EFFECTS OF MANAGEMENT OF ICT INFRASTRUCTURAL RESOURCES ON THE IMPLEMENTATION OF TPAD POLICY IN PUBLIC SECONDARY SCHOOLS IN TRANS NZOIA COUNTY, KENYA

This study sought to find out the effect of management of ICT infrastructural resources on the implementation of TPAD Policy in Public Secondary Schools in Trans Nzoia County, Kenya. The study was guided by ‘goal-setting theory. Concurrent triangulation design was used to sample 342 Principals and teachers from a target population of 2340 respondents comprising of 242 principals and 2098 teachers from 242 public secondary schools. Stratified and random sampling methods were used to select respondents. Questionnaires were used to collect information and opinions from Principals and teachers. Expert judgments from supervisors were used to improve content validity. Data was analyzed using descriptive and inferential statistics. The results of the study were presented using frequency tables and percentages. From the linear regression model, the study revealed a positive significant effect of teachers’ perception on implthe ementation of TPAD policy. From linear regression model, (R2 = .206) showed that ICT infrastructure resources account for 20.6% variation in the implementation of TPAD policy. There was a positive significant effect of ICT infrastructure resource (β3=0.700 and p value<0.05) on implementation of TPAD policy. Therefore, an increase in ICT infrastructure resources leads to an increase in the implementation of the TPAD policy. The null hypothesis (Ho1) was rejected. ICT infrastructure resoresources a significant influence on the implementation of TPAD policy. This implies that for each increase in the ICT infrastructure resource, there was more implementation of the TPAD policy. The study concluded that the management of teaching staff affects the implementation of TPAD in public secondary schools in Trans Nzoia County. Head teachers with better staff management skills helped teachers to shift to the new paradigm of an appraisal system which has openness, reliability, and accountability as its hallmarks. The Ministry of Education and TSC should improve ICT infrastructure especially in sub-county schools and continuously capacity build teachers and school administrators on emerging trends in education management information systems. There is a need for the ministry of education to provide ICT infrastructural resources in every public secondary school in Trans Nzoia County in order to enhance the implementation of TPAD policy.  Article visualizations

Infective Endocarditis in Low- And Middle-Income Countries

Infective endocarditis (IE) is a rare, life-threatening disease with a mortality rate of upto 25% and significant debilitating morbidities. Although much has been reported on contemporary IE in high income countries, conclusions on the state of IE in low and middle income countries (LMICs) are based on studies conducted before the year 2000. Furthermore, unique challenges in the diagnosis and management of IE persist in LMICs. This article is a review of IE studies conducted in LMICs documenting clinical experiences from the year 2000 to present. We present the causes of IE, management of patients with IE and the prevailing challenges in diagnosis and treatment of IE in LMICs

Proactive prevention: Act now to disrupt the impending non-communicable disease crisis in low-burden populations

Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as proactive prevention. This emphasis is based on the priority to put in place policies, programs, and infrastructure that can disrupt the epidemiological transition to develop NCDs among these groups, thereby averting future NCD crises. Proactive prevention strategies can be classified, and their implementation prioritized, based on a 2-dimensional assessment: impact and feasibility. Thus, potential interventions can be categorized into a 2-by-2 matrix: high impact/high feasibility, high impact/low feasibility, low impact/high feasibility, and low impact/low feasibility. We propose that high impact/high feasibility interventions are ready to be implemented (act), while high impact/low feasibility interventions require efforts to foster buy-in first. Low impact/high feasibility interventions need to be changed to improve their impact while low impact/low feasibility might be best re-designed in the context of limited resources. Using this framework, policy makers, public health experts, and other stakeholders can more effectively prioritize and leverage limited resources in an effort to slow or prevent the evolving global NCD crisis

To address emerging infections, we must invest in enduring systems: The kinetics and dynamics of health systems strengthening

Clinical pharmacology uses foundational principles of pharmacokinetics (PK) and pharmacodynamics (PD) to address medication use spanning a continuum from molecules to the masses. In the realm of infectious diseases, PK/PD attributes are considered especially important, because subtherapeutic dosing of antibiotics has been associated with poorer clinical outcomes in patients and increased incidences of drug resistance in populations. In consideration of these PK/PD principles, we will describe the analogous relationship between health systems strengthening, including for educating healthcare providers about emerging infections, and the tenets of therapeutic drug monitoring

A Critical Review of the Leadership Styles on the Performance of Public Secondary Schools In National Examinations In Tana River County, Kenya

In Kenya, many teachers have been elevated to leadership positions without much formal training leading to mismanagement of schools hence poor students’ performance and disappointing results. The kind of leadership style adopted by a leader greatly determines the nature of performance in national examinations. Experience in Kenya reveals that many schools that were once effective in academic performance have lowered their standards due to poor leadership while others have greatly improved through effective leadership. Whereas good leadership initiates and sustains a slow but steady upward spiral, ineffective leadership makes academic standards plummet. The purpose of this study was therefore to examine the impact of principals’ leadership style on the performance of students in public secondary schools in K.C.S.E. The researcher used an explanatory approach based on a descriptive analysis design to establish opinions and knowledge about the impact of principals ‘leadership style on students performance in Tana River County. The study targeted 9 secondary schools in the county that had presented candidates for the national examinations between 2005 & 2009. Both purposive and simple random sampling techniques were used to select a sample of 9 principals and 40 teachers respectively. From this a sample size of 49 respondents was selected for the study. Primary data was collected from the teachers and principals using self administered questionnaires based on the profile of leadership behavior and own behavior. Both inferential and descriptive statistics were used to analyze the data. ANOVA was used to establish the perception of teachers and their principals on leadership styles exhibited by the head teachers. Correlation analysis was used to show the relationship between principals’ leadership styles and student performance in national examinations. The finding of this study strongly indicate a positive relationship between the principals’ leadership styles and students’ performance. Autocratic leadership style was found to have a significant effect on the students’ performance in national examinations. The study recommends the principals to shift to transformative approaches of leadership to enhance good performance of at the national level. The study proposes mandatory leadership training programs for the secondary school principals to update them with modern leadership trends and techniques needed for effective performance

Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya : a prospective comparison of point of care diagnostic methods.

Background: Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Methods: Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Results: Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. Conclusions: POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify sensitive and specific POC GDM screening strategies using adverse pregnancy outcomes as end points are required

Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) in western Kenya: a study protocol of a cluster randomized trial

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease (CVD), yet treatment and control rates for hypertension are very low in low- and middle-income countries (LMICs). Lack of effective referral networks between different levels of the health system is one factor that threatens the ability to achieve adequate blood pressure control and prevent CVD-related morbidity. Health information technology and peer support are two strategies that have improved care coordination and clinical outcomes for other disease entities in other settings; however, their effectiveness and cost-effectiveness in strengthening referral networks to improve blood pressure control and reduce CVD risk in low-resource settings are unknown. METHODS/DESIGN: We will use the PRECEDE-PROCEED framework to conduct transdisciplinary implementation research, focused on strengthening referral networks for hypertension in western Kenya. We will conduct a baseline needs and contextual assessment using a mixed-methods approach, in order to inform a participatory, community-based design process to fully develop a contextually and culturally appropriate intervention model that combines health information technology and peer support. Subsequently, we will conduct a two-arm cluster randomized trial comparing 1) usual care for referrals vs 2) referral networks strengthened with our intervention. The primary outcome will be one-year change in systolic blood pressure. The key secondary clinical outcome will be CVD risk reduction, and the key secondary implementation outcomes will include referral process metrics such as referral appropriateness and completion rates. We will conduct a mediation analysis to evaluate the influence of changes in referral network characteristics on intervention outcomes, a moderation analysis to evaluate the influence of baseline referral network characteristics on the effectiveness of the intervention, as well as a process evaluation using the Saunders framework. Finally, we will analyze the incremental cost-effectiveness of the intervention relative to usual care, in terms of costs per unit decrease in systolic blood pressure, per percentage change in CVD risk score, and per disability-adjusted life year saved. DISCUSSION: This study will provide evidence for the implementation of innovative strategies for strengthening referral networks to improve hypertension control in LMICs. If effective, it has the potential to be a scalable model for health systems strengthening in other low-resource settings worldwide

Proactive prevention: Act now to disrupt the impending non-communicable disease crisis in low-burden populations

Non-communicable disease (NCD) prevention efforts have traditionally targeted high-risk and high-burden populations. We propose an alteration in prevention efforts to also include emphasis and focus on low-risk populations, predominantly younger individuals and low-prevalence populations. We refer to this approach as “proactive prevention.” This emphasis is based on the priority to put in place policies, programs, and infrastructure that can disrupt the epidemiological transition to develop NCDs among these groups, thereby averting future NCD crises. Proactive prevention strategies can be classified, and their implementation prioritized, based on a 2-dimensional assessment: impact and feasibility. Thus, potential interventions can be categorized into a 2-by-2 matrix: high impact/high feasibility, high impact/ low feasibility, low impact/high feasibility, and low impact/low feasibility. We propose that high impact/high feasibility interventions are ready to be implemented (act), while high impact/low feasibility interventions require efforts to foster buy-in first. Low impact/high feasibility interventions need to be changed to improve their impact while low impact/low feasibility might be best re-designed in the context of limited resources. Using this framework, policy makers, public health experts, and other stakeholders can more effectively prioritize and leverage limited resources in an effort to slow or prevent the evolving global NCD crisis.Fil: Njuguna, Benson. Moi Teaching & Referral Hospital; KeniaFil: Fletcher, Sara L.. State University of Oregon; Estados UnidosFil: Akwanalo, Constantine. Moi Teaching & Referral Hospital; KeniaFil: Asante, Kwaku Poku. Kintampo Health Research Centre; GhanaFil: Baumann, Ana. Washington University in St. Louis; Estados UnidosFil: Brown, Angela. Washington University in St. Louis; Estados UnidosFil: Davila Roman, Victor G.. Washington University in St. Louis; Estados UnidosFil: Dickhaus, Julia. New York University Grossman School of Medicine; Estados UnidosFil: Fort, Meredith. Colorado School Of Public Health; Estados UnidosFil: Iwelunmor, Juliet. Saint Louis University; Estados UnidosFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Mohan, Sailesh. Centre For Chronic Disease Control; India. Public Health Foundation Of India; IndiaFil: Mutabazi, Vincent. Regional Alliance For Sustainable Development; RuandaFil: Newsome, Brad. Center for Translation Research and Implementation Science; Estados UnidosFil: Ogedegbe, Olugbenga. New York University Grossman School of Medicine; Estados UnidosFil: Pastakia, Sonak D.. Purdue University College Of Pharmacy; Estados UnidosFil: Peprah, Emmanuel K.. University of New York; Estados UnidosFil: Plange Rhule, Jacob. Ghana College Of Physicians And Surgeons; GhanaFil: Roth, Gregory. University of Washington; Estados UnidosFil: Shrestha, Archana. Kathmandu University School Of Medical Sciences; NepalFil: Watkins, David A.. University of Washington; Estados UnidosFil: Vedanthan, Rajesh. New York University Grossman School of Medicine; Estados Unido

A mobile solution for savings by the youth in Kenya

Submitted in partial fulfillment of the requirements for the Degree of Master of Science in Mobile Telecommunications and Innovation (MSc. MTI)Kenya as a country has a poor financial savings culture as compared to its East African neighbours. Kenya is consumption driven and a majority of the people especially the youth aged 18 to 25 years lack control in their spending. The youth are not frequent savers yet their potential for saving is high as exhibited by their high expenditures on airtime. The existing saving systems in Kenya have failed to take advantage of the evident financial power of the youth, by failing to design products that entice them to frequently save. These existing systems are not individually tailored to address the saving needs of the youth in terms of convenience, appeal and familiarity. Based on the aforementioned challenges, this dissertation proposes a mobile based solution tailored for the youth to encourage frequent savings. The solution leverages on the high airtime expenditures by the youth, to bring about a savings model. The solution comprises of a mobile application that can automatically deduct airtime from the youth’s airtime account as well as deduct airtime from their parents’ or sponsors’ airtime accounts and transfer the deductions as savings for the youth in an airtime savings account. The youth can later withdraw the airtime savings in form of either airtime or money after a maturity period. The solution is based on Evolutionary Prototyping software methodology. The proposed system recorded impressive results in terms of functionality. Over 90 % of the respondents established that the accuracy, responsiveness, scalability, robustness and usability of the application range from moderate to extremely high. It is important to note that if the system is widely adopted in the country, the economic status of the youth as well as the country will be elevated

Research on Distribution and Morphology of Primary Si Under the Effect of Direct Current

A source of pure silicon was added into an alloy refining system during a refining process with the application of a direct electric current. The effect of the temperature difference between the graphite electrodes and the alloy was decreased. The temperature increase value (ΔT) of the Al-28.51wt.%Si alloy sample caused by Joule heating was calculated by weighing the mass of primary silicon. When the current density was 5.0×105A/m2, the overall temperature increase in the alloy was about 90°C regardless of the alloy composition. Adequate silicon atoms recorded the footprint of the electric current in the alloy melt. The flow convection generated by the electric current in the melt during the solidification process resulted in the refinement of primary silicon. The Fe impurity content in alloy refining without the electric current density was 2.16 ppm. However, it decreased to 1.27 ppmw with the application of an electric current density of 5.0×105A/m2