EFFECT OF COST LEADERSHIP STRATEGY ON PERFORMANCE BY KENYA SELECTED CAR RENTAL BUSINESS IN NAIROBI CITY COUNTY,

Purpose of this study was to determine the effect of cost leadership strategyon performance of selected car rental business in Nairobi City County. Thisstudy was a cross-sectional descriptive study design where purposivesampling technique was used to select fifteen (15) car rental business inNairobi City County. Stratified and simple random sampling technique wasemployed in recruiting three categories of respondents. The three category ofstaff included, top level, middle level and bottom level management.Structured questionnaires were used to collect primary data which was thenanalyzed. Both descriptive and inferential statistics was used. The findings ofthe study revealed that cost leadership strategy was not statisticallysignificant in affecting the performance of Car hire firms in Nairobi CityCounty. Many of the car hire business in Nairobi City County charged sameas their competitor. Cost leadership strategy affected performance of carrental business in Nairobi City to a very large extend. This studyrecommends the need to evaluate other competitive strategies onperformance of car rental business in Nairobi City. This study findingsimplies that sustaining a cost leadership strategy an entrepreneur shouldbecome aware of the competitors offer and consider developing customerintimacy and focus on a narrow target market

Retention of HIV-infected and exposed children in a comprehensive HIV clinical care program in Western Kenya

Background  To describe incidence rates (IR) and risk factors for loss-to-follow-up (LTFU) among HIV-infected and HIV-exposed children in a large HIV treatment programme in Western Kenya. Methods  The USAID-AMPATH Partnership has enrolled >100 000 patients (20% children) at 23 clinic sites throughout western Kenya. LTFU is defined as being absent from the clinic for >3 months if on combination antiretroviral treatment (cART) and >6 months if not. Included in this analysis were children aged <14 years, HIV exposed or infected at enrolment, and enrolled between April 2002 and March 2009. The IR for LTFU are presented per 100 child-years (CY) of follow-up. Proportional hazards models with time-independent and time-dependent covariates were used to model factors associated with LTFU. Weight for height Z-scores were calculated using EpiInfo, with severe malnutrition being defined as a Z-score ≤−3.0. Immune suppression was defined as per WHO age-specific categories. Results  There were 13 510 children eligible for analysis, comprising 3106 children who at enrolment were HIV infected and 10 404 children who were HIV exposed. The overall IR of LTFU was 18.4 (17.8–18.9) per 100 CY. Among HIV-infected children, 15.2 (13.8–16.7) and 14.1 (13.1–15.8) per 100 CY became LTFU, pre- and post-cART initiation, respectively. The only independent risk factor for becoming LTFU among the HIV-infected children was severe immune suppression (AHR: 2.17, 95% CI: 1.51–3.12). Among the HIV-exposed children, 20.1 per 100 (19.4–20.7) became LTFU. Independent risk factors for LTFU among them were being severely low weight for height (AHR: 1.69, 95% CI: 1.25–2.28), being orphaned at enrolment (AHR: 1.57, 95% CI: 1.23–1.64), being CDC Class B or C (AHR: 1.41, 95% CI: 1.14–1.74), and having received cART (AHR: 1.56, 95% CI: 1.23–1.99). Protective against becoming LTFU among the HIV exposed were testing HIV positive (AHR: 0.26, 95% CI: 0.21–0.32), older age (AHR: 0.90, 95% CI: 0.85–0.96), enrolling in later time periods, and receiving food supplementation (AHR: 0.58, 95% CI: 0.32–1.04). Conclusions  There is a high rate of LTFU among these highly vulnerable children, particularly among the HIV exposed. These data suggest that HIV-infected and HIV-exposed children are at especially high risk for LTFU if they are sick or malnourished

Sampling-Based Approaches to Improve Estimation of Mortality among Patient Dropouts: Experience from a Large PEPFAR-Funded Program in Western Kenya

Monitoring and evaluation (M&E) of HIV care and treatment programs is impacted by losses to follow-up (LTFU) in the patient population. The severity of this effect is undeniable but its extent unknown. Tracing all lost patients addresses this but census methods are not feasible in programs involving rapid scale-up of HIV treatment in the developing world. Sampling-based approaches and statistical adjustment are the only scaleable methods permitting accurate estimation of M&E indices.In a large antiretroviral therapy (ART) program in western Kenya, we assessed the impact of LTFU on estimating patient mortality among 8,977 adult clients of whom, 3,624 were LTFU. Overall, dropouts were more likely male (36.8% versus 33.7%; p = 0.003), and younger than non-dropouts (35.3 versus 35.7 years old; p = 0.020), with lower median CD4 count at enrollment (160 versus 189 cells/ml; p<0.001) and WHO stage 3-4 disease (47.5% versus 41.1%; p<0.001). Urban clinic clients were 75.0% of non-dropouts but 70.3% of dropouts (p<0.001). Of the 3,624 dropouts, 1,143 were sought and 621 had their vital status ascertained. Statistical techniques were used to adjust mortality estimates based on information obtained from located LTFU patients. Observed mortality estimates one year after enrollment were 1.7% (95% CI 1.3%-2.0%), revised to 2.8% (2.3%-3.1%) when deaths discovered through outreach were added and adjusted to 9.2% (7.8%-10.6%) and 9.9% (8.4%-11.5%) through statistical modeling depending on the method used. The estimates 12 months after ART initiation were 1.7% (1.3%-2.2%), 3.4% (2.9%-4.0%), 10.5% (8.7%-12.3%) and 10.7% (8.9%-12.6%) respectively. CONCLUSIONS/SIGNIFICANCE ABSTRACT: Assessment of the impact of LTFU is critical in program M&E as estimated mortality based on passive monitoring may underestimate true mortality by up to 80%. This bias can be ameliorated by tracing a sample of dropouts and statistically adjust the mortality estimates to properly evaluate and guide large HIV care and treatment programs

Establishing African genomics and bioinformatics programs through annual regional workshops

The African BioGenome Project (AfricaBP) Open Institute for Genomics and Bioinformatics aims to overcome barriers to capacity building through its distributed African regional workshops and prioritizes the exchange of grassroots knowledge and innovation in biodiversity genomics and bioinformatics. In 2023, we implemented 28 workshops on biodiversity genomics and bioinformatics, covering 11 African countries across the 5 African geographical regions. These regional workshops trained 408 African scientists in hands-on molecular biology, genomics and bioinformatics techniques as well as the ethical, legal and social issues associated with acquiring genetic resources. Here, we discuss the implementation of transformative strategies, such as expanding the regional workshop model of AfricaBP to involve multiple countries, institutions and partners, including the proposed creation of an African digital database with sequence information relating to both biodiversity and agriculture. This will ultimately help create a critical mass of skilled genomics and bioinformatics scientists across Africa.</p

Exploratory study of new housing finance in Kenya

Partial fulfillment for award of Master of Business AdministrationThis dissertation is an exploratory study of new housing finance in Kenya which is viewed as ‘risky’ and is largely avoided by financial institutions. This is against the background of a housing industry where 80% of the houses are constructed as opposed to purchased. The study is justified by the fact that Kenya suffers from a problem of inadequate housing with approximately 60% of the urban population living in slum settlements. The main objective is to understand how banks in Kenya handle the risk associated with new housing lending and the building process within it. A comprehensive literature review section of the dissertation surveys relevant theories around the topic of housing finance, risk and the building process. The literature review demonstrates that overall, new housing finance is faced by challenges of quantifying and mitigating risk. Three leading new housing lenders were studied and compared focusing on how they assess and make decisions to lend and how they manage the risk of the construction process. The methodology involved is case study based and descriptive. The dissertation concludes that banks can successfully mitigate risk associated with new housing lending and succeed in it by such actions as securing of long term finance and working closely with construction professionals. The study has implications for the government which needs to institute reforms to improve the finance sector and for the building industry in general, which will better play their role in risk mitigation. The dissertation recommends further research on other forms of new housing finance such as housing micro-finance

An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

Background: The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary: The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP

The aspect of nationality and performance in a mountain ultra-marathon - the ‘Swiss Alpine Marathon’

Runners from East Africa and especially from Kenya dominate middle- and long- distance running races worldwide. The aim of the present study was to investigate the participation and performance trends regarding the nationality of runners in a mountain ultra-marathon held in partially high alpine terrain. We hypothesized that Kenyan runners, living and training in the Great Rift Valley, a predominantly hilly, mountainous and altitudinous region like the Alps, would dominate also a mountain ultra-marathon because they are accustomed to high altitudes and mountainous terrains. We examined the participation and performance trends of ultra-marathoners regarding their nationalities in the 78-km ‘Swiss Alpine Marathon’ including 21 km in high alpine terrain where 12,194 men and 1,781 women finished between 1998 and 2011. A total of 1,682 women and 11,580 men, corresponding to 94.9 % of all finishers, originated from Switzerland, Germany, Denmark, Italy, Sweden, Great Britain, Austria, the Netherlands and Luxembourg where only one male Kenyan runner ever participated. Female runners from Denmark, Great Britain, Germany, Luxembourg, Switzerland and Sweden as well as male runners from Denmark, Great Britain, and Sweden increased their participation significantly. Women from the Netherlands became slower whereas women originating from Great Britain became faster. Men from the Netherlands, Denmark, Germany and Switzerland became slower. The fastest runners originated from Switzerland for both women and men. To summarize, runners from Switzerland dominated the ‘Swiss Alpine Marathon’. Paradoxically, and interestingly, the Kenyan runners were not dominating the ‘Swiss Alpine Marathon’. Further studies should investigate Kenyan participation and performance in ultra-marathons in Africa such as the ‘Comrades Marathon’

Trends of non-vaccination, under-vaccination and missed opportunities for vaccination (2003-2014) amongst children 0-23 months in Kenya.

Vaccines are effective and cost-effective. Non-vaccination, under-vaccination, and missed opportunities for vaccination (MOV), have contributed to incomplete vaccination coverage in Kenya. Analyzing their trends is essential for targeting interventions and improvement strategies. This study aimed to assess trends of non-vaccination, under-vaccination, and MOV among children aged 0-23 months in Kenya using data obtained from the Kenya Demographic and Health Surveys (KDHS) conducted in 2003, 2008/09, and 2014. A two-stage, multi-stage, and stratified sampling technique was used. Weighted analysis was conducted to ensure generalizability to the full population. Using the KDHS sample size estimation process, the sample size was estimated for each indicator, with varying standard error estimates, level of coverage and estimated response rates. Final sample size was 2380 (2003), 2237 (2008/09) and 7380 (2014). To determine the level of non-vaccination, under-vaccination and MOV among children aged 0-23 months, a weighted descriptive analysis was used to estimate their prevalence, with 95% confidence intervals (CI) for each year. MOV was defined using an algorithm as a binary variable. Data coding and recoding were done using Stata (version 14; College Station, TX: StataCorp LP). Trends in proportions of non-vaccination, under-vaccination and MOV were compared between 2003, 2008/09, and 2014 using the Cochrane-Armitage trend test. All results with P≤0.05 were considered statistically significant. Trends in proportion of non-vaccination among children aged 0-23 months in Kenya was 13.2%, 6.1% and 3.2% in 2003, 2008/09 and 2014, respectively (P = 0.0001). Trends in proportion of under-vaccination among children aged 0-23 months in Kenya was 54.3%, 50% and 51.3% in 2003, 2008/09 and 2014, respectively (P = 0.0109). The trends in proportion of children who experienced MOV was 22.7% in 2003, 31.9% in 2008/09 and 37.6% in 2014 (P = 0.0001). In the study duration, non-vaccination decreased by 10%, under-vaccination remained relatively stable, and MOV increased by ~15%. There is need for the Government and partners to implement initiatives that improve vaccine access and coverage, particularly in regions with low coverage rates, and to address missed opportunities for vaccination

Sorption of melanoidin onto surfactant modified zeolite

Melanoidin is responsible for the dark brown colour of distillery wastewater. Discharge of coloured wastewater has a major environmental impact on the biota of the receiving water body. Consequently, this study explores the removal of melanodin from aqueous solution. The equilibrium, kinetics and thermodynamics of melanoidin sorption are studied by varying initial solution pH, initial concentration, adsorbent dose and temperature. Kinetically, the melanoidin removal from solution by a surfactant modified zeolite is rapid and the amount adsorbed is dependent on pH, initial concentration, adsorbent dose and temperature. The equilibrium sorption data are fitted to the Freundlich and Langmuir models while the sorption, kinetics is described by the Ho pseudo-second order and Elovich models. The thermodynamic analysis indicates that the sorption is spontaneous and endothermic in nature. The FTIR spectra analyses show no new peaks or shift in peaks after sorption indicating that the melanoidin sorption may have occurred by a physical process. The results from desorption studies showed that melanoidin eluted back easily to the solution using distilled water which corroborates the physical sorption mechanism