Special Needs Education (SNE) in Kenyan public primary schools: exploring government policy and teachers’ understandings

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This research focuses on Special Needs Education (SNE) in Kenyan Public Primary Schools: Exploring Government Policy and Teachers’ understandings. At a time when Kenya is introducing reforms with a view to addressing broad national objectives and providing universal primary education (UPE) after the massive enrolment increases arising from the free primary education declaration (FPE), it was important to establish teachers’ understandings on SEN. The study was undertaken in 27 primary schools in urban, municipal and rural parts of Kenya. A phenomenological qualitative approach was mainly used and data were collected from teachers through a survey comprising: (i) 159 self-administered questionnaires ii) Nine in-depth interviews. From the results of a pilot study, necessary adaptations were made for the main study. The data provided insights to teachers’ teaching strategies, impacts of mainstreaming, factors that prevent the participation of children said to have SEN, challenges in meeting the diverse needs in the classroom and the support they may require in providing more engaging and effective learning instructions. The findings show that many teachers lack a repertoire of learning and teaching strategies appropriate for addressing barriers to learning and providing individualized approaches in the classrooms. Some teachers were positive about teaching children said to have SEN but lacked the infrastructure of support and guidance, were confused by different terminologies and found the concept of SEN not to be enabling. What teachers are calling for is more training to help them develop strategies which are responsive to the identified learning difficulties. Through Documentary Analysis of the Kenya National Special Needs Education (SNE) Policy Framework, Ministry of Education (MoE, 2009), it was identified that the policy is difficult and ambiguous for teachers to implement. The policy fails to include salient definitions to facilitate a common way of addressing children said to have SEN which results in them being labelled. The recommendations of the research indicate that children’s unique needs be made transparent and addressed using effective individualized education plans to influence and maintain high expectations, positive and enriched ways of teaching in order to improve the children’s learning opportunities as well as other extracurricular activities. The national policy should be revised to include feasible targets in order to facilitate on-going evaluation and embed definitions of key words which are pivotal to planning, assessment, identification, provision and placement of children said to have SEN. Suggestions for further research have also been included

Effects of Working Capital Management on Performance of Non-Financial Companies Listed In NSE, Kenya

The purpose of this study was to investigate the effect of working capital management on the performance of non-financial companies listed in the Nairobi Securities Exchange (NSE), Kenya. The study employed an explanatory non-experimental research design. A census of 42 non-financial companies listed in the Nairobi Securities Exchange, Kenya was taken. The study used secondary panel data contained in the annual reports and financial statements of listed non-financial companies. The data were extracted from the Nairobi Securities Exchange hand books for the period 2006-2012.The study applied panel data models (random effects). Feasible Generalised Least Square (FGLS) regression results revealed that an aggressive financing policy had a significant positive effect on return on assets and return on equity while a conservative investing policy was found to affect performance positively. The study recommended that managers of listed non-financial companies should adopt an aggressive financing policy and a conservative investing policy should be employed to enhance the performance of non-financial companies listed in the NSE, Kenya. Key words: working capital management, performance, non-financial companie

FINANCIAL LITERACY AND CONSUMER PROTECTION: A ROAD MAP TO DIGITAL FINANCIAL ACCESS BY SMEs IN KENYA

This paper seeks to ascertain the influence of financial literacy and financial consumer protection on digital financial access. The objectives of the study were to find out the effect of financial literacy on digital monetary access, and to find out the effect of f consumer financial protection on digital access of finances of SMEs in Sub County of Ruiru in County government of Kiambu, Kenya. Financial Literacy Theory, Information Asymmetry Theory and Social Learning Theory are the theories that guided formulation of study’s objectives. Descriptive research design was used with the population of interest comprising of all SMEs owners in Ruiru Sub County in Kiambu County. The sample size for the study was 384 respondents derived byFisher (1998) formula. Primary data as collected by use of questionnaires. Descriptive statistics of mean, frequency, percentages and standard deviation were used combined with inferential analysis of correlation as well as multiple regression to analyse the data. Findings of the study indicated that financial literacy and financial consumer protection significantly and positively influence on digital financial access of SMEs. The paper concluded that an improvement in the knowledge of financial products, developing a financial attitude towards the long term, debt management literacy of SME owner, financial product choice knowledge and having the ability to make informed decisions regarding finances generally improves digital financial access of SMEs

Optimizing Linkage to Care and Initiation and Retention on Treatment of Adolescents with Newly Diagnosed HIV Infection.

Objective: Unsuccessful linkage to care and treatment increases adolescent HIV-related morbidity and mortality. This study evaluated the effect of a novel adolescent and youth Red Carpet Program (RCP) on the timing and outcomes of linkage to care. Design: A prepost implementation evaluation of the pilot RCP program. Settings: Healthcare facilities (HCFs) and schools in Homa Bay County, Kenya. Study participants: HIV-infected adolescents (15–19 years) and youth (20–21 years). Interventions: RCP provided fast-track peer-navigated services, peer counseling, and psychosocial support at HCFs and schools in six Homa Bay subcounties in 2016. RCP training and sensitization was implemented in 50 HCFs and 25 boarding schools. Main outcome measures: New adolescent and youth HIV diagnosis, linkage to and retention in care and treatment. Results: Within 6 months of program rollout, 559 adolescents and youths (481 women; 78 men) were newly diagnosed with HIV (15–19 years n = 277; 20–21 years, n = 282). The majority (n = 544; 97.3%) were linked to care, compared to 56.5% at preimplementation (P \u3c 0.001). All (100.0%; n = 559) adolescents and youths received peer counseling and psychosocial support, and the majority (n = 430; 79.0%) were initiated on treatment. Compared to preimplementation, the proportion of adolescents and youths who were retained on treatment increased from 66.0 to 90.0% at 3 months (P \u3c 0.001), and from 54.4 to 98.6% at 6 months (P \u3c 0.001). Conclusion: Implementation of RCP was associated with significant improvement in linkage to and early retention in care among adolescent and youth. The ongoing study will fully assess the efficacy of this linkage-to-care approach

Wellbeing among sub-Saharan African patients with advanced HIV and/or cancer: an international multicentred comparison study of two outcome measures

BACKGROUND: Despite the high mortality rates of HIV and cancer in sub-Saharan Africa, there are few outcome tools and no comparative data across conditions. This study aimed to measure multidimensional wellbeing among advanced HIV and/or cancer patients in three African countries, and determine the relationship between two validated outcome measures. METHODS: Cross-sectional self-reported data from palliative care populations in Kenya, Uganda and South Africa using FACIT-G+Pal and POS measures. RESULTS: Among 461 participants across all countries, subscale "social and family wellbeing" had highest (best) score. Significant country effect showed lower (worse) scores for Uganda on 3 FACIT G subscales: Physical, Social + family, and functional. In multiple regression, country and functional status accounted for 21% variance in FACIT-Pal. Worsening functional status was associated with poorer POS score. Kenyans had worse POS score, followed by Uganda and South Africa. Matrix of correlational coefficients revealed moderate correlation between the POS and FACIT-Pal core scale (0.60), the FACIT-G and POS (0.64), and FACIT-G+Pal with POS (0.66). CONCLUSIONS: The data reveal best status for family and social wellbeing, which may reflect the sample being from less individualistic societies. The tools appear to measure different constructs of wellbeing in palliative care, and reveal different levels of wellbeing between countries. Those with poorest physical function require greatest palliative and supportive care, and this does not appear to differ according to diagnosis

Relation between falciparum malaria and bacteraemia in Kenyan children: a population-based, case-control study and a longitudinal study.

BACKGROUND: Many investigators have suggested that malaria infection predisposes individuals to bacteraemia. We tested this hypothesis with mendelian randomisation studies of children with the malaria-protective phenotype of sickle-cell trait (HbAS). METHODS: This study was done in a defined area around Kilifi District Hospital, Kilifi, Kenya. We did a matched case-control study to identify risk factors for invasive bacterial disease, in which cases were children aged 3 months to 13 years who were admitted to hospital with bacteraemia between Sept 16, 1999, and July 31, 2002. We aimed to match two controls, by age, sex, location, and time of recruitment, for every case. We then did a longitudinal case-control study to assess the relation between HbAS and invasive bacterial disease as malaria incidence decreased. Cases were children aged 0-13 years who were admitted to hospital with bacteraemia between Jan 1, 1999, and Dec 31, 2007. Controls were born in the study area between Jan 1, 2006, and June 23, 2009. Finally, we modelled the annual incidence of bacteraemia against the community prevalence of malaria during 9 years with Poisson regression. RESULTS: In the matched case-control study, we recruited 292 cases-we recruited two controls for 236, and one for the remaining 56. Sickle-cell disease, HIV, leucocyte haemozoin pigment, and undernutrition were positively associated with bacteraemia and HbAS was strongly negatively associated with bacteraemia (odds ratio 0·36; 95% CI 0·20-0·65). In the longitudinal case-control study, we assessed data from 1454 cases and 10,749 controls. During the study period, the incidence of admission to hospital with malaria per 1000 child-years decreased from 28·5 to 3·45, with a reduction in protection afforded by HbAS against bacteraemia occurring in parallel (p=0·0008). The incidence of hospital admissions for bacteraemia per 1000 child-years also decreased from 2·59 to 1·45. The bacteraemia incidence rate ratio associated with malaria parasitaemia was 6·69 (95% CI 1·31-34·3) and, at a community parasite prevalence of 29% in 1999, 62% (8·2-91) of bacteraemia cases were attributable to malaria. INTERPRETATION: Malaria infection strongly predisposes individuals to bacteraemia and can account for more than half of all cases of bacteraemia in malaria-endemic areas. Interventions to control malaria will have a major additional benefit by reducing the burden of invasive bacterial disease. FUNDING: Wellcome Trust

Where Are the Newly Diagnosed HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach the “First 90”

Background: The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status – the “first 90.” In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere. Methods: We analyzed facility-level HTS data in Kenya from 1 October 2015 to 30 September 2016 to assess the spatial distribution of newly diagnosed HIV-positives. We used the Moran's Index (Moran's I) to assess global and local spatial auto-correlation of newly diagnosed HIV-positive tests and Kulldorff spatial scan statistics to detect hotspots of newly diagnosed HIV-positive tests. For aggregated data, we used Kruskal-Wallis equality-of-populations non-parametric rank test to compare absolute numbers across classes. Results: Out of 4,021 HTS sites, 3,969 (98.7%) had geocodes available. Most facilities (3,034, 76.4%), were not spatially autocorrelated for the number of newly diagnosed HIV-positives. For the rest, clustering occurred as follows; 438 (11.0%) were HH, 66 (1.7%) HL, 275 (6.9%) LH, and 156 (3.9%) LL. Of the HH sites, 301 (68.7%) were in high HIV-burden counties. Over half of 123 clusters with a significantly high number of newly diagnosed HIV-infected persons, 73(59.3%) were not in the five highest HIV-burden counties. Clusters with a high number of newly diagnosed persons had twice the number of positives per 1,000,000 tests than clusters with lower numbers (29,856 vs. 14,172). Conclusions: Although high HIV-burden counties contain clusters of sites with a high number of newly diagnosed HIV-infected persons, we detected many such clusters in low-burden counties as well. To expand HTS where most needed and reach the “first 90” targets, geospatial analyses and mapping make it easier to identify and describe localized epidemic patterns in a spatially dispersed epidemic like Kenya's, and consequently, reorient and prioritize HTS strategies.publishedVersio