Maternal and child healthcare services in South Sudan: the factors associated with non - use of antenatal care, skilled birth attendants, facility delivery services and child survival

Objectives The aim of this body of research is to examine the factors associated with non-use of maternal and child healthcare services in South Sudan. The specific aims include examining the associations between socio- demographic, economic and physical accessibility factors on utilization of maternal and child health care services. It also investigated the barriers facing healthcare providers to deliver appropriate services to their clients and the extent to which these barriers are associated with use or non-use of antenatal care, skilled birth attendance, facility delivery and neonatal services. Methods This research constituted both quantitative and qualitative methods. For the quantitative analyses, data were obtained from the South Sudan House- hold Health Survey second round (SSHHSII) carried out in 2010 that used the Multiple Indicator Cluster Survey (MICS) methodology developed by UNICEF. The logistic regression analysis (Chapter 4, 5 and 7) and multinomial logistic regression analysis methods (Chapter 6) were used. All statistical analyses were carried out using STATA/MP version 12. For the qualitative analyses, data were derived from a study conducted in Juba County, Central Equatoria State, South Sudan. The study participants involved were mothers and their partner, healthcare providers and trained traditional birth attendance. About 63 in-depth interviews were audio recorded and then transcribed. All the data were manually managed and a list of topical codes was developed followed by a content and thematic analysis (Chapter 8 and 9). Results Chapter 3 Identified the barriers and challenges of promoting maternal, newborn and child health (MNCH) gains, and identifies priorities that will contribute to addressing the Millennium Development Goals and the emerging health priorities for the post-2015 development agenda. Chapter 4 indicates that the prevalence of nonuse of antenatal care services in South Sudan were significantly higher among mothers who were in polygamous relationships, illiterate mothers, mothers who had limited knowledge of a newborns’ danger signs and those residing in Warap and Jounglei states. Chapter 5 shows that the use of skilled birth attendance at delivery was determinate by household wealth, place of residency, access to at least 1–3 antenatal care (ANC) visits during pregnancy, maternal education and mothers who experienced three and more complications during pregnancy. Chapter 6 indicates higher odds of unattended home birth among never-married single mothers, uneducated mothers, those with first birth order, those who never attended ANC visits and those who experienced lower quality of ANC services. In addition, household poverty, lacking knowledge about obstetric danger signs, and lacking experience with pregnancy complications were associated with unattended home birth. Chapter 7 identifies the determinants of neonatal, infant and under-five mortality in South Sudan. The risk of under-five mortality was found higher among low socioeconomic groups that included urban dwellers, children born to teenager mother, those born to mothers who ever had a child that died later, and male children. Chapter 8 identifies a combination of physical environment, socioeconomic factors or healthcare’s characteristic as contributory factors to a higher percentage of mothers giving birth at home unattended. Sudden labor and lack of safety and security were the main reasons for home delivery in this study. In addition, lack of essential medicines, supplies and equipment were linked to individual mother’s dissatisfaction with services they received. Furthermore, lack of access to transport and out of pocket fees for accessing the services further delayed women reaching health services for delivery or complications. In Chapter 9 the data from the qualitative study shows the challenges and barriers facing healthcare providers to deliver appropriate maternal and child health care services. The major barriers to health services provision were poor management of staff, stock out of medical supplies, lack electricity and water supply. In addition, lack of supervision, few training opportunities and low salaries were the major elements for health workers’ de-motivation and low performance. Furthermore, security instability as a result of political and armed conflicts further impacted on their services delivery. Conclusion The findings in this thesis highlight the urgent need to implement strategies that address barriers to access to maternal and child health care services in South Sudan. At the facility level, investment is needed to upgrade the existing health system infrastructure, ensuring adequately resourced services, training opportunities for the health workers and reliable disbursement of staff salaries are essential. Implementing strategies that target women at the community level, such as, deploying community health workers to identify women who need care, could increase the number of women who deliver with skilled birth attendant (SBAs). The government needs to address the socio-economic factors that prevent women from using maternal health services and provide free reproductive services and conditional cash transfers to encourage women to deliver with SBAs either at home or in a health facility. Implementing a cash transfer program targeting poor families to keep their daughters in school and unmarried throughout their secondary education is essential. Wider socio-political aspects such as safety and security must be considered in the long-term policies of the Government of South Sudan that will have direct and indirect impact on the use of maternal and child health service

Effects of Reward Strategies on Employee Performance at Kabete Technical Training Institute, Nairobi, Kenya

The main objective this study was to investigate the effects of reward strategies on employee performance at Kabete Technical Training Institute (KTTI). The study was guided by four specific objectives: To determine the extent to which personal drive for achievement influences employee performance at KTTI; to determine how growth opportunities influence employee performance at KTTI; to establish the extent to which recognition influences employee performance at KTTI; to establish the extent to which staff promotion influences employee performance at KTTI. The study reviewed several theories of motivation as possible avenues towards a framework of understanding what motivates employees. It also conducted an empirical literature review in order to establish a link with similar past studies. A stratified random sampling technique was used to select a sample of 159 respondents from a target population of 270 employees. The study adopted a descriptive research design and utilized both primary and secondary data. Structured and unstructured questionnaires were used to collect primary data while secondary data was collected through document review. Data analysis was carried out using both qualitative and quantitative techniques with the aid of SPSS while the main method of data presentation was frequency distribution, pie charts, graphs and cross tabulation. The study found a significant relationship between the reward strategies and employee work performance. The study concluded that personal need for achievement played a key role in influencing employee performance and given a choice employees showed preference for promotion, better remuneration, cash gifts and training opportunities as reward strategies. The study recommends that KTTI should: Leverage on the intrinsic motivation factors by providing a working environment that encourages employees sense of achievement; develop and maintain a training policy for all categories of employees; establish a criterion for recognizing employee performance to ensure the whole process of reward strategy is deemed fair by all employees; design an attractive scheme of service that will also enhance retention and have a structured method of identifying and recommending teachers for promotion by the Teachers Service Commission; finally, the research study recommends a similar research study on the negative effects of reward strategies to avoid a situation where they can backfire and bring exactly the opposite of the desired behavior. Keywords: Motivation, Reward, Reward Management, KTTI, Reward policies, Performance contract, TVET, Extrinsic rewards, intrinsic rewards

Examining the Antimicrobial Activity of Plant Extracts used in Traditional Medicine

With the increasing prevalence of antibiotic resistance, the need for novel antimicrobials is high. In Africa, local populations use native plant extracts to treat infection; however, whether or not they are antimicrobial remains largely unknown. If these plant extracts demonstrate antimicrobial activity they may prove useful in the fight against antibiotic resistance. The purpose of this project was to develop a standard method to evaluate the antimicrobial activity of extracts from eleven plant species used in traditional medicine, and to examine if these extracts inhibit growth of four different bacterial species representing various pathogen groups. Using a modified disk diffusion assay, increasing volumes of plant extracts, antibiotic solutions, or control solutions were added to filter paper disks. These disks were then placed onto agar plates inoculated with test bacteria. The zones of inhibition were measured and additional visual growth effects were recorded. Seven of the eleven extracts produced zones of inhibition against at least one bacterial species. This effect was dose-dependent. Of the four bacterial species tested, E. coli, B. subtilis and S. epidermidis had their growth inhibited by at least one extract. Interestingly, ten of the extracts had additional bio-activity that resulted in visible morphological changes in the bacteria, indicating these extracts affect growth and gene expression. This effect was produced in all four bacterial species by at least one extract. This investigation was essential in characterizing the extracts’ biological properties so they may be studied further and potentially used in industrial or medical applications. *Indicates faculty mento

Inexpensive Mobile Cheapstat Sensor for Environmental, Food and Clinical Chemical Analysis

The chemical analysis can benefit from the development of integrated hand-held devices that can be used by non-experts, in non-lab settings to determine various contaminants in their environment. Coupled with abundant information on the Internet and a large variety of available electronics, such devices can be fabricated and made available at an economical price. The potentiostat, a staple in electrochemistry, is such a device under current investigation by the authors. A potentiostat is a simple device that applies a voltage and measures current in response to electrochemical reactions from a specific contaminant under investigation. Potentiostats have many different applications in terms of analytes it can detect. For example, it could be used to determine the quantity of metals in water, glucose in blood, and antioxidants in food. Typically, commercial potentiostats cost from $1000 to$25,000. Since these devices are expensive, a means of finding a cheaper alternative for public use is beneficial. The CheapStat potentiostat is a device that meets these criteria. The Cheapstat is a do-it-yourself potentiostat that costs a little under $100 and can be made with minimal proficiency in electronics. We have assembled and tested the Cheapstat to determine its practicality and application for electrochemistry, and we have developed and tested bio-sensors that can be used in conjunction with the Cheapstat to determine antioxidants in fruits. The data we obtain from this project can be used in analytical research and assist in teaching electrochemistry to students. *Indicates faculty mento

Do Stock Splits Affect Ownership Concentration of Firms Listed at the Nairobi Securities Exchange?

Corporations split their shares in order to make them more affordable to the retail investors. Theoretically, increased buying of the stock post split by retail investors should be experienced. Existing literature on effect of stock splits are from studies conducted in developed markets, much of it focusing on market efficiency. The objective of this study was to analyze the effect of stock splits on ownership structure of listed firms in Kenya. Using a data collection sheet, secondary data was collected from the published financial statements of listed firms, which had conducted stock splits between 2004 and 2010. A Herfindahl- Hirschman Index was used to measure ownership concentration among the top ten shareholders before and after the split. The overall change in ownership structure was analyzed using the Wilcoxon Rank Sum Test at 95% confidence level. The results show that although the ownership structure for the companies in the study significantly changed, the change was generally not in favor of retail investors. Contrary to expectations, the holding by institutional investors significantly increased in most cases, implying that stock splits do not cause enough interest in the shares amongst retail investors to tilt the proportions owned in their favor. To the contrary, stock split encourages retail investors to off load their shares in a bid to lock in profits occasioned by the appreciation in the value of the shares after the split. An important recommendation for market regulators and corporate managers is that a stock split may not be a useful tool for dispersing firm ownership but rather only for improving stock liquidity. Investors looking to buy stocks that have announced a stock split should carefully analyze their information content, because during stock market bubble a split may not convey accurate future prospects for the company. Given the increased demand for stocks when a split is announced, it is an ample opportunity to lock in profits for investors looking to sell their shares. Keywords: Controlling Shareholding; Ownership Concentration; Ownership Structure; Stock Splits; Nairobi Securities Exchang

Antiulcerogenic effect of Capparis cartillaginea decne on indomethacin induced gastric ulcer in wistar rats

Background: Peptic ulcer disease is a non-malignant, mucosal lesion of the stomach or duodenum. The mucosal defect reaches the muscularis mucosa and sometimes, beyond causing life threatening complications, including haemorrhage, perforations, gastrointestinal obstruction and malignancy.Methods: The animals were pre-treated with omeprazole 20 mg/kg and 300 mg/kg of Capparis cartillaginea decne orally for 14 days. On the 15th day, ulcers were induced using indomethacin 30 mg/kg and 4 hours post ulcer induction, they were sacrificed. Ulcer index, pH, total acidity and volume were determined.Results: Extensive lesions were seen in indomethacin ulcerated rats with mean ulcer score of (1.260±0.18). In comparison, there were minimal areas of erosion on animals pre-treated with omeprazole (0.14±0.025) and plant extracts (0.280±0.097). Indomethacin-induced ulcer treated animals showed the highest volume of gastric juice output (3.14±0.21 ml), whereas the animals pre-treated with omeprazole had lower gastric juice output (2.20±0.2 9ml). This was comparable to animals pre-treated with the plant extract (1.80±0.13 ml). The pH was high in animals pre-treated with omeprazole (5.02±0.53). This was also seen in animals pre-treated with the extract (4.82±0.31). This was in comparison to the low pH seen in indomethacin ulcerated animals (2.20±0.16). Indomethacin-induced ulcer treated animals showed high levels of total acidity (88.64±1.71 mEq/L). Whereas the animals pre-treated with omeprazole had lower total acidity (55.26±3.77 mEq/L), which was also mirrored in animals pre-treated with the plant extracts (61.44±2.42 mEq/L).Conclusions: The extracts of Capparis cartillaginea decne showed anti-ulcer effect on indomethacin induced ulcers in Wistar rats