Syntactic Properties of Dholuo Verbal Extensions

According to the existing literatures on verbal morphology of agglutinating languages, there are morphological behaviors characterized by creation of new verb stems from existing roots by affixation of derivative morphemes to the roots. The affixes are referred to as verbal extensions. Verbal extensions have syntactic characteristics realized in verbal matrices of verbs they get attached to. This paper discusses the syntactic properties of Dholuo verbal extensions. The verbal extensions under investigation are the applicative, the locative, the reflexive, the reciprocal and the stative. Although studies exist on syntactic properties of Dholuo applicative, reciprocal and reflexive extensions, effects of these extensions on the argument structure of Dholuo verbs still need further inquiry. This paper therefore analyses syntactic characteristics of Dholuo applicative, reflexive and reciprocal extensions in addition to locative and stative extensions that are yet to be analyzed in Dholuo. Most of the data examined in this study was generated by two of the researchers who are themselves native speakers of Dholuo. In some instances however, consultations were made with other native speakers for cross-checking purposes. Keywords: valence, in situ, local domain, argument and transitivity

Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year

In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention.This paper uses data from a health facility needs assessment (n = 81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (n = 2,675 VMMC clients) to describe Kenya's experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK's decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV.This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya's VMMC implementation experience are likely generalizable to other African countries

Household Health Responses to the Introduction of Highly Active Antiretroviral Therapy in Kenya

There is little work on the complementarity effects of HIV treatment programs on health investments, despite the salience associated with mitigation of HIV-related mortality risk. Estimates of such spillover effects are vital for cost-benefit assessments of HIV programs and for resource allocation decisions. I exploit temporal and spatial variation in the rollout of HIV treatment programs using difference-in-differences and instrumental variables to assess for these effects. I find that HIV programs in Kenya were associated with an increase in birth weights of around 90 grams (40 -- 290 grams). The evidence for such effects on vaccinations is mixed, with significant effects noted across all vaccines with the exception of those under the third schedule. I find weaker evidence for complementarity effects in BCG and DPT vaccine uptake rates. These results are robust to a number of robustness checks, two-stage least squares, sample restrictions to HIV negative subpopulations and Monte Carlo simulation regressions

Educational expansion and the emerging fertility transition in Kenya.

This study examines the relationship between education and fertility behavior in Kenya. The general hypothesis being tested is that involvement in formal education earlier in the life course influences the individual's subsequent fertility decisions later in the life course. This study uses data from the 1978, 1989, and 1993 demographic surveys. Combining the data from the three surveys allows one to study the effects of spread of education in Kenya over much of this century by examining the educational attainment of cohorts born as early as 1926 and as late as 1978. This study has generated several interesting findings. First, the large gender gap in education that was evident among those born before 1940 has essentially disappeared among younger generations with at least upper primary education. However, a higher proportion of males than females still make the critical transition from upper primary to lower secondary. Second, analysis of age-specific fertility rates shows the pace of fertility decline accelerated in the early 1990s. Fertility decline in the 1980s occurred among all age groups, with women aged over 34 contributing more to the decline than younger age groups. Subsequent decline in the early 1990s can be attributed to a significant fertility decline among younger age groups and sustained lower fertility rates among women age 35 or older. Lastly, the amount of education needed before any significant decline in fertility occurs has also been declining. For women born between 1944-1948, it took 11 to 12 years of education to have a significant negative effect on fertility. Women born after 1954 require a minimum of 6 to 7 years of schooling. With increasing educational attainment among both men and women, these findings imply that fertility decline will continue in the future.Ph.D.DemographyEducationEducational sociologySocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131501/2/9909958.pd

The PrePex device is unlikely to achieve cost-savings compared to the forceps-guided method in male circumcision programs in sub-Saharan Africa.

Male circumcision (MC) reduces the risk of heterosexual HIV acquisition in men by approximately 60%. MC programs for HIV prevention are currently being scaled-up in fourteen countries in sub-Saharan Africa. The current standard surgical technique for MC in many sub-Saharan African countries is the forceps-guided male circumcision (FGMC) method. The PrePex male circumcision (PMC) method could replace FGMC and potentially reduce MC programming costs. We compared the potential costs of introducing the PrePex device into MC programming to the cost of the forceps-guided method.Data were obtained from the Nyanza Reproductive Health Society (NRHS), an MC service delivery organization in Kenya, and from the Kenya Ministry of Health. Analyses are based on 48,265 MC procedures performed in four Districts in western Kenya from 2009 through 2011. Data were entered into the WHO/UNAIDS Decision Makers Program Planning Tool. The tool assesses direct and indirect costs of MC programming. Various sensitivity analyses were performed. Costs were discounted at an annual rate of 6% and are presented in United States Dollars.Not including the costs of the PrePex device or referral costs for men with phimosis/tight foreskin, the costs of one MC surgery were $44.54-$49.02 and $54.52-$55.29 for PMC and FGMC, respectively.The PrePex device is unlikely to result in significant cost-savings in comparison to the forceps-guided method. MC programmers should target other aspects of the male circumcision minimum package for improved cost efficiency

Identifying and addressing barriers to uptake of voluntary medical male circumcision in Nyanza, Kenya among men 18-35: a qualitative study.

BACKGROUND: Uptake of VMMC among adult men has been lower than desired in Nyanza, Kenya. Previous research has identified several barriers to uptake but qualitative exploration of barriers is limited and evidence-informed interventions have not been fully developed. This study was conducted in 2012 to 1) increase understanding of barriers to VMMC and 2) to inform VMMC rollout through the identification of evidence-informed interventions among adult men at high risk of HIV in Nyanza Province, Kenya. METHODS: Focus groups (n = 8) and interviews were conducted with circumcised (n = 8) and uncircumcised men (n = 14) from the two districts in Nyanza, Kenya. Additional interviews were conducted with female partners (n = 20), health providers (n = 12), community leaders (n = 12) and employers (n = 12). Interview and focus group guides included questions about individual, interpersonal and societal barriers to VMMC uptake and ways to overcome them. Inductive thematic coding and analysis were conducted through a standard iterative process. RESULTS: Two primary concerns with VMMC emerged 1) financial issues including missing work, losing income during the procedure and healing and family survival during the recovery period and 2) fear of pain during and after the procedure. Key interventions to address financial concerns included: a food or cash transfer, education on saving and employer-based benefits. Interventions to address concerns about pain included refining the content of demand creation and counseling messages about pain and improving the ways these messages are delivered. CONCLUSIONS: Men need accurate and detailed information on what to expect during and after VMMC regarding both pain and time away from work. This information should be incorporated into demand creation activities for men considering circumcision. Media content should frankly and correctly address these concerns. Study findings support scale up and/or further improvement of these ongoing educational programs and specifically targeting the demand creation period

Cost in USD (%) of one MC surgery using PrePex and forceps-guided method under various assumptions.

<p>AE, Adverse Event; F/U, follow-up; not all percentages add to 100 due to rounding.</p><p><b>Consumable Supplies.</b><i>Both methods:</i> non-sterile gloves, alcohol hand rub, antiseptic soap, providone antiseptic solution, diclofenac {analgesic} tabs, paraffin gauze {Vaseline gauze}, gauze swabs, cohesive bandage. <i>PMC:</i> Lignocaine cream {local anesthesia cream}. <i>FGMC:</i> sterile gloves, face mask, Bupivacaine, Lignocaine, Needles (21 gauge and 19 gauge), 10 ml syringe, surgical blade (size 10), chromic catgut suture 3/0.</p><p><b>Non-consumable supplies.</b><i>Both methods:</i> client underpants. <i>FGMC:</i> weighing scale, blood pressure cuff, thermometer, surgical scrubs, shoe cover, sterile drape, center 'o', circumcision surgical tray (gallipot Kocher clamp mosquito artery forceps, blade holder, kidney dish, Dunhill artery forceps, tissue scissors, suture scissors, Adson forceps, needle holder, sponge holding forceps), emergency tray supplies. <i>PMC:</i> dressing tray (kidney dish, gallipot, sponge holding forceps, scissors).</p><p><b>Direct Personnel:</b><i>Both methods:</i> counselor, hygiene officer. <i>FGMC:</i> Clinical officer, nurse, consultant urologist (for AEs). <i>PMC:</i> Nurse/nurse pair or nurse/nurse aide pair.</p><p><b>Training:</b><i>Both methods</i>: 3 days of theory. <i>FGMC:</i> 7 days practicum PMC: 3 days practicum; costs include staff time, lunch/refreshments for participants and trainers, stationery, and MC manual.</p><p><b>Capital:</b><i>Both methods:</i> autoclave (PMC assumed to use 1/2 that of FGMC), surgical couch, cell phones, incinerator, office furniture, vehicles, facility space, generator, surgical equipment (mayo tray, trolley, waste bin).</p><p><b>Maintenance and Utility:</b><i>Both methods:</i> internet, office rent, electricity (power), water, vehicle costs (maintenance, insurance, and fuel). <i>FGMC:</i> facility renovations.</p><p><b>Support Personnel:</b><i>Both methods:</i> MOH supervision, quality assurance/quality improvement (QA/QI) team, training team, department managers and staff (human resources, transport, finance, administration, stores, information technology, data, mobilization). <i>PMC:</i> MOH supervision, mobilization team, QA/QI team and training team assumed to require 1/2 the full-time equivalents of FGMC.</p><p><b>Management and Supervision:</b><i>Both methods:</i> senior management team salaries, travel expenses for circumcision camps and management supervision.</p

Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.

To assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC) in routine service delivery in Kenya.We enrolled 427 men ages 18-49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs) and time to complete healing, and interviewed men about acceptability and pain.Placement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%-8.5%), all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%). Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30-0.58), and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family.The PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates.ClinicalTrials.gov NCT01711411

Safety, effectiveness and acceptability of the PrePex device for adult male circumcision in Kenya.

To assess the safety, effectiveness and acceptability of the PrePex device for adult medical male circumcision (MMC) in routine service delivery in Kenya.We enrolled 427 men ages 18-49 at one fixed and two outreach clinics. Procedures were performed by trained clinical officers and nurses. The first 50 enrollees were scheduled for six follow-up visits, and remaining men were followed at Days 7 and 42. We recorded adverse events (AEs) and time to complete healing, and interviewed men about acceptability and pain.Placement and removal procedures each averaged between 3 and 4 minutes. Self-reported pain was minimal during placement but was fleetingly intense during removal. The rate of moderate/severe AEs was 5.9% overall (95% confidence interval [CI] 3.8%-8.5%), all of which resolved without sequelae. AEs included 5 device displacements, 2 spontaneous foreskin detachments, and 9 cases of insufficient foreskin removal. Surgical completion of MMC was required for 9 men (2.1%). Among the closely monitored first 50 participants, the probability of complete healing by Day 42 was 0.44 (95% CI 0.30-0.58), and 0.90 by Day 56. A large majority of men was favorable about their MMC procedure and would recommend PrePex to friends and family.The PrePex device was effective for MMC in Kenya, and well-accepted. The AE rate was higher than reported for surgical procedures there, or in previous PrePex studies. Healing time is longer than following surgical circumcision. Provider experience and clearer counseling on post-placement and post-removal care should lead to lower AE rates.ClinicalTrials.gov NCT01711411

Surgical efficiencies and quality in the performance of voluntary medical male circumcision (VMMC) procedures in Kenya, South Africa, Tanzania, and Zimbabwe.

This analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC), quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider's time with the client (PPTC) and total elapsed operating time (TEOT).Two serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed quality of surgical technique and timed 9 steps in the VMMC procedure. Four elements of efficiency (task-shifting, task-sharing [of suturing], rotation among multiple surgical beds, and use of electrocautery) and quality of surgical technique were assessed as explanatory variables. Mann Whitney and Kruskal Wallis tests were used in the bivariate analysis and linear regression models for the multivariate analyses to test the relationship between these five explanatory variables and two outcomes: PPTC and TEOT. The VMMC procedure TEOT and PPTC averaged 23-25 minutes and 6-15 minutes, respectively, across the four countries and two years. The data showed time savings from task-sharing in suturing and use of electrocautery in South Africa and Zimbabwe (where task-shifting is not authorized). After adjusting for confounders, results demonstrated that having a secondary provider complete suturing and use of electrocautery reduced PPTC. Factors related to TEOT varied by country and year, but task-sharing of suturing and/or electrocautery were significant in two countries. Quality of surgical technique was not significantly related to PPTC or TEOT, except for South Africa in 2012 where higher quality was associated with lower TEOT.SYMMACS data confirm the efficiency benefits of task-sharing of suturing and use of electrocautery for decreasing TEOT. Reduced TEOT and PPTC in high volume setting did not result in decreased quality of surgical care