An Interrogation into Strategy-Technology Linkage at the Department of Immigration Services, Kenya

There exists a debate on the nature of strategy-technology linkage. Consensus is lacking on whether strategy informs technology, whether technology informs strategy, whether strategy and technology develop independently but match at a later stage, and whether there is no linkage between strategy and technology. This study aimed to find out the extant nature of strategy-technology linkage at the Department of Immigration Services, Kenya. Through a case study research design, primary data were obtained through personal interviews using a structured interview guide. The interviewees were top level managers comprising of the Director of Immigration Services and Assistant Directors of Immigration Services in charge of regions namely: Coast, Eastern, North Eastern, South Rift/Nairobi, North Rift/Western and Nyanza. The study also made use of secondary data from documents in the Department. The data gathered were then analyzed using thematic content analysis. The findings revealed presence of strategytechnology linkage at the Department of Immigration Services, Kenya. The nature cuts across the four thematic areas, but leans more towards strategy informing technology. Incidences supportive of the finding that technology informs strategy, strategy and technology develop independently but match at a later stage and no linkage between strategy and strategy were found but not as recurrent as those of strategy informing technology. The study findings largely support postulations of Configuration and Resource Based theories. The study concludes that strategy informs technology at the Department of Immigration Services, Kenya. For policy making, the study recommends the Department of Immigration Services expends more effort to develop a robust strategy that will inform appropriate technology with selective juxtapositions of technology informing strategy where necessary. For practice, the study recommends strategy-technology linkage that fits the environmental setting with a keen eye on the ever changing environment. The study acknowledged limitations on the contextual setting, design, data collection and analysis methods. The design was a case study which means findings might not be generalized. Data collection was through interviews and analysis was through content analysis, both viewed as largely subjective. Interviews were administered to only the top management within the department. Lower cadres were not represented. The study suggests for further research on the subject through different contextual settings, different designs and different instruments

Randomised control trial on immediate post-operative outcomes on patients done either closure or non-closure of peritoneum at caesarean delivery at the Kenyatta national hospital

Objectives: To assess effects of non-closure as compared to closure of the peritoneum at caesarean delivery on the intra-operative and early post-operative outcomes.Design: Randomised controlled trial.Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.Subjects: One hundred and thirty (130) women undergoing first elective or emergency caesarean delivery.Main outcome measure: Primary outcome measures were operation time, number of sutures used, post-operative pain, febrile morbidity, wound dehiscence and hospital stay.Results: The mean duration of Caesarean Section (CS) was 42.8 minutes ± SD12.5. The closure group took longer than non-closure group (45.7±15Vs. 39.6 ±8, P<0.05). The number of sutures used was on average were 4.7 ± SD 0.8, the closure group more compared with the non-closure group (5.2 ±0.7 Vs. 4.2 ±0.7, p<0.05). Post-operative pain was generally not a problem to the patients with a mean Visual analogue score of 1.4 ± SD 1.0 on a scale of 0-10. The non-closure group however indicated slightly more pain (1.5± SD0.93) compared with the closure group (1.2 ±1.1), but this difference was not significant. The adverse outcomes like febrile morbidity and wound complications at Caesarean section were rare and not different whether peritoneum was closed or not during Caesarean section.Conclusion: Non-closure of peritoneum during CS took less time (42.8± SD 8) and number of sutures used (4.2±0.7) can result in cost savings. There were no statistically significant differences in post-operative pain scores, febrile morbidity, wound complications and length of hospital stay. Obstetricians and Medical institutions should consider adoption of non-closure of peritoneum at Caesarean delivery as part of the standard operating procedures

The linkage between settlement profile and choice of sanitation system in peri-urban areas: a case study of Nakuru municipality

Presently human settlements in developing societies do not effectively address problems in urban areas including inadequate housing, unreliable energy sources, inadequate water supply, poor sanitation systems and lack of access roads in informal settlements. Recently, Nakuru town water supply has been characterized by chronic shortages and this threatens sanitation in residential and industrial functions within the Municipality. “Flying toilets” and pit latrines are conspicuous in low income high density settlements, while flush toilets, sewer systems and septic tanks are common among middle and high income low density settlements. A study was carried out to assess and map linkages between sanitation technologies and settlements profile in the municipality and examine implications of resource-oriented sanitation technologies. Results showed that sanitation situation in low income settlements and choice of sanitation technology is limited to multi-factors. 70% of respondents indicated a strain economically as a determining factor in the choice of sanitation technology. The research recommended the adoption of ecological sanitation as a paradigm shift from conventional sanitation

Contraceptive Adoption, Discontinuation, and Switching among Postpartum Women in Nairobi's Urban Slums.

Unmet need for contraception is highest within 12 months post-delivery, according to research. Using longitudinal data from the Nairobi Urban Health and Demographic Surveillance System, we assess the dynamics of contraceptive use during the postpartum period among women in Nairobi's slums. Results show that by 6 months postpartum, 83 percent of women had resumed sexual activity and 51 percent had resumed menses, yet only 49 percent had adopted a modern contraceptive method. Furthermore, almost half of women discontinued a modern method within 12 months of initiating use, with many likely to switch to another short-term method with high method-related dissatisfaction. Women who adopted a method after resumption of menses had higher discontinuation rates, though the effect was much reduced after adjusting for other variables. To reduce unmet need, effective intervention programs are essential to lower high levels of discontinuation and encourage switching to more effective methods

Barriers to Access and Utilization of Maternal and Infant Health Services in Migori, Kenya

Barriers to accessing and utilizing maternal and infant services hinder the progress of achieving the Millenium Development Goals 4 and 5, consequently improving maternal and infant health is an international priority.Maternal and infant mortality is highest in developing countries where several barriers to access and utilization of health care exist. This was a study of an on-going Maternal and Infant Survival to Health care Advancement (MAISHA) project to identify barriers to access and utilization of maternal and infant health services in Migori County, Kenya among 446 women of reproductive age. This was a cross sectional study which employed bothqualitative and quantitative methods. Data was collected using Interviewer - administered questionnaires, Key Informant Interview guides and Focus Group Discussion guides.Barriers to access of the services included socio-economic, cultural barriers and lack of up – to date training among the staff. Success in improving access and utilization of these services requires concerted efforts. Keywords:Barriers, Access, Utilization, Maternal and infant health, Maternal and infant mortality

Childbearing desires and behaviour: a prospective assessment in Nairobi slums.

BACKGROUND: Advancing an understanding of childbearing desires is an important precursor to achievement of the policy goal of reducing unintended pregnancies. It has been long debated that concepts of fertility desires and planning may be particularly problematic in sub-Saharan Africa. However, examination of the utility of fertility preference measures and their link to reproductive behaviour is still rare in the region. The aim of this study is to assess the predictive validity of future childbearing desires on subsequent reproduction among women living in the highly unpredictable circumstances of Nairobi slums. METHODS: We used data from a longitudinal study (2007-2010) nested in the Nairobi Urban Health Demographic Surveillance System that is located in two slums in Nairobi, Kenya. We analysed baseline fertility desires among 4577 postpartum women. Cox proportional hazard model was employed to examine the effect of fertility desires on subsequent reproduction. RESULTS: One-third of the women wanted no more children and 37% wanted to wait for at least five years at baseline. While two-thirds of the women who wanted to have a child soon became pregnant within three years, less than one-third of those wanting no more children became pregnant. The multivariable analysis shows that the probability of becoming pregnant among women who expressed desires to stop or delay childbearing at least for five years was 50% less than among women who wanted to have a child in two to four years. In addition to prospective fertility desires, level of woman's education, residence and ethnicity exerted important influences on implementation of baseline preferences. CONCLUSIONS: Our study finds a strong link between baseline fertility desires and subsequent reproduction. A large difference in pregnancy risk was observed between those who wanted no more children and those who wanted another child. The link between a woman's stated desire to stop childbearing and subsequent childbearing is just as strong in the Nairobi slums as elsewhere. In addition, the findings revealed a pronounced gradient in pregnancy risk according to preferred spacing length, which support other evidence on the important contribution of long-term spacing or postponement to fertility decline in sub-Saharan Africa

Effects of vitamin D deficiency on neurobehavioural outcomes in children: a systematic review

Introduction: Vitamin D plays an important role in brain development in experimental studies; however, the effect of vitamin D deficiency on child development remains inadequately characterized. We aimed to estimate the effects of vitamin D deficiency on neurobehavioural outcomes in children up to 18 years of age. Methods: We searched PubMed, EMBASE, PsycINFO, Scopus, Cochrane Library, Web of Science and Open Grey for published studies up to 10th January 2020. We included all studies that assessed the effects of maternal or child vitamin D status or vitamin D supplementation on neurobehavioural outcomes in children. Study findings were synthesized qualitatively as the high level of heterogeneity in study populations and methodologies precluded a quantitative meta-analysis. Results: Our search identified 5,633 studies, of which 31 studies with 31,375 participants from 18 countries were included in the systematic review. Of the studies identified, one was a randomised controlled trial (RCT) of vitamin D supplementation in children, while 30 were observational. The RCT (n=55) reported a beneficial effect of supplementation with lower doses compared to higher doses of vitamin D on motor development. Twelve mother-child studies (n=17,136) and five studies in children (n=1,091) reported an association between low maternal or child 25-hydroxyvitamin D levels and impaired neurobehavioural outcomes in children, while 15 mother-child studies (n=20,778) and eight studies in children (n=7,496) reported no association. Conclusions: Although animal studies point to an effect of vitamin D deficiency on brain development, there are few studies on the effects of vitamin D deficiency on neurobehavioural outcomes in children and their findings are inconsistent. There is a need for well-conducted, adequately powered studies to further determine these effects in children

Long-term outcomes of survivors of neonatal insults: A systematic review and meta-analysis

Background: The Millennium Developmental Goals ensured a significant reduction in childhood mortality. However, this reduction simultaneously raised concerns about the long-term outcomes of survivors of early childhood insults. This systematic review focuses on the long-term neurocognitive and mental health outcomes of neonatal insults (NNI) survivors who are six years or older. Methods: Two independent reviewers conducted a comprehensive search for empirical literature by combining index and free terms from the inception of the databases until 10th October 2019. We also searched for additional relevant literature from grey literature and using reference tracking. Studies were included if they: were empirical studies conducted in humans; the study participants were followed at six years of age or longer; have an explicit diagnosis of NNI, and explicitly define the outcome and impairment. Medians and interquartile range (IQR) of the proportions of survivors of the different NNI with any impairment were calculated. A random-effect model was used to explore the estimates accounted for by each impairment domain. Results: Fifty-two studies with 94,978 participants who survived NNI were included in this systematic review. The overall prevalence of impairment in the survivors of NNI was 10.0% (95% CI 9.8–10.2). The highest prevalence of impairment was accounted for by congenital rubella (38.8%: 95% CI 18.8–60.9), congenital cytomegalovirus (23.6%: 95% CI 9.5–41.5), and hypoxic-ischemic encephalopathy (23.3%: 95% CI 14.7–33.1) while neonatal jaundice has the lowest proportion (8.6%: 95% CI 2.7–17.3). The most affected domain was the neurodevelopmental domain (16.6%: 95% CI 13.6–19.8). The frequency of impairment was highest for neurodevelopmental impairment [22.0% (IQR = 9.2–24.8)] and least for school problems [0.0% (IQR = 0.0–0.00)] in any of the conditions. Conclusion: The long-term impact of NNI is also experienced in survivors of NNI who are 6 years or older, with impairments mostly experienced in the neurodevelopmental domain. However, there are limited studies on long-term outcomes of NNI in sub-Saharan Africa despite the high burden of NNI in the region