Obstetric fistula: Can community midwives make a difference? Findings from four districts in Kenya

As part of the UNFPA Global Campaign to End Obstetric Fistula, the Population Council and UNFPA built on Kenya’s Community Midwifery Approach to develop a comprehensive community midwifery intervention strategy that aimed at increasing skilled attendants at birth and prevention of obstetric fistula. This report seeks to understand the experiences of women affected by fistula and whether community midwives can contribute to preventing obstetric fistula in rural settings in Kenya. The key recommendations emerging from this report are to: update health facility midwives in maternal and neonatal health (MNH) skills including prevention, treatment, and care of obstetric fistula; train more community midwives; increase community awareness; and listen to men and women and involve them in community health committees and district health plans for improving MNH, taking into account cultural sensitivities. Detailed activities regarding the recommendations are outlined at four different levels: the community, the linkages between community and health services, the health facility, and the policy level. The report recommends that these be reviewed and incorporated into annual operational plans

Adoption of Maize Production Technologies in the Coastal Lowlands of Kenya

Maize is the major food crop grown in the coastal region of Kenya and constitutes a major component of the diet of the population in the region. However, average yields are far below the potential for the region and low production levels create serious food deficits. Over the years, new technologies have been introduced but adoption has remained low, especially for fertilizer. This paper examined current maize-farming practices and technological and socioeconomic factors that influenced adoption in the Kilifi and Kwale Districts of the Coast Province, that together account for half of maize production in the region. The study found low adoption levels for improved maize varieties and technology, especially fertilizer, among farmers in the area. Farmers cited poor availability of improved varieties, high cost, lack of knowledge, and unfavourable characteristics of improved varieties as reasons for non-adoption. The high price and poor availability of fertilizers, farmers’ inexperience with them, and their perception that soils were already fertile were among reasons given for low fertilizer use. The low levels of adoption of improved varieties indicate that they are not meeting farmers’ needs. The authors recommend that researchers communicate with and include farmers’ criteria when breeding varieties. In addition, alternative options should be extended to farmers who are not able to use inorganic fertilizers. Finally, given the major influence of the institutional environment found in the study, it is recommended that extension services be strengthened, especially where lack of knowledge was cited as a hindrance to adoption.Maize, Crops, Innovation adoption, Technology transfer, Food production, Production economics, Production factors, Plant breeding, Fertilizers, Yields, Kenya, Crop Production/Industries, E14, E16,

Sahiwal Breed in Pastoral Production Systems in Kenya: Future Roles and Existing Gaps in Knowledge and Supportive Technical Logistics; \u3ci\u3eA Review\u3c/i\u3e

Sahiwal genetic resources is an integral part of the ASALs economy of Kenya. Sahiwal is the largest single dual purpose cattle breed kept by the pastoral communities in the ASALs where livestock products are the main drivers of food and nutrition security, and a source of income to support other household obligations. It was introduced in Kenya to upgrade the low performing small east African Zebu because of its superior productive and reproductive performance. The promising results of this upgrading programme led to the breed gaining preference over the local Zebu among the Maasai pastoralists. Despite the impressive results from this breed and subsequent high demand for milk and beef due to increase in population, supply of superior bulls and cows from the nucleus herd to the commercial herds remain low. It is likely that the problem will continue and perhaps in future the numbers of Sahiwal population may reduce unless appropriate measures are put in place. Pastoralists and other stakeholders such as policy makers need technical guidance to identify the most seemly approaches to ensure long term breed multiplication and conservation as well as optimal utilisation in ASALs. This study looks at the underlying challenges and opportunities that are there to exploit advantages of the breed. Gaps in knowledge and supportive logistics for low input production system for the breed are also discussed as well as implications of Sahiwal cattle and practices and technologies for pastoral-based systems

Home Management of Febrile Children Under-Five Years in Kahama District, North-Western Tanzania

An assessment of the prevalence and the factors associated with home treatment of children less than five years with febrile illnesses was carried out at Mmuhungura Ward in Kahama District, Shinyanga, Tanzania. Out of the 400 under-fives who participated in the study, 79% had fallen sick during the previous six months. Majority of the children had diarrhoea (64%) and 34% had cough. Thirty nine percent of the parents provided home treatment to their under-five children. The self-administered drugs were antimalarials 45%, antipyretics 34%, antidiarrhoeals 26%, cough syrups 23% and analgesics 17%. The drugs used were obtained from drug stores (68%) while left-overs from previous supplies accounted for 15%. Univariate analysis revealed that diarrhoeal diseases, shortness of breath, being a single parent and frequency of illnesses in the children were significantly associated with home treatment. Multivariate analysis showed that walking time to the health facilities of more than one hour, frequency of morbidity, being a single parent and unemployment of the parent were significantly associated with home treatment. Illiteracy of the parents had low association with home treatment. Home treatment of children less than five years was prevalent in the studied area.Key words: Home treatment, fever, under-five children, Kahama, Tanzani

'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in low income countries : "inserting new ideas into a timeless wine skin"

Background: Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. Discussion: The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries Conclusion: In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS

INTERVENING EFFECT OF INTERNATIONAL COMPETIVENESS ON THE RELATIONSHIP BETWEEN TAX INCENTIVES AND FOREIGN DIRECT INVESTMENT AMONG THE EAST AFRICA COMMUNITY PARTNER STATES

Countries around the world employ different efforts aimed at attracting more FDI, top most being tax incentives. Appropriate fiscal policy framework establishes tax incentive that improves country’s investment climate. However, tax incentives may at times not adequately compensate for poor investment climate in developing countries resulting from poor infrastructure, lack of trade openness, weak judicial system, small market size and most importantly political instability. Therefore, this study sought to determine the moderating effect of investment climate on the relationship between tax incentives and FDI among the East Africa Community partner states. The study was carried out using data relating to the five states in the East Africa Community: Tanzania, Rwanda, Kenya, Burundi, and Uganda.   Secondary data covering a period of 15 years from 2002 to 2016 was used. The results revealed that tax holiday and the period of losses carried forward had an insignificant and positive relationship with FDI inflows but investment allowances had an insignificant negative relation with FDI inflows. The study revealed that consumer prices and tax holiday had a positive and statistically insignificant relationship with FDI and that investment allowances and the period of losses carried forward had a negative and statistically insignificant relationship. The findings also revealed that tax holiday and export growth had a negative and statistically significant relationship while investment allowances and the period of losses carried forward and export growth had a negative and insignificant relationship. The findings further revealed that consumer prices had a statistically insignificant positive relationship with FDI inflows while export growth had negative and statistically insignificant relationship with FDI. Finally, the study found that tax holiday, consumer prices and export growth had negative and statistically insignificant relationship with FDI while investment allowances and the period of losses carried forward had a positive and statistically insignificant relation with FDI

TAX INCENTIVES AND FOREIGN DIRECT INVESTMENT ELATIONSHIP IN THE EAST AFRICA COMMUNITY PARTNER STATES

The relationship between tax incentives and Foreign Direct Investments (FDI) isone of the unresolved issues in public finance. The existing studies on theeffectiveness of tax incentives in attracting foreign investors differ depending onjurisdiction of research and the methodological approach employed. This studywas to establish the relationship between tax incentives and FDI in East AfricaCommunity Partner States. A panel descriptive study design was used todetermine the relationship between tax incentives and foreign direct investment inEast Africa Community Partner States, which included Tanzania, Rwanda,Kenya, Burundi, and Uganda. The study used panel secondary data, whichcovered a period of 16 years from 2002 to 2017. The study revealed that taxholidays and period of losses carried forward did not have statistically significantinfluence on FDI inflow. However, investment allowances had a positivestatistically significance influence on and FDI inflow in EAC. The studyconcluded that the investment allowance had a significant influence on FDIinflows among the East African community partner states. The studyrecommended that the leadership of East Africa community partner states shouldencourage use of investment allowances to attract FDI. The study alsorecommended that tax holidays and period of losses carried forward should not beused as a means of attracting FDI since the empirical evidences shows that the twoare not significant in attracting FDI

Strengthening postnatal care services including postpartum family planning in Kenya

The objectives of this study were to develop and introduce a strengthened postnatal care package into one hospital and four health centers in one district in Kenya, to document the feasibility, acceptability, and quality of care of the strengthened postnatal care, and to evaluate the effectiveness of the postnatal package on women’s reproductive health behaviors. The study was implemented jointly by the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project and by Jhpiego’s ACCESS-FP project, both funded by USAID. A postnatal care–family planning orientation package for providers was developed that incorporated relevant maternal and newborn healthcare services in the postnatal period with a specific focus on postpartum family planning. The package developed and tested through this project proved to be acceptable to clients and providers and can be introduced fairly easily through a three-day orientation training and enhanced through supportive supervision. To raise the standard of care further, future use of this training and supervision package as a standard protocol for the Ministry of Health in Kenya or elsewhere should include a clinical skills component for maternal and neonatal complications

Physicochemical characteristics of undrainable water dams utilized for fish rearing in the semi-arid Naromoru area, central Kenya

Naromoru is a semiarid area in Central Kenya, occurring on the leeward side of Mt. Kenya. Its water sources include a few permanent rivers such as Nairobi River, intermittent streams and a large number of undrainable water reservoirs. Most of the undrainable water resources have been stocked with fish but their utilization for fish rearing has generally remained very low. The purpose of this study was therefore to examine the water quality status of the dams to assess their suitability and potential for fish production. pH, electro-conductivity and total dissoved solutes (TDS) were measured in-situ from three reservoirs (Gathathini, Lusoi and Kianda dams) differing in their habitat characteristics. Water samples were collected for determination of the ionic concentartions of the reservoirs. Water quality status differed markedly between sites, with electric conductivity ranging from 350μScm-1 at Gathathini dam to over 1350μScm-1 at Lusoi dam. pH however showed only a slight variation from 8-9.6. Water temperature and transparency varied significantly between the sites, while cationic constituents (Ca2+, K+, Mg2+ and Na+), anions (SO42-, HCO32-, and Cl-1), heavy metals (Pb2- and Cu2+) and nutrients (NO3 - and PO42-) were all within the recommended WHO levels for fish production. Generally the water quality status was within the standards recommended for fisheries production.Key words: Mt. Kenya, limnology, fisheries, productivit