Conflicting priorities: evaluation of an intervention to improve nurse-parent relationships on a Tanzanian paediatric ward.

BACKGROUND: Patient, or parent/guardian, satisfaction with health care provision is important to health outcomes. Poor relationships with health workers, particularly with nursing staff, have been reported to reduce satisfaction with care in Africa. Participatory research approaches such as the Health Workers for Change initiative have been successful in improving provider-client relationships in various developing country settings, but have not yet been reported in the complex environment of hospital wards. We evaluated the HWC approach for improving the relationship between nurses and parents on a paediatric ward in a busy regional hospital in Tanzania. METHODS: The intervention consisted of six workshops, attended by 29 of 31 trained nurses and nurse attendants working on the paediatric ward. Parental satisfaction with nursing care was measured with 288 parents before and six weeks after the workshops, by means of an adapted Picker questionnaire. Two focus-group discussions were held with the workshop participants six months after the intervention. RESULTS: During the workshops, nurses demonstrated awareness of poor relationships between themselves and mothers. To tackle this, they proposed measures including weekly meetings to solve problems, maintain respect and increase cooperation, and representation to administrative forces to request better working conditions such as equipment, salaries and staff numbers. The results of the parent satisfaction questionnaire showed some improvement in responsiveness of nurses to client needs, but overall the mean percentage of parents reporting each of 20 problems was not statistically significantly different after the intervention, compared to before it (38.9% versus 41.2%). Post-workshop focus-group discussions with nursing staff suggested that nurses felt more empathic towards mothers and perceived an improvement in the relationship, but that this was hindered by persisting problems in their working environment, including poor relationships with other staff and a lack of response from hospital administration to their needs. CONCLUSION: The intended outcome of the intervention was not met. The priorities of the intervention--to improve nurse-parent relationships--did not match the priorities of the nursing staff. Development of awareness and empathy was not enough to provide care that was satisfactory to clients in the context of working conditions that were unsatisfactory to nurses

Gender and Age Analysis on Factors Influencing Output Market Access by Smallholder Farmers in Machakos County, Kenya

Output markets are key prerequisite for enhancing agriculture-based economic growth and increasing rural incomes. However majority of smallholder farmers rarely access output markets. The study determined factors influencing smallholder farmers in Yatta district to access output market based on data collected from 160 households. The data was disaggregated in terms of gender and age and analyzed using SPSS and STATA version 10. Descriptive results revealed a gender and age disparity in accessing output market. Tobit model result indicated that households with access to extension, credit, land, own means of transport, and are members in groups are more likely to access output market.   Nevertheless access to output market was reduced by enterprise diversification, higher education level, household size, age and marital status of household head. To enable farmers to access output market, there is need for policies that promote group membership, improve physical infrastructure, and facilitate access to credit (for example free interest loan) as well as extension services especially to women and youths. Keywords: output market, gender, age-group, disaggregation

Phytochemicals Present in Engleromyces goetzei and Antimicrobial Activity Against Phytopathogenic Bacteria

Interest in the extraction of bioactive compounds from natural sources has increased in recent years due to the potential applications of these compounds in food, chemical, and pharmaceutical industries. The methanolic extract of the fungus Engleromyces goetzei was investigated for the presence of phytochemicals and the antibacterial properties. The study shows that the extract has flavonoids, coumarins, saponins, terpenoids and steroids. Engleromyces goetzei has potential as a source of useful antibacterial compounds active against phytopathogenic bacteria. Disk diffusion assay was used to analyze the susceptibility of an organism which help in identifying the proper antibacterial biopesticide. In this experiment, this was done by placing the antimicrobial disks impregnated with E. goetzei on the NA plates swabbed with Xanthomonas campestris, Pseudomonas sryingae pv phaseolicola, Erwinia carotovora and Xanthomonas axonopodis pv. phaseoli. After twenty-four hours of incubation, there were areas around the antimicrobial disks with no bacterial growth. The MIC of E. goetzei against X. axonopodis pv. phaseoli, Ps. syringae pv phaseolicola and X. campestris was found to be 1mg/ml while that of E. carotovora was 10mg/ml. Keywords: Phytochemicals, Engleromyces goetzei, X. axonopodis pv. phaseoli, E. carotovora, Ps. syringae pv phaseolicola, X. campestri

Diabetic Retinopathy in Kenya: assessment of services and interventions to improve access

The majority of the estimated 425 million people living with diabetes (PLWD) reside in low and middle-income countries. An estimated 35% of PLWD have diabetic retinopathy (DR) and 10% have vision threatening retinopathy (VTDR) requiring urgent treatment. There is a high unmet need for DR services in many of these countries, which highlights the need to strengthen health systems. The purpose of this PhD is to provide evidence on the factors and interventions for promoting access and utilisation of services for DR. The study setting is Kenya, which has adopted Universal Health Coverage (UHC) as a target for 2030. The specific objectives were: i) To synthesise the literature on the magnitude, needs and priorities for diabetic retinopathy services; ii)To conduct an assessment of the health system for PLWD and diabetic retinopathy in Kenya; iii) To use the evidence from the literature and evidence from the health system assessment as a platform for health system strengthening; and iv) To develop and test an intervention through a randomized clinical trial to improve uptake of eye care services for PLWD in Kenya. Methods: The first objective was achieved through a literature review. For the second objective, a health system assessment for diabetes and DR was conducted, based on the World Health Organization’s framework for health systems building blocks and the tracer condition approach. For the third objective, as part of health system strengthening, national guidelines for DR and a short online course for health care workers were developed. For the fourth objective, using the evidence from the health system assessment, we designed and implemented a two arm (1:1) pragmatic cluster randomized controlled trial to test whether a peer-supporter-led package of interventions can increase uptake of DR screening among members of diabetes support groups who have never had screening. The primary outcome measure was attendance at DR screening in the 14 clusters and 734 participants followed up over six months. Results: A review of the literature on the epidemiology and interventions for diabetes and DR, identified that the key priorities of health systems in reducing the incidence of DR-related blindness are: (1) control of diabetes (2) early detection of DR and (3) appropriate treatment of DR. However, most of the available evidence is from highincome countries. The health system assessment for diabetes and DR in Kenya identified a high unmet need for DR screening, and uptake of screening was the bottleneck to entry to DR services. The barriers were lack of referral and inadequate knowledge of diabetes eye health. The lack of clinical guidelines and inadequate opportunities for continuous professional development limit the availability of DR services. To address this barrier, national clinical guidelines were developed through a process of adaptation from generic guidelines. The scope of the guidelines is screening, diagnosis, treatment and follow-up for DR. In addition, an online training course on the control of DR has been developed using the theories of adult learning and instructional design. The results of the cluster-randomized trial indicate that the peer-led interventions are acceptable and reach the population most vulnerable to DR. One in two of the participants in the intervention arm compared to one in ten in the control arm attended DR screening. We also found that most of the effect occurs early—within the first month of the intervention. Conclusions: This thesis provides evidence about how national DR guidelines and online training programmes for health workers can be developed to strengthen health systems and improve eye services for PLWD. The thesis also provides evidence that the uptake of DR screening by PLWD can be significantly increased through a community based intervention utilising diabetes support groups and peer-supporters. This can lead to earlier diagnosis of DR and the prevention of blindness

Biocontrol of Green Mould Disease of Oyster Mushroom (Pleurotus ostreatus) using Bacillus amyloliquefaciens

The occurrence of Trichoderma harzianum and T. asperellum in cultivation of oyster mushroom (Pleurotus ostreatus) frequently results in serious crop losses and considerable inhibition of growth of mycelium and fruiting bodies of oyster mushroom thus lowering the yield substantially. Bacillus amyloliquefaciens strain isolated from groundnuts proved very effective in antagonizing the oyster mushroom pathogenic T. harzianum and T. asperellum without having a negative effect on P. ostreatus mycelia. The Bacillus amyloliquefaciens was found to produce diffusible and volatile organic compounds. This strain is a potential biocontrol candidate, in addition to the lack of antagonistic activity towards P. ostreatus mycelia. The present study, hence, provides a potential biocontrol agent for Trichoderma green mould. However, field studies of this isolate as substrate inoculant in oyster mushroom are required in order to establish its actual performance. Keywords: Bacillus amyloliquefaciens, Green mould, Mushroom, Biocontro

Effect of Inoculation with Mycorrhizae on Growth Parameters of Dombeya torrida, Leucaena leucocephala and Tephrosia vogelii

The present work evaluated the impact of arbuscular mycorrhizal (AM) fungus on growth. Three species of trees, Tephrosia vogelii, Leucaena leucocephala and Dombeya torrida were treated with fragments of arbuscular mycorrhizae and grown in greenhouse. The aim of the present work was to determine whether arbuscular mycorrhizal symbiotic association with these tree species would enhance their growth. Data on height, stem diameter and number of leaves were taken after every two weeks for a period of three months. Mycorrhizal plants demonstrated higher vigor with Tephrosia vogelii giving a mean height of 57.50 cm, 0.50 cm diameter and 9.33 number of leaves which were significantly different from the control plants at p ≤ 0.05 according to least significant difference (LSD). The biomass was also taken at the end of 90 days of growth and the same trend was exhibited. Mycorrhizal plants also showed root nodules with mycorrhizal arbuscles. This work contributes to our understanding of the effects of AM symbiosis on the accumulation of certain micronutrients in valuable woody tree species. Keywords: arbuscular mycorrhizae, Tephrosia vogelii, Leucaena leucocephala, plant growt

Impact of Enclosures on Range Productivity in Chepareria West Pokot County Kenya

In the semi-arid areas of West Pokot particularly Chepareria, majority of the people live semi sedentary lives while others are nomadic pastoralists. In the last three decades, there have been concerted efforts to restore and improve rangeland in this area. Use of enclosures, which is one of the key interventions, by the Vi Agro- forestry a Non-Governmental Organisation, enhancing with many ecological processes such as disturbance, is a method of rehabilitating degraded rangeland, which in turn affects vegetation dynamics. Adoption of these strategies by farmers has been gradual and some areas are still open and degraded. The aim of this study was to evaluate the effects of enclosures on range productivity in the semi-arid rangeland in West Pokot. Plant productivity, diversity and density were assessed in enclosures of different ages and in adjacent open land used for communal grazing. Questionnaires were also used to assess local community perception of the range restoration and improvement. Modified Whittaker plot was used for sampling in the selected enclosures and open areas. Herbaceous biomass and plant cover were greater in enclosures than in open areas. The average herbaceous cover in the enclosed area was 76% while that in the open it was 55% which was significantly different, P \u3c 0.001. The average herbaceous biomass in the enclosure was 137.2kg/ha while in the open it was 37.8kg/ha respectively. Enclosed areas are more productive than open areas and should be adopted in other dry areas as a method of rehabilitating degraded grazing lands