Prevalence and Risk Factors for Perineal Trauma among Women at a Teaching and Referral Hospital in Kenya

Perineal trauma is classified according to the degree of structures involved or according to the depth of the injury. Mild perineal trauma is very common following vaginal delivery. Risk factors for perineal trauma include primiparity, precipitate labour, instrumental deliveries, pushing techniques and birth positions. Perineal trauma is associated with significant short-term and long-term complications. The objective of the study was to determine the prevalence and risk factors for perineal trauma among women at teaching and referral hospital in western Kenya. A cross-sectional study was carried out at the teaching hospital between April and May 2015. Two hundred and nine women who had come to deliver at the facility were consented to participate in the study. A structured checklist was used to obtain data from the women and make observations as skilled care givers attended to deliveries. All analyses were performed at 95% level of confidence. Two hundred and nine (209) deliveries were observed. Majority of the women, 76 (36.40%), were in the 20-24 age group. Ninety seven (46.10%) of them were para 0. Eighty one (38.8%) of the women sustained various types of perineal trauma. Supine position during delivery was the most preferred position, in 201 (96.2%), of the women. Age of the mother, parity, infant birth weight, and history of previous trauma, were statistically significant, associated with trauma in the univariate analysis (p=0.013; p=0.000; p= 0.010; p= 0.033) respectively. Adjusting for other factors, the odds of sustaining perineal trauma increased with increased birth weight (OR 2.878; p= 0.005) and decreased with increasing parity (OR 0.037; p=0.000). The prevalence of perineal tears as revealed by the study was 38.8%. This study recommended evidence based practice during labour and delivery in order to improve pelvic floor outcomes as well as reduce operative deliveries and long term morbidities. Key words: Perineal trauma, Risk factors, Prevalence, Women DOI: 10.7176/JHMN/65-09 Publication date: August 31st 201

International criminal court Proprio motu intervention where a truth commission exists: the Kenyan situation

Magister Legum - LLMKenya’s December 2007 Presidential elections sparked a wave of violent clashes over allegations of election rigging. The protests broke out along ethnic lines, causing greater civil unrest. There have been allegations that during these outbreaks of violence crimes against humanity were committed. This violence attracted world-wide concern and was universally condemned. Kenya is loathe to prosecute the perpetrators or those who bear the highest responsibility for the alleged commission of crimes against humanity. It has instead established a national investigatory mechanism, the Kenyan Truth, Justice and Reconciliation Commission (hereafter TJRC). This approach adopted by Kenya has been criticized for the fact that it fosters a culture of impunity. However, the Prosecutor of International Criminal Court (hereafter ICC) has used his proprio motu powers to initiate an investigation of alleged commission of crimes that fall within the jurisdiction of the Court. This research paper has analysed the reasons for the proprio motu intervention of the ICC in Kenyan situation. It also examined whether Kenya was unwilling or genuinely unable to prosecute the perpetrators of the post-election violence of 2007. Furthermore, the paper evaluated the provisions of the Kenyan TJRC, the major shortcomings of the Commission and the challenges it is facing in fulfilling its mandate. In conclusion the paper analysed the relationship between TJRC and ICC and re-evaluate any role that the two bodies could play in dispensing justice in Kenya. But before that, the paper laid down the factual background that led to the proprio motu interevention of the ICC in Kenya where a truth commission had alreday been established.South Afric

Entrenching Waste Hierarchy for Sustainable Municipal Solid Waste Management in Kenya

Prioritizing waste prevention, reuse, recycling and recovery of materials and energy over disposal through landfilling, offers the waste hierarchy approach (WHA) a sustainable pathway to the management of municipal solid wastes (MSW) and realization of a circular economy. The concept is now part of the legal framework in some developing countries and its implementation has been credited for addressing waste problems linked to high rates of economic growth and urbanization. Even though Africa Vision 2063 prioritizes improvements in urban waste recycling in the continent, much of the MSW generated on the continent is disposed through landfilling evidencing weak adoption of the WHA. This article contends that because WHA is not adequately incorporated in the current legal framework at national and sub-national levels of government, Kenya is unlikely to achieve a circular economy approach necessary for realizing sustainable waste management. Operationalization of the WHA is impeded by inadequate financing, weak institutional coordination, gaps in private sector and informal actors’ engagement and risks associated with investments in large-scale waste recovery initiatives. It is therefore necessary for Kenya to elaborate the WHA in its legal framework at both national and county level, while ensuring adequate financing, involvement of informal actors, incentivization of private sector and adoption of waste planning procedures

EVALUATION OF THE USAGE OF DEVOLVED FUNDS IN KENYA A CASE STUDY OF COUNTY GOVERNMENT OF KITUI

Devolution in Kenya started in early 1961 but did not stand the test of time. The newly independent Kenya government through parliament implemented piecemeal devolution and weakened it in three ways; much control was exercised over departmental civil servants than the independent constitution wanted, Parliament failed to give provincial assemblies full responsibilities to control their own resources and delayed ministerial functions to regions. The research justified that the amount of money from National government, Donor community and locally collected revenue was being used for the benefit of the rural poor, slum dwellers and the marginalized villagers. The research was undertaken at eight sub counties of the county government of Kitui between the month of July, august and September, 2016. The researcher adopted stratified research design and used descriptive research method the sample population was 100 respondents using stratified random sampling methods. The data collection instruments were questionnaires, direct interviews with respondents, while making observation where necessary. Data analysis methods were both quantitative and qualitative. The finding showed that accountability, stakeholders‘ role, governance skills and procurement system positively and significantly affects the usage of devolved funds at the county Government of Kitui. This study recommends areas for further research in other counties for the purpose of making comparison of the findings with the current study

Female Genital Mutilation: A Religio-Cultural Sensitive Issue Determining Maternal Health Care Choices among Somali Women in Dadaab Refugee Camp, Kenya

The paper addresses Kenya’s development challenges in maternal health care with a specific focus on the impact of traditional birth attendants (TBAs) and female genital mutilation (FGM) among the refugees. It purposes to achieve four objectives: to discuss the persistence of FGM among Somali women in Ifo Refugee Camp, to establish the hospital process of providing maternal health care to mothers who have gone through FGM; find out the level of preparedness of the midwives to handle mothers with religio- cultural concerns such as prayer, non-involvement of male nurses and how the practice of FGM contributes to the preference of TBA by mothers. The study assumes that midwives’ training may not have effectively addressed FGM, a social-cultural sensitive issue affecting childbirth and care. Secondly, the specific support of midwives in refugee camps contexts remains limited. A qualitative research approach was used in the study, involving Snowballing sampling method, in-depth interviews, and focus group discussions (FGDs). These methods brought out pertinent issues that make TBAs the preferential option for some mothers in spite of the presence of level 4 category hospitals in the refugee camps. In case of birth complications, the mother’s choice for TBA delays the family’s decision to take her to the hospital and for health care workers to save mother and child. The shortage of midwives and the presence of male midwives in hospitals make some Somali mothers seek assistance from TBAs. There is a need to contextualize midwifery training by enhancing the curriculum with evidence-based /mother-centered skills

Female Genital Mutilation: A Religio-Cultural Sensitive Issue Determining Maternal Health Care Choices among Somali Women in Dadaab Refugee Camp, Kenya

The paper addresses Kenya’s development challenges in maternal health care with a specific focus on the impact of traditional birth attendants (TBAs) and female genital mutilation (FGM) among the refugees. It purposes to achieve four objectives: to discuss the persistence of FGM among Somali women in Ifo Refugee Camp, to establish the hospital process of providing maternal health care to mothers who have gone through FGM; find out the level of preparedness of the midwives to handle mothers with religio- cultural concerns such as prayer, non-involvement of male nurses and how the practice of FGM contributes to the preference of TBA by mothers. The study assumes that midwives’ training may not have effectively addressed FGM, a social-cultural sensitive issue affecting childbirth and care. Secondly, the specific support of midwives in refugee camps contexts remains limited. A qualitative research approach was used in the study, involving Snowballing sampling method, in-depth interviews, and focus group discussions (FGDs). These methods brought out pertinent issues that make TBAs the preferential option for some mothers in spite of the presence of level 4 category hospitals in the refugee camps. In case of birth complications, the mother’s choice for TBA delays the family’s decision to take her to the hospital and for health care workers to save mother and child. The shortage of midwives and the presence of male midwives in hospitals make some Somali mothers seek assistance from TBAs. There is a need to contextualize midwifery training by enhancing the curriculum with evidence-based /mother-centered skills

Increasing bitterbrush nutrient quality with 2,4-D, mowing, and burning in southcentral Wyoming

Effects of burning, mowing, and 2,4-D on antelope bitterbrush (Purshia tridentata Pursh.) nutrient contents were evaluated in southcentral Wyoming. During the first growing season following treatments, spraying of 2,4-D increased bitterbrush nitrogen (N) contents from 1.5 to 1.9%, phosphorus (P) from 0.12 to 0.15%, and in vitro digestible dry matter (IVDDM) from 44.1 to 48.4%. Mowing increased N from 1.5 to 1.7%, P from 0.12 to 0.16%, and IVDDM from 44.1 to 46.1%. Burning increased N from 1.4 to 1.9%, P from 0.11 to 0.17%, ash from 3.7 to 5.3%, and IVDDM from 47.4 to 51.0%, and decreased gross energy from 4,640 to 4,380 kcal/g. There were no differences in N and IVDDM contents among treatments at the end of the second growing season, but P content was still greater in mowed bitterbrush regrowth than on untreated bitterbrush. Ash contents were not affected by treatments, but were higher in summer (3.9%) than in winter (2.4%). Gross energy contents varied only 5 to 10% among all treatments and seasons. Correlation coefficients between N, P, ash, and IVDDM contents varied from +0.54 to +0.76, and all of these nutrients were negatively correlated with gross energy. Bitterbrush nutrient contents can be increased by shrub management practices, but short-term responses require that small portions of the total area be treated annually in a rotational shrub management program.This material was digitized as part of a cooperative project between the Society for Range Management and the University of Arizona Libraries.The Journal of Range Management archives are made available by the Society for Range Management and the University of Arizona Libraries. Contact [email protected] for further information.Migrated from OJS platform August 202

Combinatorial Properties, Invariants and Structures of the Action of Sn×An on X×Y

The transitivity, primitivity, rank and subdegrees, as well as pairing of the suborbits associated with the action of the actions of the direct product , of the symmetric group    by the alternating group   alternating on the Cartesian product , where  and  are disjoint sets each containing n elements is an area that has never received attention from researchers for a very long time. In this paper, we prove that the action is both transitive and imprimitive when . Also, we establish that that the rank is  if , but is  for all . In addition, we show in this paper that the subdegrees associated with the action are . Lastly, we show that all the suborbits corresponding to the action, are self-paired when