Quest for Teacher Effectiveness Parameters: A Survey of Public and Private Schools in North-Rift Kenya.

Teacher effectiveness is the capacity of teachers to perform their duties optimally and achieve desired educational goals and standards. The purpose of this study was to establish the factors influencing teacher effectiveness and quality education in public and private secondary schools in the north rift region. To establish factors that influence the effectiveness of teachers, the study employed descriptive research design, which entailed the collection of data using questionnaires observations and interviews. The target populations for the study were teachers and head teachers in selected public and private secondary schools. Stratified sampling method was used in the selection of permanent and temporary teachers, whereas purposive sampling method was used in the selection of head teachers. The study sampled 22 temporary teachers from the private schools and 100 teachers from public schools, where 13 were temporary teachers and 87 were permanent teachers.  Data were analyzed using both descriptive and inferential statistics. The findings showed that a myriad of parameters gravitate around the teacher effectiveness concept and the earlier these parameters are isolated and teased out the better for the education fraternity. The study therefore recommends that parameters such administration, teachers, students, and classroom be leveraged to improve teacher effectiveness in both public and private secondary schools

Conflict and Trade-Offs between Efficiency and Access: A Case of Day and Boarding Secondary Schools in Uasin-Gishu District, Kenya

While education is considered to be a human right and need, the delivery of secondary education in Kenya has been slow due to a number of bottlenecks that includes:- one, differential trends in access and participation in secondary school education with low participation of the poor and two, low efficiency and quality of education as indicated in the poor performance.The purpose of this study was to find ways of making secondary school education more accessible and efficient given that day schools are considered to be more accessible but inefficient while boarding schools are less accessible but efficient.Purposive sampling was used to select 12 day and 14 boarding schools whose head teachers and 296 Form Four students in Uasin-Gishu district responded to questionnaires related to academic performance availability of learning facilities, supervisory support of learners, time available for learners private studies and effects of distance walked to school on performance.The findings of the study showed that students in boarding schools generally have better study facilities, receive professional and more supervisory support, that long distance walked to school had negative impact on student performance and lastly students in boarding schools had more time available for their studies.The study recommends that efforts be made to build more day schools and equip them with proper learning facilities for better access and efficiency respectively. Keywords: Efficiency Trade-offs Conflic

Incidence and bacteriological pattern of puerperal infections within the first 120 hours post caesarean section in Redemption Hospital Monrovia, Liberia

Background: Maternal infection contributes to 11% of all maternal mortalities globally, with most of these deaths in developing countries. This study was triggered by an anecdotal evidence of a high prevalence of puerperal infection following Caesarean sections at the Redemption Hospital, Monrovia Liberia.Objective: To determine the incidence and bacteriological pattern of puerperal infections within the first 120 hours among women delivered by Caesarean section.Design: Prospective descriptive cohort study.Setting: Redemption Hospital in Monrovia, Liberia.Subjects: Two hundred and thirty five immediate post Caesarean section mothers.Results: The Mean (SD) age of study participants was 27 years. The incidence of puerperal sepsis was 21% (49/235), out of which 49% (24/49) met the clinical criteria of puerperal infection and 51% (25/49) had laboratory confirmed puerperal sepsis. Of the specimens cultured, 44% were Staphylococcus aureus, 44% were Escherichia coli and 12% Pseudomonas aeuroginosum. About three quarters of Staphylococcus aureus and Escherichia coli infections are resistant to ceftriaxone, while more than half these infections are resistant to gentamicin.Conclusion: The incidence of puerperal infection in Redemption Hospital, Liberia, within the first 120 hours after Caesarean section is 21%. Staphylococcus aureus and Escherichia coli were the most common pathogens isolated and showed resistance to ceftriaxone and gentamicin

Adherence to ministry of health guidelines in management of severe pre-eclampsia/eclampsia in Pumwani maternity hospital, Kenya

Background: Guidelines have shown to impact positively on the management of medical conditions. The impact of these guidelines has not been evaluated for severe preeclampsia and eclampsia in Kenya.Objective: To evaluate the level of adherence to Kenya Ministry of Health (MOH) guidelines in the management of severe pre-eclampsia and eclampsia at PumwaniMaternity Hospital, Kenya.Design: A cross sectionalSetting: Pumwani Maternity Hospital, Kenya.Subjects: Records of women managed for severe pre-eclampsia and eclampsia, deliveredbetween 2010 and 2013.Results: The overall adherence to guidelines was 31.4%. Adherence to specific parameters: history taking and examination, investigations, fetomaternal monitoring, use of recommended guidelines and post-partum guidelines was 67.8%, 13.9%, 26.1%, 29.5% and 20% respectively.Conclusions: Adherence to Kenya Ministry of Health (MOH) guidelines in management of severe pre-eclampsia and eclampsia in Pumwani Maternity Hospital is poor. Studies on the reasons for poor adherence and implementation need to be carried out

Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya

OBJECTIVE: To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development–Academic Model Providing Access to Healthcare partnership. DESIGN: Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR). RESULTS: Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and mycobacterial cultures. CXRs were performed in 26 symptomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a negative symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates). CONCLUSION: This study did not support the utility of isolated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women

Establishment of a catchment monitoring network through a participatory approach in a small rural catchment in South Africa

International audienceThe establishment of a catchment monitoring network is a process, from the inception of the idea to its implementation, the latter being the construction of relevant gauging structures and installation of the various instruments. It is useful that the local communities and other stakeholders are involved and participate in such a process as was realised during the establishment of the hydrological monitoring network in the Potshini catchment in the Bergville district in the KwaZulu-Natal Province in South Africa. The paper illustrates the participatory application of various methods and techniques for establishing a hydrological monitoring network, in a small rural inhabited catchment, to monitor hydrological processes at both field and catchment scale for research purposes in water resources management. The authors conclude that the participation of the local community and other stakeholders in catchment monitoring and instilling the sense of ownership and management of natural resources to the local communities needs to be encouraged at all times. Success stories in water resources management by local communities can be realized if such a process is integrated with other development plans in the catchment at all forums with due recognition of the social dynamics of the communities living in the catchment

Do clinicians adhere to practice guidelines? A descriptive study at a referral hospital in Kenya

Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester.Objective: To describe adherence to clinical guideline in management of antepartum haemorrhage at Garissa Provincial General Hospital Design: Crossectional mixed methods studySetting: Garissa Provincial General HospitalSubjects: Medical records of patients managed for APH between 2002 and 2012 and Key Informant Interviews (KIIs) of Health workers.Results: 36.1% of the cases assessed were managed with strict adherence to guidelines. 90% of health care workers had high levels of awareness of the existence of guidelines and sited utilization challenges attributed to resource inadequacies.Conclusion: Clinicians are skilled on APH guidelines, but adherence levels are still low. Therefore, continuous appraisal of clinical practices, availing equipment, facilities and supplies to reinforce adherence is recommended

Evaluation of treatment outcomes and associated factors among patients managed for tuberculosis in Vihiga County, 2012‐ 2015

Background: Tuberculosis (TB) treatment outcomes are used to evaluate program and patient success. Despite this, factors driving and sustaining high rates of poor TB treatment outcomes in Vihiga County are not well understood.Objective: To evaluate treatment outcomes and associated factors among patients managed for TB in Vihiga County between 2012 and 2015.Design: Descriptive cohort study.Setting: Vihiga County.Subjects: Notified TB patients >15years who were on drug susceptible TB treatment.Results: Of the 3288 eligible patients more than half were male 1961 (60%), 85% were from the public sector while 23% were over 45years. Among the TB patients, 2865 (87%) were successfully treated, 299 (9%) died and 124 (4%) had other poor treatment outcomes. On multivariate analysis, advancing age (Adjusted Odds Ratio (AOR) 3.3, 95% CI2.03‐5.38, P<0.001), HIV positive (AOR1.78, 95% CI1.27‐2.49, P0.001), previously treated (AOR1.78, 95% CI1.2‐2.49, P<0.001) and unknown HIV status (AOR 2.11, 95% CI 1.21‐3.68, P 0.008) increased the risk of death. TB patients with positive sputum results during initiation of treatment (AOR=0.68, CI=0.50‐0.94, P‐value 0.018) and those with normal body mass index (BMI) (AOR 0.37, 95% CI 0.24‐0.58, P<0.001), were less likely to die.Conclusion: While higher BMI and bacteriological confirmation reduced the risk of death, advancing age, unknown HIV status, HIV positive, being a previously treated TB case increased the risk of death. We recommend early and accurate diagnosis of TB cases, TB/HIV integration and active involvement of community health volunteers in TB management

Treatment outcomes for drug resistant tuberculosis among children below 15 years in Kenya, 2010‐2016

Background: Tuberculosis is a common cause of morbidity and mortality in children. Children are less likely to acquire resistance during the treatment of tuberculosis (TB). Most of the drug resistant TB infection in children is transmitted from adults.Objective: To determine the characteristics and treatment outcomes among children below 15 years managed for drug resistant TB in Kenya, 2010 – 2016.Design: Retrospective descriptive study.Setting: All health facilities managing drug resistant TB in KenyaSubjects: Children below 15 years treated for drug resistant TB between 2010 and 2016.Results: Sixty three children were notified with DR TB between 2010 and 2016. The median (IQR) age was11 (10‐13) years with a female to male ratio of 1:1. With 32 (52%) and 31 (51%) with smear and culture positive laboratory results respectively. Primary drug resistance was present in 25 (40%) of the children All the sputum and culture converted negative at month three of treatment. HIV testing uptake was 100% with a positivity rate of 26 (41%) and 100% anti‐retroviral therapy uptake. The treatment success rate for the cases was 31(91%) with a mortality rate of 2(5%) and lost‐to‐follow up 1 (3%).Conclusion: Drug‐resistant tuberculosis can be successfully treated and therapy well tolerated among children. There  is need for contact tracing and screening for all at risk including paediatric population

Diagnostic methods and treatment outcomes for TB in children under 15 years in Kisii County, 2012-2016

Background: Diagnosis of TB in children poses a challenge due to the paucibacillairy nature of TB and difficulties in making a bacteriological confirmation. Globally, the TB burden in children is unknown with WHO estimating that they account for 10‐15% of all cases. In Kenya, children contributed to 8.5% of all notified TB cases in 2016.Objective: To describe the diagnostic methods and treatment outcomes among children aged<15 years in Kisii County, 2012‐2016.Design: A descriptive analysis of children aged <15 years in Kisii County diagnosed and notified of TB to the National TB program.Results: We abstracted 825 records of children:217 in 2012,156 in 2013,164 in 2014,136 in 2015 and 152 in 2016.The median age was 8(IQR 2‐13) years with a male: female of ratio 1:1. The 10‐15 years age‐group accounted for 43% (351) while those aged<1year accounted for 10% (81). HIV testing was done among 806 (98%) with a TB/HIV co‐infection of 31% and 96% ART initiation rate. Bacteriological and clinical diagnosis was done for 129/825 (16%) and 696/825(84 %). Gene Xpert was done for 28/825 (3%) in 2016 and 1/825 in 2012. Overall, for the period 2012‐2015, the treatment success rate (TSR) was 96%Conclusion: There has been a decline in notification rates over time, however, it was not clear whether this was due to absence of disease or improved use of diagnostics which requires further research. Older children accounted for majority of the cases diagnosed for TB. Most of the children in the younger age groups <5 years were initiated on treatment based on clinical diagnosis or a chest X‐ray and hence a need to support health workers and health system in general on acquisition of sputum specimen in this younger age group