Spatial Equity in Devolved Healthcare: Geospatially Exploring Local Disparities in Maternal Healthcare Uptake After Devolution in Kenya

Devolved healthcare in Kenya was to ensure provision of proximate and easily accessible services throughout the Country, thereby improving local uptake as an outcome from patient perspective. Over five years after operationalization of the devolved healthcare, it isn’t certain whether or not there have been reducing spatial disparities and/or improving prospects of spatial equity in local utilizations of essential primary healthcare. The paper seeks to explore spatial disparities in maternal healthcare utilization and prospects of realising spatial equity after devolution of healthcare in Kenya. County of Siaya and 30 Wards therein were, respectively, selected as spatially heterogeneous and homogenous multiple cases for the study through retrospective patient-based surveys. The study leveraged on Kenyan webbased health information systems to capture spatial and attribute data on skilled birth attendance and antenatal care before and after devolution by each of the 220 registered health facility the County by Wards. Local utilization ratio, a new innovative indicator, was applied to effectively measure and analyse the spatial disparities in maternal healthcare through ordinary least square spatial regression analysis within spatio-temporal analysis realm using ArcGIS 10.3. Result showed significant positive spatial relationship in maternal service utilizations before and after devolution by Wards (p<0.01, R 2>90%). but stagnating or deteriorating spatial disparities irrespective of either increasing or decreasing uptake of the services. This trend points to lower prospects by devolved healthcare in realizing spatial health equity without improving quality and comprehensiveness of primary health services in Siaya County and related decentralised units in Kenya and beyond

The Drivers of audit report lag by listed companies in Kenya

Thesis submitted in partial fulfillment for the requirements for the Degree of Master of Commerce (MCOM) at Strathmore UniversityDespite the time taken by external auditors to release the audit report (herein referred to as the auditor report lag, ARL) being regarded as a significant qualitative aspect of timely financial reporting, little known about the determinants of ARL in listed companies in developing economies. This study sought to investigate the determinants of ARL in companies listed in Kenya. A descriptive research design was used to study the auditor-related factors, company-specific factors and corporate governance factors affecting ARL. Two-stage panel least squares regressions were performed to establish the drivers of ARL. The study focused on a ten-year period from 2006 to 2015. The findings revealed that auditor type was the most significant auditor related factor that was associated with ARL. In terms of company-specific factors, the return on assets (ROA) was significant and negatively associated with ARL. In terms of industry sector, the study found that listed companies in the banking sector had lower ARLs. Similarly, companies in the manufacturing sector had lower ARLs. The study found that listed companies in the investment sector had longer ARLs. Next, the study found that listed companies with a higher corporate governance score had shorter ARL. The findings revealed that there exists auditor-specific, company-specific and corporate governance influences on ARL. To corroborate findings from secondary data, semi-structured questionnaires were used. The findings from the questionnaires demonstrated that alongside auditor-, company- and corporate governance-related factors, there are also regulatory factors influencing ARL. The findings should be of interest to managers, auditors and policy makers because these results may help the assessment of the influence of such variables on improving the timeliness of audit reports. Despite the study focusing on ARL in a single country-setting, it contributes to the sparse literature of drivers of ARL in developing countries

UPTAKE OF TASK SHIFTING AS A COMMUNITY STRATEGY IN KENYA

The objective of the study was to evaluate the uptake of task shifting as a community strategy in Kenya. This study adopted qualitative data collection methods in three different contexts; peri-urban, rural and arid Kenya. The results suggest that voluntary counselling and testing, community health education, hygiene, referrals and family planning services should be shifted to Community Health Workers (CHWs) and they should be trained to diagnose and treat some common childhood ailment. There is evidence that CHWs perform an important role in helping to achieve the Millennium Development Goals (MDGs) for health, particularly for child survival and treatment of TB and HIV/AIDS. Effective task shifting requires appropriate utilization of primary health care services, effective training and incentives for health workers to provide services

DETERMINANTS DE LA SOUS-ALIMENTATION DES MENAGES EN CÔTE D’IVOIRE : CAS DES REGIONS CENTRE ET CENTRE-EST

Undernutrition is one of the major issues in the development agenda; the increase in food prices in recent years increases the vulnerability of households and climate change has adverse impacts on agricultural production.The objective of this study is to identify the determinants of undernutrition households in the Central and East-Central Côte d'Ivoire, ranked among the most deprived areas. Using data from the Survey of Household Living Standards (ENV 2002), Logit econometric models revealed that among these factors include household size, gender of household head, education level of the head household, the main occupation of the household head, the industry, living environment and the practice of farming. This analysis shows that the undernourished households are characterized in particular by high size, low level of education, the exercise of the profession of craftsman in the informal sector and are mostly headed by women. These determinants are levers that authorities may rely to reduce undernutrition. Therefore, it is desirable for the government to popularize family planning (reduction in household size), raising the level of education of the population at least at the secondary level, to promote the profession of craftsman by the capacity building and stakeholder access to microfinance to combat undernutrition

Corporate governance and the timeliness of audited financial statements: the case of Kenyan listed firms

Purpose: the nature of corporate governance (CG) mechanisms in an entity may influence the timeliness of the audited annual report. We argue that the “quality” of CG in a firm has a significant association with the time it takes the audited annual report and financial statements to be released.Design/methodology/approach: using a set of 543 firm-year observations over the period 2007 – 2016, we examine whether a validated CG-Index is associated with audit report delay (ARD). We employ both granular as well as aggregated approaches to the analyses. In addition, we include control variables known to have an association with ARD in the panel data regressions.Findings: our findings, which are robust for self-selection among other checks, reveal that financial expertise in the audit committee, board size, board meetings and independence in the board are associated with longer ARDs. Some CG attributes such as board diversity (i.e., women and different nationalities in the board) are associated with improved timeliness of the annual reports. The results also reveal that a longer tenure for independent directors in the board is associated with a shorter ARD. Overall, we find that the composite CG score has a positive influence on the timeliness of annual reports.Limitations: the study focuses on listed companies in one developing country. Additional studies focusing on other jurisdictions could yield more results.Practical implications: the study is useful in highlighting those CG characteristics firms should focus on towards the attainment of timely corporate reporting to aid in decision making by users.Originality/value: the study is unique since it emphasizes the importance of focusing on an aggregate CG-Index, and the contribution of the CG-Index towards the timeliness of annual reports.<br/

Occurrence, formation and environmental fate of polycyclic aromatic hydrocarbons in biochars

Biochar application for soil and agro-environmental development has attracted great attention due to its numerous advantages: improving the soil, mitigating greenhouse gas emissions, increasing crop productivity, and augmenting soil carbon storage. However, during the pyrolytic conversion of waste biomass, polycyclic aromatic hydrocarbons (PAHs), a category of toxic organic pollutants, are inescapably generated and linger on the residual solid coproduct called biochar. Therefore, it is crucial to assess the environmental persistence, bioavailability, effects of biochar-borne PAHs on plant growth and soil microbial community dynamics, food safety, and human health after application into soils. This review highlights the basic need to unravel critical mechanisms driving PAH formation in biochar and the dynamics between the sorbent (biochar) and soil microbes, along with the possible mitigation strategies. Current research gaps, including the influence of biochar application on the short and long-term fate of PAHs, as well as the proper control measures for biochar quality and associated risks, will be discussed herein. The key research findings from this script will lead to proposals in technological and quality control measures during biochar production to ensure they are clean and safe

Pit latrine fill-up rates: variation determinants and public health implications in informal settlements, Nakuru-Kenya

Abstract Background Pit latrine operational management and sludge accumulation rate, presents a challenging sanitation problem in low-income urban settlements. However, these challenges have been under-researched. This study was carried out between December 2014 and September 2015 in Nakuru, Kenya. Its objectives were to determine pit latrine management activities and content accumulation rates. Methods A longitudinal design was used to study 100 households and their respective pit latrines. Sludge accumulation in 73 pit latrines was monitored for 10 months using a digital laser range-finder. Data analysis included normality testing and descriptive statistics. Differences in fill up across and within the study areas were analysed using one-way analysis of variance and the Fisher’s Exact Test used to determine areas with significant differences. Results Sixty-one percent of the pit latrines were used as solid waste disposal points while 45% of the respondents had no hygiene awareness. The annual fill-up rate and individual sludge contribution were 0.87 ± 0.20 m3 and 41.82 l respectively. The sludge accumulation rates across the study areas had statistically significant mean differences (p < 0.05). Conclusion Operational management and design affect the fill-up rates and post fill-up management operations. This study argues for a need to link information and awareness to users, construction artisans, property owners and local authorities on appropriate vault volumes and management practices. Linking the variables would ensure efficient sanitation service delivery and public health protection

Motivational drivers for non-skilled Kenyan community health volunteers

Community based health volunteerism view skilled and non-skilled health volunteers as making significant contributions towards improved healthcare for mankind. They are a 'workforce' that has made significant efforts towards delivery of health services at the community level. A cross-sectional and descriptive study was carried out in Nyanza Province of Kenya. Mixed research methods were utilized to derive datum from 261 respondents. Four sampling methods were employed to select the respondents. Variables were selected and subjected to chi square testing to determine their level of significance. The largest proportion of volunteers were providing services in areas of maternal and child health followed by HIV/AIDS and malaria. Drivers that motivate volunteers to keep on providing free services include in-born leadership qualities, fulfilling religious values and serving humanity. Access to incentives such as training, supervision and follow through the support services from various agencies was reported

MOTIVATIONAL DRIVERS FOR NON-SKILLED KENYAN COMMUNITY HEALTH VOLUNTEERS

ABSTRACT Community based health volunteerism view skilled and non-skilled health volunteers as makin

Preexposure prophylaxis for HIV infection among African women.

BACKGROUND: Preexposure prophylaxis with antiretroviral drugs has been effective in the prevention of human immunodeficiency virus (HIV) infection in some trials but not in others. METHODS: In this randomized, double-blind, placebo-controlled trial, we assigned 2120 HIV-negative women in Kenya, South Africa, and Tanzania to receive either a combination of tenofovir disoproxil fumarate and emtricitabine (TDF-FTC) or placebo once daily. The primary objective was to assess the effectiveness of TDF-FTC in preventing HIV acquisition and to evaluate safety. RESULTS: HIV infections occurred in 33 women in the TDF-FTC group (incidence rate, 4.7 per 100 person-years) and in 35 in the placebo group (incidence rate, 5.0 per 100 person-years), for an estimated hazard ratio in the TDF-FTC group of 0.94 (95% confidence interval, 0.59 to 1.52; P=0.81). The proportions of women with nausea, vomiting, or elevated alanine aminotransferase levels were significantly higher in the TDF-FTC group (P=0.04, P<0.001, and P=0.03, respectively). Rates of drug discontinuation because of hepatic or renal abnormalities were higher in the TDF-FTC group (4.7%) than in the placebo group (3.0%, P=0.051). Less than 40% of the HIV-uninfected women in the TDF-FTC group had evidence of recent pill use at visits that were matched to the HIV-infection window for women with seroconversion. The study was stopped early, on April 18, 2011, because of lack of efficacy. CONCLUSIONS: Prophylaxis with TDF-FTC did not significantly reduce the rate of HIV infection and was associated with increased rates of side effects, as compared with placebo. Despite substantial counseling efforts, drug adherence appeared to be low. (Supported by the U.S. Agency for International Development and others; FEM-PrEP ClinicalTrials.gov number, NCT00625404.)