Culture in Africa and Imperialism.

A seminar presentation

Household Food Security Status and Child Health Outcomes in Kenya

Interminable access to sufficient, nutritious, and safely prepared food is a human right. Attributed to insufficient food and nutrient intake, malnutrition is a major health burden in developing economies that has maimed socioeconomic development. In children, undernourishment impairs the functioning of the immune system, increases susceptibility to diseases, and undermines physical and cognitive development. In Kenya, there exists a paucity of empirical corroboration of the effect of household food security status (HFSS) on child health outcomes. Using data drawn from the 2014 Kenya Demographic and Health Survey, this paper focuses on analyzing the causal link between HFSS and child health outcomes and to provide evidencebased policy recommendations to promote child health outcomes. We employed three measures of HFSS: households that lacked food/enough money to purchase food, the Reduced Coping Strategy Index (CSI), and the Food Consumption Score (FCS). The child health production function was estimated using the two-stage residual inclusion (2SRI) technique to control for potential endogeneity. The results indicate that households that lacked food/enough money to purchase food were significantly associated with stunted, wasted, and underweight growth in children. Similarly, the Reduced CSI was a significant determinant of stunted and underweight growth in children. However, the effect was insignificant relative to wasted growth. The findings also indicate that FCS contributes significantly to improvements in child health outcomes. Our evidence has the potential to inform policies on the promotion of child health outcomes. We recommend implementation of programs such as social assistance, integration of nutrition and WASH, and capacity-building to promote women’s knowledge of health, nutrition, and better child-care practices

Management of posterior urethral valves in rural Kenya

Background: Posterior Urethral Valves (PUV) are the most common cause of bladder outlet obstruction in children. Early detection is necessary to prevent potentially irreversible sequel. We conducted a study to determine the presentation, interventions and outcome of patients with PUV.Methods: A retrospective study was conducted over a six year period with an average of two years follow-up.Results: The commonest presenting symptoms were dysuria (55%), poor urinary stream(67%)and straining (39%). Malnutrition was present in 36%. Four patients developed chronic renal failure. There were four mortalities due to urosepsis, acute renal failure, and complications of Mainz-II ureterosigmoidostomy. 40% of patients developed valve bladder syndrome.Conclusion: The high incidence of valve bladder indicates delayed intervention even when addressed in the early postnatal period. This, coupled with malnutrition call for a multidisciplinary approach and long term follow up of these patients.Keywords: Posterior Urethral Valves, Valve Bladder Syndrome, LMIC

Improving the nutritional status of malnourished children using soybean products in Rwanda

The prevalence of malnutrition is high in Rwanda especially in Ruhango District of Southern Province (23.5% in 2009). The contribution of soybean (Glycine max L), which is an important source of high quality and inexpensive protein and oil, to improvement of nutritional status of  malnourished children is unclear. Although a lot of research has been done on the production of soybean in Rwanda, research on soybean in the diet to improve the nutritional status of malnourished children has not been done. The aim of this study was to determine the effect of soybean flour and soybean milk on the nutritional status of malnourished children under the age of five. The objective was to determine the weight gain due to each treatment in comparison with the control group. This study was conducted in Ruhango District of Southern Province Rwanda. A survey was conducted where households growing and utilizing soybean were identified and  anthropometric measurements were taken on 294 children to select malnourished children. Thirty malnourished children participate in the intervention which lasted three months. One cup (250ml) of soybean milk was supplemented to ten children per day. An equal number was  supplemented with 25g of soybean flour in soup (250ml). The caregivers of the ten children in the control group received nutrition education together with the two treatment groups. Anthropometric measurements were taken every month and entered in WHO ANTHRO software. Data was analyzed by regression models using GenStat 14th edition and the magnitude of weight gain due to each of the treatments was predicted at 5% level of  significance. A linear mixed model was used to estimate and compareweight gain among children fed on soybean milk and soybean flour supplement in comparison with the control group. Soybean products were found to affect weight gain of children (P = 0.04). The mean weight gain was 0.9 (±0.5) kg within three months of intervention. The difference in weight gain between the two treatment groups was not significant. To improve the nutritional status of malnourished children under five years further intervention is needed in terms of education and training on soybean based diet formulation.Key words: soybean products, under five, Rwand

The effects of household food practices and diseases prevalence on nutritional status of under-five children in Ruhango District, Rwanda

Malnutrition in the Southern province of Rwanda is a significant public health concern. According to the Rwanda Demographic and Health Survey (RDHS) 2010, chronic malnutrition in children under 5 years was widespread 44% children having stunting (insufficient height for age), 11 % underweight (weight for age) and 3% wasting (weight for height). Ruhango district (Southern Rwanda) had the highest malnutrition prevalence (23.5%) in 2009. This study aimed to measure the prevalence of malnutrition among Ruhango children in 2012 and to identify relationship between comorbidities occurrence, food intake and their nutrition status. A multistage sampling was done across four hierarchical levels: district, sector, cell and village, where households (N=294) with children under five years were purposively selected to form the sampling units in which the survey was conducted. The study showed that Ruhango has improved in prevention of malnutrition as compared to 2010 study. However, stunting was still a problem with those aged between 24 and 35 months being most affected. Wasting did not affect large population of the target group. Better educated household members had less malnourished kids (3%) than those who did not attend school (12%). Co-morbidities occurrence was significantly higher in malnourished children (P = 0.006). Acute Respiratory Tract Infection had the highest occurrence (52%). The children reported to have been sick had significantly lower weight than those who were normal (P<0.05). Food intake (mean dietary diversity of 25%) was not adequate for most households and only few people took protein of high quality like meat and milk. Household food practices were tested at 95% confidence interval and this affected the nutrition status of children (P = 0.02). In households with mean dietary diversity above four food groups, only 2.17 % of children were underweight as compared to 18.18% those from households with mean dietary diversity below three. Thus, interventions to eliminate malnutrition should focus on household food diversification and disease prevention.Key words: Prevalence, malnutrition, diseases, 24hr recall

An Econometric Analysis Of Health Care Utilization In Kenya

Background: Increasing access to health care has been a policy concern for many governments, Kenya included. The Kenyan government introduced and implemented a number of initiatives in a bid to address the healthcare utilization challenge. These initiatives include 10/20 policy, exemptions for user fees for some specific health services (treatment of children less than five years, maternity services in dispensaries and health centers, Tuberculosis treatment in public health facilities), and increase in the number of health facilities and health workforce. These initiatives notwithstanding, healthcare utilization in Kenya remains a challenge. The Kenya Household Health Expenditure and Utilization Survey of 2007 found that 17 percent of those who needed health care services could not access the services from both government and private health facilities largely due to financial constraints. This paper employed econometric analysis to examine what could be constraining health care utilization in Kenya despite all the efforts employed. Methods: Using the 2007 Kenya Household Health Expenditures and Utilization Survey (KHHEUS) data (n = 8414), this paper investigates the factors that affect health care utilization in Kenya by estimating a count data negative binomial model. The model was also applied to public and private health facilities to better understand the specificities of poverty in these two facility types. Common estimation problems of endogeneity, heterogeneity, multicollinearity and heteroskedasticity are addressed. Findings: The econometric analysis reveals that out-of-pocket expenditures, waiting time, distance, household size, income, chronic illness area of residence and working status of the household head are significant factors affecting health care utilization in Kenya. While income and distance are significant factors affecting public health care utilization they are not significant in explaining healthcare utilization in private facilities. In addition, working status of the household head, insurance cover and education are significant in explaining private and not public health care utilization. A striking finding is the positive relationship between distance and health care utilization implying that people will travel long distances to obtain treatment. This is perhaps associated with expectations of higher quality of care at far away higher level facilities, especially in rural areas. Conclusion: The paper confirms the existing evidence of the negative effects of Out-of-Pocket (OOP) expenditures and other determinants of health care utilization. With a better understanding of why people use or do not use health services, health care organizations can seek to improve the quality of human life. The bypassing of health facilities for higher level far away facilities implies that it is not so much about availing health facilities, but the quality of the services offered in those facilities. The government should therefore assure quality to increase utilization of the lower level facilities, especially in the rural areas

Catastrophic Health Expenditures And Impoverishment In Kenya

Background: Out-of-pocket health expenditures leave households exposed to the risk of financial catastrophe and poverty whenever they entail significant dissaving or the sale of key household assets. Even relatively small expenditures on health can be financially disastrous for poor households and similarly, large health care expenditures can lead to financial catastrophe and bankruptcy for rich households. Objective: There is increasing evidence that out-of-pocket expenditures act as a financial barrier to accessing health care, and are a source of catastrophic expenditures and impoverishment. This paper estimates the burden of out-of-pocket payments in Kenya; the incidence and intensity of catastrophic health care expenditure and impoverishment in Kenya. Methods: Using Kenya Household Health Expenditures and Utilization Survey data of 2007, the study uses both descriptive and econometric analysis to investigate the incidence and intensity of catastrophic health expenditures and impoverishment as well as the determinants of catastrophic health expenditures. To estimate the incidence and intensity of catastrophic expenditures and impoverishment, the study used both Wagstaff and van Doorslaer, (2002) and Xu et al. (2005) and applied various thresholds to demonstrate the sensitivity of catastrophic measures. For determinants of catastrophic health expenditures, a logit model was employed. Findings: Among those who utilized health care, 11.7 percent experienced catastrophic expenditures and 4 percent were impoverished by health care payments. In addition, approximately 2.5 million individuals were pushed into poverty as a result of paying for health care. The poor experienced the highest incidence of catastrophic expenditures. Conclusion: The paper recommends that the government should establish avenues for reducing the burden of out-of-pocket expenditures borne by households. This could be through a legal requirement for everyone to belong to a health insurance and targeting the poor, the elderly and chronically ill through the devolved system of the government and devolved funds

Effects of Securities Behaviour on Performance of Nairobi Securities Exchange Indices

This study aimed at establishing the Influence of investor’s behaviour on the performance of Nairobi Securities Exchange (NSE) indices. A reliable security market index should assist investors in making investment decisions but this is not always the case: investors at times invest in stock whose performance is not reflected in the indices. This study was guided by specific objectives which included: to establish the Influence of momentum effect, financial contagion, white noise effect, Security Price Volatility, and Herding Effect (all as independent variables) on performance of NSE indices as the dependent variable. This study was anchored to finance theories such as random walk theory, rational bubbles theory, smart money and noise trader’s theory, price formation and discovery theory, and information disclosure theories. The study was based on a period of 12 years starting from January 2004 to December 2015. The population of this study comprised of all the market participants at the NSE and thus a census approach was adopted where study period was done based on each specific objective. This research relied on primary data. Primary data was collected from all the market participants. In data analysis, a significance level of 5% was used on all objectives and a multiple regression model on each objective was used. The Statistical Package for Social Sciences (SPSS) was used on primary data for analysis. The findings for primary data showed all the indices to be insignificantly influenced by the securities behaviour but the overall NSE indices performance was statistically affected. Hypotheses were tested at 0.05 level of significance. The first hypothesis on momentum effect was not rejected on primary. The second hypothesis on financial contagion was rejected and.on the hypothesis of white noise effect, it was not rejected. The hypothesis of Security Price Volatility effect was not rejected while hypothesis of herding effect was rejected. It was concluded that all the indices play a complimentary role thus the need for the retention of all. NSE is highly contagious of the events that happen around it. The study recommends that future researchers should increase the respondents to also include investors. For the objective of momentum effect, the study recommends that more exchanges be included to get a finer detail. NSE and CMA should ensure that information availed to the researchers is obtained at minimal cost or for free to encourage more research into the security markets. Keywords: Momentum Effect, Financial Contagion, White Noise Effect, Share Price volality effect, Herding Effect and Nairobi Securities Exchange Indice

Influence of Momentum Effect on Stock Performance of Firms Listed in the Nairobi Securities Exchange

This research article intended to establish the influence of momentum effect on stock performance of firms listed in Kenya. Nairobi Securities Exchange (NSE) is the most robust securities market in Eastern and Central Africa and among the best performing in the African continent. Despite this, there is still a lot to be desired in terms of upholding the efficient market hypothesis. Stocks here do not always uphold this theory despite the fact that the NSE is among the few African exchanges that are not weak form efficient. This study looked at all the listed firms in the NSE for the period between January 2004 to December 2015. The research was based on the efficient market hypothesis and behavioral finance theories. Descriptive research design was used and target population was all the listed firms in the NSE. Secondary data was used in the analysis where the researcher used market prices and risk free interest rates. These were obtained from the data vendors at the NSE and website of Central Bank of Kenya. Caharts four factor model was used in the analysis and hypothesis was tested using 0.05 level of significance. The researcher conducted diagnostic tests such as normality, linearilty and collinearity tests. Missing values in the data collected were corrected by the use of linear interpolation. The diagnostic tests showed that the data was good for analysis. Z test results showed that the momentum effect was statistically significant at 0.0165. The model was also statistically significant showing that the momentum effect influenced the returns for NSE at about 25.8%. the null hypothesis was therefore rejected. It was concluded that NSE stocks over the span of 12 years studied demonstrated momentum effect. Future researchers would be advised to study the momentum effect on a shorter span like 12 months where they are working with weekly prices. The researcher would also recommend future scholars to do a regional comparative study