Representations of the postcolonial state in the childhood metaphor in selected postcolonial texts

In the analysis of postcolonial literature, there is no systematic construction of a framework to factor in childhood as a metaphor. Postcolonial criticism has not been engaged further in the enterprise of literary analysis, particularly on form. Consequently, this research fills the need to recast the focus of postcolonial criticism to the analysis of form in literature†(through the use of metaphor of childhood). Hawley picks out one author, Salman Rushdie who is often studied under postcolonial criticism. He singles out that postcolonial critics look only for Rushdie-like characteristics. It is in the interest of this research to apply childhood as a different set of characteristic or criterion to profit the agency of postcoloniality. This research also, therefore, contributes to this critique by establishing further that postcolonial criticism embodies a wider canon and that postcolonial texts are not a ‘handful and recurring’. This research introduces pericolonial zones as well as exposing further ‘the list’ to include the selected texts; Beneath the Lion’s Gaze, in addition to The God of Small Things and Nervous Conditions. A sifting of childhood metaphor, in relation to postcoloniality, engenders further appreciation on the analysis of the literary context and beyond

Determinants of Livelihood Outcome Differentials among Urban Youth in Nairobi, Kenya

Youth livelihood outcomes (YLO) are important factors in the development of sustainable community livelihoods in Kenya.  The purpose of the study was to determine the predictors of urban youth livelihood outcomes in Nairobi, Kenya. The study was guided by the General Systems Theory by Bertalanffy (1968) and the Department for International Development (DFID) livelihoods framework (1999). A survey of 206 youths was conducted in Kamukunji Sub-County in Nairobi County. Results showed that there was a significant relationship between individual attributes and youth livelihood outcomes (χ2= 44.47; d.f. =14; ρ<0.01). Specifically, age (p<0.05), marital status (p<0.05), household headship (p<0.01), individual savings (p<0.05), individual assets (p<0.01) were important predictors of youth livelihood outcomes. Implications for formulating appropriate intervention programs to enhance youth livelihood outcomes are included. Keywords: capitals, individual attributes, livelihood strategies, youth livelihood outcome

Characterisation of productivity and diseases affecting dairy goats in smallholder systems of Greater Thika Region, Kenya

The current cross-sectional study aimed at characterising the productivity and diseases affecting dairy goats kept by smallholder farmers in three sub-counties in Thika Region, Kenya. Standard questionnaires were administered to 240 farmers through face-to-face interviews and the outputs were analysed using descriptive and inferential statistics. The farmers mainly kept crosses of Toggenburg (45.9 %), Kenyan Alpine (29.5 %) and Saanen (17.4 %) dairy goats. The average dairy goat flock size was 4.5 (range 1–23) and 77.5 % of the goats were kept for production of milk for domestic consumption. The average milk production per goat per day was 1.26 litres (range 0.5 to 3.5 litres) and was significantly (p 0.05) associated with sub-county of origin, main occupation of the owner, breed, and lactation stages. Goats were mainly fed on napier grass, maize stovers, natural grass and hay; and these feeds did not influence (p 0.05) the milk production levels. The farmers identified helminthosis (84.6 %), pneumonia (32.9 %), coccidiosis (25.8 %) and mastitis (25 %), as the most prevalent goat diseases. In conclusion, the study showed that dairy goat farming in greater Thika Region was characterised by low-input with an objective of provision of milk for home consumption. The observed challenges of low milk productivity and diseases should be addressed by the local extension workers through training on improved husbandry, nutrition and health management of the dairy goats

Hypothermia amongst neonatal admissions in Kenya: a retrospective cohort study assessing prevalence, trends, associated factors, and its relationship with all-cause neonatal mortality

Background: Reports on hypothermia from high-burden countries like Kenya amongst sick newborns often include few centers or relatively small sample sizes. Objectives: This study endeavored to describe: (i) the burden of hypothermia on admission across 21 newborn units in Kenya, (ii) any trend in prevalence of hypothermia over time, (iii) factors associated with hypothermia at admission, and (iv) hypothermia's association with inpatient neonatal mortality. Methods: A retrospective cohort study was conducted from January 2020 to March 2023, focusing on small and sick newborns admitted in 21 NBUs. The primary and secondary outcome measures were the prevalence of hypothermia at admission and mortality during the index admission, respectively. An ordinal logistic regression model was used to estimate the relationship between selected factors and the outcomes cold stress (36.0°C–36.4°C) and hypothermia (<36.0°C). Factors associated with neonatal mortality, including hypothermia defined as body temperature below 36.0°C, were also explored using logistic regression. Results: A total of 58,804 newborns from newborn units in 21 study hospitals were included in the analysis. Out of these, 47,999 (82%) had their admission temperature recorded and 8,391 (17.5%) had hypothermia. Hypothermia prevalence decreased over the study period while admission temperature documentation increased. Significant associations were found between low birthweight and very low (0–3) APGAR scores with hypothermia at admission. Odds of hypothermia reduced as ambient temperature and month of participation in the Clinical Information Network (a collaborative learning health platform for healthcare improvement) increased. Hypothermia at admission was associated with 35% (OR 1.35, 95% CI 1.22, 1.50) increase in odds of neonatal inpatient death. Conclusions: A substantial proportion of newborns are admitted with hypothermia, indicating a breakdown in warm chain protocols after birth and intra-hospital transport that increases odds of mortality. Urgent implementation of rigorous warm chain protocols, particularly for low-birth-weight babies, is crucial to protect these vulnerable newborns from the detrimental effects of hypothermia

Neonatal inpatient dataset for small and sick newborn care in low- and middle-income countries: systematic development and multi-country operationalisation with NEST360.

BACKGROUND: Every Newborn Action Plan (ENAP) coverage target 4 necessitates national scale-up of Level-2 Small and Sick Newborn Care (SSNC) (with Continuous Positive Airway Pressure (CPAP)) in 80% of districts by 2025. Routine neonatal inpatient data is important for improving quality of care, targeting equity gaps, and enabling data-driven decision-making at individual, district, and national-levels. Existing neonatal inpatient datasets vary in purpose, size, definitions, and collection processes. We describe the co-design and operationalisation of a core inpatient dataset for use to track outcomes and improve quality of care for small and sick newborns in high-mortality settings. METHODS: A three-step systematic framework was used to review, co-design, and operationalise this novel neonatal inpatient dataset in four countries (Malawi, Kenya, Tanzania, and Nigeria) implementing with the Newborn Essential Solutions and Technologies (NEST360) Alliance. Existing global and national datasets were identified, and variables were mapped according to categories. A priori considerations for variable inclusion were determined by clinicians and policymakers from the four African governments by facilitated group discussions. These included prioritising clinical care and newborn outcomes data, a parsimonious variable list, and electronic data entry. The tool was designed and refined by > 40 implementers and policymakers during a multi-stakeholder workshop and online interactions. RESULTS: Identified national and international datasets (n = 6) contained a median of 89 (IQR:61-154) variables, with many relating to research-specific initiatives. Maternal antenatal/intrapartum history was the largest variable category (21, 23.3%). The Neonatal Inpatient Dataset (NID) includes 60 core variables organised in six categories: (1) birth details/maternal history; (2) admission details/identifiers; (3) clinical complications/observations; (4) interventions/investigations; (5) discharge outcomes; and (6) diagnosis/cause-of-death. Categories were informed through the mapping process. The NID has been implemented at 69 neonatal units in four African countries and links to a facility-level quality improvement (QI) dashboard used in real-time by facility staff. CONCLUSION: The NEST360 NID is a novel, parsimonious tool for use in routine information systems to inform inpatient SSNC quality. Available on the NEST360/United Nations Children's Fund (UNICEF) Implementation Toolkit for SSNC, this adaptable tool enables facility and country-level comparisons to accelerate progress toward ENAP targets. Additional linked modules could include neonatal at-risk follow-up, retinopathy of prematurity, and Level-3 intensive care

Health facility assessment of small and sick newborn care in low- and middle-income countries: systematic tool development and operationalisation with NEST360 and UNICEF.

BACKGROUND: Each year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC). METHODS: Health systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021. RESULTS: Eight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania. CONCLUSION: This HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action

Harnessing the job creation capacity of young rural agripreneurs: A quasi-experimental study of the ENABLE program in Africa

With evidence of increasing investment in youth agribusiness empowerment programs across Africa, employment discussions and strategies are increasingly focusing on how youth-owned agribusinesses can facilitate long-term job creation and contribute to revitalizing rural economies in the coming years. In light of these changing employment dynamics, we assessed the evolving role of youth and small agribusinesses in employment creation in rural areas. Further, we assessed the impact of agribusiness empowerment programs in unlocking the job creation capacity of young agribusiness owners, taking evidence from the youth component of the African Development Bank (AfDB) Technologies for African Agricultural Transformation (TAAT) program, Empowering Novel Agribusiness-Led Employment (ENABLE) implemented in Kenya, Nigeria, and Uganda. A total of 1435 respondents, comprising 737 participants and 698 non-participants were surveyed across the three countries. An Endogenous Switching Regression (ESR) model was used to identify factors that determined program participation, and factors influencing job creation, and assess the program's impact on job creation. The results validate our assumption of changing employment dynamics in the rural areas where youth-owned small agribusinesses hired an average of 4 employees. The ESR results show the significance of the program on the job creation capacity of participants across the three countries. Also, we found that non-participants could potentially increase their job creation capacity if they had participated in the program. Factors that influence job creation include socio-economic, such as age and marital status, business attributes including agribusiness experience, business level, income, and access to land. These results indicate that continuous concerted efforts on agribusiness empowerment will have a notable impact in generating more jobs and reducing the rates of unemployment, particularly among young people. Thus, more investment should be directed towards empowering young people in agribusiness in the study countries, and elsewhere in Africa

Assessing food security among young farmers in Africa: evidence from Kenya, Nigeria, and Uganda

Food insecurity remains a serious challenge for many households in Africa and the situation is even more prevalent among young people. However, there is a dearth of empirical evidence on youth food security status in Africa. We assessed the level and determinants of food security among young farmers in Africa. We adopted a multi-stage sampling technique to select 400, 429, and 606 young farmers in Kenya, Nigeria, and Uganda, respectively. Individual food consumption was assessed following a 7 days recall method. The Food Consumption Score, which combines dietary diversity and consumption frequency was used to assess food security status while the determinants of food security were identified using a logistic regression model. Results suggest low dietary diversity across the three countries. Also, the majority of the respondents had an unacceptable food consumption score, suggesting that despite being food producers, young farmers are still food insecure. The odds of being food secure was positively determined by access to extension services, participation in the ENABLE TAAT business incubation programme, and access to market information but, negatively by access to credit, number of employees, Covid-19 pandemic, and location. Additionally, the food security status of young female farmers was positively influenced by age, suggesting that younger youths are less food secure compared to older ones. These results suggest that more efforts should be directed towards improving the food security of young African farmers and that policy- and programme-level interventions should support access to extension services, market information, and land. Additionally, more investments should be directed towards developing need-based agribusiness incubation programmes with an effort to scale existing programmes beyond the regular one-time period

Development of a small and sick newborn clinical audit tool and its implementation guide using a human-centred design approach newborn clinical audit process and design.

Clinical audits are an important intervention that enables health workers to reflect on their practice and identify and act on modifiable gaps in the care provided. To effectively audit the quality of care provided to the small and sick newborns, the clinical audit process must use a structured tool that comprehensively covers the continuum of newborn care from immediately after birth to the period of newborn unit care. The objective of the study was to co-design a newborn clinical audit tool that considered the key principles of a Human Centred Design approach. A three-step Human Centred Design approach was used that began by (1) understanding the context, the users and the available audit tools through literature, focus group discussions and a consensus meeting that was used to develop a prototype audit tool and its implementation guide, (2) the prototype audit tool was taken through several cycles of reviewing with users on real cases in a high volume newborn unit and refining it based on their feedback, and (3) the final prototype tool and the implementation guide were then tested in two high volume newborn units to determine their usability. Several cycles of evaluation and redesigning of the prototype audit tool revealed that the users preferred a comprehensive tool that catered to human factors such as reduced free text for ease of filling, length of the tool, and aesthetics. Identified facilitators and barriers influencing the newborn clinical audit in Kenyan public hospitals informed the design of an implementation guide that builds on the strengths and overcomes the barriers. We adopted a Human Centred Design approach to developing a newborn clinical audit tool and an implementation guide that we believe are comprehensive and consider the characteristics of the context of use and the user requirements