, and where acquisition of immunity would reduce the clinical impact of malaria upon adult labour. These vulnerabilities in the specification of the model and the data collected, probably affect the results obtained. Our empirical work raises a number of interesting and important questions which should be taken into account in future research

JASPA Working Paper, ILO, Addis Ababa

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In order to design an effective small ruminant (i.e., goats and sheep) breeding program in Kenya and other areas with similar production circumstances, it is important to understand the socio-economic factors applying to the relevant production system. Information on these was obtained from a questionnaire carried out on both smallholders and pastoral/ extensive farmers in seven selected districts. From the 458 responding households, 18% kept only goats, 34% kept only sheep, and 48% kept both species. Goats were generally ranked lower in popularity. The most represented breeds in the households were the indigenous East African goat and the Red Maasai sheep, and crossbred genotypes of goats and sheep. However, according to the farmers, the pure breeds were more popular than the crossbreeds. The households owned the majority of the used land for small ruminant production. In many cases, male household members were in control of the land. Animals were in most cases owned by the household head only or by both the household head and the spouse. The most important water source for animals was the river with the frequency of watering in the dry season in some cases being as low as once a day. Both males and females made most decisions in smallholder households. Women in the pastoral/ extensive systems participated less significantly in decision making than those in smallholder households, although they were responsible to many animal production related activities. In general, it is important to take into consideration socio-economic factors that influence small ruminant breeding programs to enhance their success.

Socio-economic and medical information on Bondo sub-county community was studied to help establish the relationship between the water quality challenges, community health and water rights conditions. Health challenges have been linked to water quality and household income. A total of 1,510 households/respondents were studied by means of a questionnaire. About 69% of the households have no access to treated water. Although 92% of the respondents appear to be aware that treatment of water prevents waterborne diseases, the lowest income group and children share a high burden of waterborne diseases requiring hospitalization and causing mortality. Open defecation (12.3%) in these study areas contributes to a high incidence of waterborne diseases. The community’s constitutional rights to quality water in adequate quantities are greatly infringed. The source of low-quality water is not a significant determinant of waterborne disease. The differences in poverty level in the sub-county are statistically insignificant and contribute less than other factors. Increased investment in water provision across regions, improved sanitation and availability of affordable point-of-use water purification systems will have major positive impacts on the health and economic well-being of the community.

Abstract This study analysed the factors influencing the intensity of adoption of improved fallows in Western Kenya. Three hundred farmers were interviewed. Descriptive results showed the adopters to be older, more educated and had more contact with technology promoters than the non-adopters. Partial budgets were constructed and marginal rates of returns (MRR) showed that the technology is profitable. Based on the censored Tobit, the results indicate that the intensity of adoption was significantly influenced by age, experience of the household head and spouse, total land area, contact with technology promoters, technology profitability and use of other soil fertility replenishment options. It is recommended that education efforts be intensified. There is need to strengthen contact with the technology promoters. In order to ensure information flow to all, there is need for improvement in the approach and methods employed in on-farm research. Further, there is need to establish and strengthen networks of information exchange among relevant and interested organisation

Department of Pathology, University of Toronto, Ontario, Canada. Red blood cells and lysate products (erythrolysate) are observed consistently in lymph draining acute and chronic inflammatory reactions and from tissues subjected to trauma or surgical procedures. Using hemoglobin as a marker for erythrolysate, we have measured hemoglobin in lymph up to the 10(-6) M range in a number of pathophysiological states. Data demonstrate that erythrolysate alters the pumping characteristics of lymphatic vessels. To test the effects of erythrolysate on lymphatic pumping, bovine lymphatics were suspended in an organ bath preparation with the vessels cannulated at both inflow and outflow ends. By raising the heights of the Krebs reservoir and the outflow catheters appropriately, a transmural pressure that stimulated pumping activity could be applied to the vessels. With a fixed transmural pressure of 6 cm H2O applied to the ducts, sheep erythrolysate depressed pumping activity between 40% and 100%, with dilutions containing between 10(-8) and 10(-5) M hemoglobin. Although the active principle in the red blood cells has not been characterized, evidence from precipitation purification experiments suggests that hemoglobin is an important component. Once suppressed, pumping could be restored in many but not all vessels (often to control levels) by elevating the distending pressure above 6 cm H2O. The relation between transmural pressure and fluid pumping is expressed as a bell-shaped curve, with pumping increasing up to a peak pressure (usually 8 cm H2O) and declining at pressures above this level. By comparing pressure/flow curves, we were able to ascertain that hemoglobin shifted the lymphatic function curve to the right and, on average, reduced the maximum pumping capability of the vessels. We speculate that the presence of erythrolysate/hemoglobin in lymph may modulate the ability of lymphatic vessels to drain liquid and protein from the tissue spaces.

This article is based on a socio-economic impact study of the introduction and adoption of tissue-culture (tc) technology in banana production in Kenya. It attempts to demonstrate that a prudent introduction and promotion of a new biotechnological innovation in farming can make a positive contribution to the socio-economic status of resource poor farmers in a developing country, such as Kenya. Adoption of tc technology in banana production in Kenya is considered a good example of biotechnological applications in agriculture. Hence the article hopes to make a contribution to recent debates at international levels as to whether biotechnology can make a difference in uplifting the living standards of people in the third world (Qaim, 1999; Graff, et al 2002; Qaim, et al 2002) by showing that it actually does so, using experiences from Kenya. The study utilizes both primary and secondary data sources. The results show that tc-banana production is relatively more capital intensive than non-tc banana production (re: about 70% fixed costs for tc banana versus about 49% fixed costs for non-tc banana). However, tc-banana production is found to offer relatively much higher financial returns than non-tc banana production. The high profitability of tc-banana production relative to traditional (non-tc) banana production and other farm enterprises in the pilot tc-banana project area in Kenya demonstrates the importance of biotechnological applications in rural development and shows that biotechnology can make a difference in uplifting the living standards of people in the third world. Therefore, efforts to promote tc-banana production in Kenya are justifiable from both food security and economic criteria.

This paper presents the results of a study conducted in a pastoral community in Kenya using participatory appraisal approaches. The objective of the study was to assess the socio-economic impact of camel trypanosomosis (surra) according to the perceptions of the pastoralists. Four livestock grazing units were conveniently selected and in each of them, three groups of key informants comprising five to eight persons were selected for the  participatory exercises. Five camel diseases were listed in order of importance according to their severity and frequency of occurrence including trypanosomosis, mange, non-specific diarrhoea, tick infestations and haemorrhagic septicaemia. The losses listed as incurred due to the five diseases were: losses in milk, meat, blood, fats and hides, dowry payments, and depreciation in sale of animals, losses due to infertility and abortions and losses due to the cost of treatment. There was good agreement (p<0.05) between the informant groups on the losses incurred as a result of the diseases for all the selected loss indicators. Surra and mange were given high median scores on all the indicators while non-specific diarrhoea, tick infestations, and haemorrhagic septicaemia received moderate median scores. Based on the study findings it is concluded that the camel plays a central role in the lives of Turkana pastoralists and that surra has a devastating social and economic impact. There is a need for veterinary and policy decision-makers to focus more attention on the control of surra in this arid and semi-arid area of Kenya.   Keywords:      Camel trypanosomosis, participatory approach, surra, Turkana pastoralists

This paper presents the results of a study conducted in a pastoral community in Kenya using participatory appraisal approaches. The objective of the study was to assess the socio-economic impact of camel trypanosomosis (surra) according to the perceptions of the pastoralists. Four livestock grazing units were conveniently selected and in each of them, three groups of key informants comprising five to eight persons were selected for the  participatory exercises. Five camel diseases were listed in order of importance according to their severity and frequency of occurrence including trypanosomosis, mange, non-specific diarrhoea, tick infestations and haemorrhagic septicaemia. The losses listed as incurred due to the five diseases were: losses in milk, meat, blood, fats and hides, dowry payments, and depreciation in sale of animals, losses due to infertility and abortions and losses due to the cost of treatment. There was good agreement (p<0.05) between the informant groups on the losses incurred as a result of the diseases for all the selected loss indicators. Surra and mange were given high median scores on all the indicators while non-specific diarrhoea, tick infestations, and haemorrhagic septicaemia received moderate median scores. Based on the study findings it is concluded that the camel plays a central role in the lives of Turkana pastoralists and that surra has a devastating social and economic impact. There is a need for veterinary and policy decision-makers to focus more attention on the control of surra in this arid and semi-arid area of Kenya.   Keywords:      Camel trypanosomosis, participatory approach, surra, Turkana pastoralists

This paper presents the results of a study conducted in a pastoral community in Kenya using participatory appraisal approaches. The objective of the study was to assess the socio-economic impact of camel trypanosomosis (surra) according to the perceptions of the pastoralists. Four livestock grazing units were conveniently selected and in each of them, three groups of key informants comprising five to eight persons were selected for the  participatory exercises. Five camel diseases were listed in order of importance according to their severity and frequency of occurrence including trypanosomosis, mange, non-specific diarrhoea, tick infestations and haemorrhagic septicaemia. The losses listed as incurred due to the five diseases were: losses in milk, meat, blood, fats and hides, dowry payments, and depreciation in sale of animals, losses due to infertility and abortions and losses due to the cost of treatment. There was good agreement (p<0.05) between the informant groups on the losses incurred as a result of the diseases for all the selected loss indicators. Surra and mange were given high median scores on all the indicators while non-specific diarrhoea, tick infestations, and haemorrhagic septicaemia received moderate median scores. Based on the study findings it is concluded that the camel plays a central role in the lives of Turkana pastoralists and that surra has a devastating social and economic impact. There is a need for veterinary and policy decision-makers to focus more attention on the control of surra in this arid and semi-arid area of Kenya.   Keywords:      Camel trypanosomosis, participatory approach, surra, Turkana pastoralists

This paper presents the results of a study conducted in a pastoral community in Kenya using partici¬patory appraisal approaches. The objective of the study was to assess the socio-economic impact of camel trypanosomosis (surra) according to the perceptions of the pastoralists. Four livestock grazing units were conveniently selected and in each of them, three groups of key informants comprising five to eight persons were selected for the participatory exercises. Five camel diseases were listed in or¬der of importance according to their severity and frequency of occurrence including trypanosomosis, mange, non-specific diarrhoea, tick infestations and haemorrhagic septicaemia. The losses listed as incurred due to the five diseases were: losses in milk, meat, blood, fats and hides, dowry payments, and depreciation in sale of animals, losses due to infertility and abortions, and losses due to the cost of treatment. There was good agreement (P < 0.05) between the informant groups on the losses in¬curred as a result of the diseases for all the selected loss indicators. Surra and mange were given high median scores on all the indicators while non-specific diarrhoea, tick infestations, and haemor¬rhagic septicaemia received moderate median scores. Based on the study findings it is concluded that the camel plays a central role in the lives of Turkana pastoralists and that surra has a devastating social and economic impact. There is a need for veterinary and policy decision-makers to focus more attention on the control of surra in this arid and semi-arid area of Kenya.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

This study set out to examine the policy position in Kenyan health care financing, with regard to implementation of the proposed social health scheme (NSHIF) and its performance potential. The specific objectives were to: examine the existing social scheme (NHIF), its role and challenges in health care financing; establish whether or not Kenya has the key pre-requisites for introduction and sustainability of a social health scheme and to provide recommendations on the way forward. This was largely a desk study, supplemented with limited primary data from key informants. The analysis indicates that: i) For a universal social health plan to be sustainable, favorable economic indicators and availability of essential infrastructures are critical prerequisites. Resources must be available, government must be in a position to afford high subsidies, the population must be ready to pay high premiums and the supply of health services must be adequate to cater for the expected increase in demand; ii) Countries that have successfully embraced social health plans introduced their schemes carefully and gradually (overtime) in terms of coverage; iii) Kenya compares unfavorably with these countries in terms of prerequisites for sustainability of a social health scheme, due largely to a poor economy, high poverty levels and shortfalls in facilities and services. The study concludes that Kenya lacks the key prerequisites for introducing and sustaining a universal social health scheme. The scheme can hardly be supported by the current status of the economy and healthcare infrastructures. The study recommends: i) Expansion and development of health care infrastructural capacities through subsidies and tax concessions for those investing in health care and providing subsidized services, particularly to the poor and rehabilitation of the GoK facilities; ii) Increasing the health budget from 7 per cent of government expenditure to above 10 per cent and directing more resources and efforts towards preventive/promotive and primary health care (P&PH); and iii) Other recommendations include subjecting the proposed scheme to an actuarial evaluation and comprehensive policy plan in order to determine the attendant and corresponding premium and benefit levels and pursuing a phased approach in the implementation of the scheme.

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