Regenerative leadership practices in Kenyan schools

This thesis examines leadership practices in which Kenyan school leaders have engaged to achieve sustainable students’ achievement (SSA). Educational reforms focusing on effective school leadership are of major concern in developing economies seeking to improve their educational systems and enhance educational performance. Kenya, a developing economy, considers education to be a powerful driver of development. One of its immediate education reforms accentuated in Kenya-vision 2030 is the introduction of an expanded institutional leadership framework for the effective delivery and management of education. However, socio-political challenges around educational management have been shown to greatly influence school leadership working environments. Accordingly, school leaders persistently struggle with the problem of fluctuations in students’ achievement and substantial disparities across schools. Reflecting on SDG4, Uwezo-Kenya report contends that learning outcomes are low and extremely inequitably distributed across geographical, socio-economical and school-type levels. While various factors (students, family, schools) inform student achievement trajectories, this thesis principally focuses on analysing how educational leadership, a school-level factor, is emerging in secondary schools in Kenya. The central aim of this research is to illuminate the school leadership contexts in which SSA might occur. To do so, the study adopted a sequential multi-strategy research design, with quantitative analysis of secondary data preceding the qualitative data collection and analysis. The study involved quantitative secondary analysis of students’ achievement data of 300 schools drawn from 3 Counties and qualitative in-depth analysis of data from 9 schools, 9 principals, 92 teachers (holding senior, middle and junior leadership positions), 6 Board of Management and Parents Association chairpersons, 5 Local Education Authority officers. The overall finding is that context is a powerful mechanism influencing leadership practice in Kenyan schools. Existing contextual mechanisms have implications for school leaders’ actions and decisions, which in turn inform teaching and learning activities. Consequently, this thesis argues for regenerative leadership practices as an alternative approach that creates enabling school environments for SSA to occur in challenging contexts, like those faced in Kenya. Regenerative leadership practices that prioritise the building of school system resilience by recreating structures, cultures, capacities, relations and pedagogical practices might circumvent the socio-political challenges and nurture environments that enhance SSA. This thesis contributes to existing knowledge by illuminating the importance of the context in educational leadership. Taking a systems perspective, the thesis demonstrates how socio-political demands inform school leadership actions and decisions, which in turn have indirect implications for teaching and learning activities, as well as SSA. Ultimately, justifying claims that encouraging schools to strive for SSA in Kenya and in other similar challenging contexts is complex and requires a comprehensive understanding of both structures and agency. This serves as a reasonable basis for questioning current assumptions about school leadership, which often partially focus on the principal’s agency while ignoring the wider socio-political environment. Secondly, this provides grounds to criticise the blind adoption of educational leadership models created in response to these assumptions, such as approaches to leadership preparation programmes in developing contexts. In response to these findings, this thesis proposes an alternative multiple level conceptual model of educational leadership that better responds to complex leadership and learning needs in challenging contexts. This model emphasises the reflexivity that school leaders need to manage, change and counter complex and often unpredictable socio-political factors to achieve sustainability

An Outreach Experience With Cleft Lip/Palate Surgery in selected Hospitals in Kenya

Objective To describe the presentation and surgical care of patients managed for cleft lips and palates during a surgical outreach program.. Study design A five year retrospective chart study of the patients operated on between January 2005 to the 31st December 2009 in selected hospitals in Kenya. Setting Smile train-facilitated surgical outreach programs at the following hospitals: St Elizabeth Mission Hospital Mukumu, St Francis Mission Hospital, Mwiki, Embu Provincial General hospital , Isiolo District Hospital.and Alupe Subdistrict Hospital. Subjects One hundred and sixty three patients with cleft lips and palates. Results The male female ratio was 1.3 to 1. Left unilateral cleft lip was the most common malformation (34.6% of the patients) with modified Millards repair the most frequent surgical procedure. More than 30% of the patients operated on had attained their fifth birthday. There were eight complications for every 100 procedures. Palatal fistulae were the most common complications. Conclusion The overall pattern of deformity encountered and the morbidity profile correlate with other studies. There is need to intensify more outreach programs to capture younger patients and address the backlog of cleft cases in the community

Recommendations for management and research on the fishery of Lake Victoria

This report is based on our experience with the Lake Victoria fishery from 1973 to 1975 while working at the E.A.F.F.R.O. substations in Kisumu and Mwanza. We shall first present management recommendations on three major topics: the on-going inshore artisanal fishery, the proposed offshore trawl fishery, and the possibility of cage culture. These will be followed by specific recommendations for research

Validity, reliability, and measurement invariance of an adapted short version of the HIV stigma scale among perinatally HIV infected adolescents at the Kenyan coast

Background: There is a dearth of instruments that have been developed and validated for use with children living with HIV under the age of 17 years in the Kenyan context. We examined the psychometric properties and measurement invariance of a short version of the Berger HIV stigma scale administered to perinatally HIV-infected adolescents in a rural setting on the Kenyan coast. Methods: A cross-sectional study was conducted among 201 perinatally HIV-infected adolescents aged 12-17 years between November 2017 and October 2018. A short version of the Berger HIV stigma scale (HSS-40) containing twelve items (HSS-12) covering the four dimensions of stigma was evaluated. The psychometric assessment included exploratory factor analysis, confirmatory factor analysis (CFA), and multi-group CFA. Additionally, scale reliability was evaluated as internal consistency by calculating Cronbach\u27s alpha. Results: Evaluation of the reliability and construct validity of the HSS-12 indicated insufficient reliability on three of the four subscales. Consequently, Exploratory Factor Analysis (EFA) was conducted to identify problematic items and determine ways to enhance the scale\u27s reliability. Based on the EFA results, two items were dropped. The Swahili version of this new 10-item HIV stigma scale (HSS-10) demonstrated excellent internal consistency with a Cronbach alpha of 0.86 (95% confidence interval (CI) 0.84-0.89). Confirmatory Factor Analysis indicated that a unidimensional model best fitted the data. The HSS-10 presented a good fit (overall Comparative Fit Index = 0.976, Tucker Lewis Index = 0.969, Root Mean Square Error of Approximation = 0.040, Standardised Root Mean Residual = 0.045). Additionally, multi-group CFA indicated measurement invariance across gender and age groups at the strict invariance level as ΔCFI was ≤ 0.01. Conclusion: Our findings indicate that the HSS-10 has good psychometric properties and is appropriate for evaluating HIV stigma among perinatally HIV-infected adolescents on the Kenyan coast. Further, study results support the unidimensional model and measurement invariance across gender and age groups of the HSS-10 measure

Surveillance of vector populations and malaria transmission during the 2009/10 El Niño event in the western Kenya highlands: opportunities for early detection of malaria hyper-transmission

<p>Abstract</p> <p>Background</p> <p>Vector control in the highlands of western Kenya has resulted in a significant reduction of malaria transmission and a change in the vectorial system. Climate variability as a result of events such as El Niño increases the highlands suitability for malaria transmission. Surveillance and monitoring is an important component of early transmission risk identification and management. However, below certain disease transmission thresholds, traditional tools for surveillance such as entomological inoculation rates may become insensitive. A rapid diagnostic kit comprising <it>Plasmodium falciparum </it>circumsporozoite surface protein and merozoite surface protein antibodies in humans was tested for early detection of transmission surges in the western Kenya highlands during an El Niño event (October 2009-February 2010).</p> <p>Methods</p> <p>Indoor resting female adult malaria vectors were collected in western Kenya highlands in four selected villages categorized into two valley systems, the U-shaped (Iguhu and Emutete) and the V-shaped valleys (Marani and Fort Ternan) for eight months. Members of the <it>Anopheles gambiae </it>complex were identified by PCR. Blood samples were collected from children 6-15 years old and exposure to malaria was tested using a circum-sporozoite protein and merozoite surface protein immunchromatographic rapid diagnostic test kit. Sporozoite ELISA was conducted to detect circum-sporozoite protein, later used for estimation of entomological inoculation rates.</p> <p>Results</p> <p>Among the four villages studied, an upsurge in antibody levels was first observed in October 2009. <it>Plasmodium falciparum </it>sporozoites were then first observed in December 2009 at Iguhu village and February 2010 at Emutete. Despite the upsurge in Marani and Fort Ternan no sporozoites were detected throughout the eight month study period. The antibody-based assay had much earlier transmission detection ability than the sporozoite-based assay. The proportion of <it>An. arabiensis </it>among <it>An. gambiae s.l</it>. ranged from 2.9-66.7% indicating a rearrangement of the sibling species of the <it>An. gambiae s.l </it>complex. This is possibly an adaptation to insecticide interventions and climate change.</p> <p>Conclusion</p> <p>The changing malaria transmission rates in the western Kenya highlands will lead to more unstable transmission, decreased immunity and a high vulnerability to epidemics unless surveillance tools are improved and effective vector control is sustained.</p

Access to Cancer Care in Kenya: Patients’, Survivors’, Caregivers’ and Health Providers’ Perspectives

Access to health care remains a complex notion with varying interpretations and no universally accepted definition. At least half of the world’s population lacks access to essential health services. The literature identifies “6As” dimensions of Access: Accessibility, Affordability, Availability, Adequacy /Appropriateness, Acceptability and Approachability. This paper employs these dimensions in documenting factors that were found to influence access to cancer care in Kenya. Health and Industry studies were conducted sequentially. The health part of the study reported in this working paper, employed a convergent parallel mixed methods study design which was undertaken in three counties of Meru, Nairobi and Mombasa. A total of 405 patients were interviewed in public sector health facilities, four focus group discussions with cancer survivors and 22 in-depth interviews with caregivers, health workers and policy makers held. Affordability of cancer services was enabled largely by cash payment with incremental use of National Hospital Insurance Fund (NHIF) from entry in health care up to the first treatment, but the high costs of cancer services were a major challenge. Payments for tests, treatment and indirect costs including transport and accommodation potentially impoverished many patients and their families as well as social networks . Facilities were financially supported by County Government funding, business and non-profit partners, and collaborations between health facilities to reduce indirect costs for the patients. Approachability was facilitated by community outreach services, local networks, awareness and knowledge promotion. However, better linkage between the community and health facility was required, especially for screening services. Availability: 30% of survey participants indicated that something they needed at the health facility was unavailable. The missing items included: medication, tests, treatment therapies, pain relief and essential commodities. Qualitative findings identified additional requirements including oncology staff and equipment. Patients also considered aspects of care that were unacceptable, and mentioned fear, stigma, cultural influences, religious and alternative beliefs. Nonetheless, having information and support from family, friends and other patient’s facilitated acceptability of cancer services. Accessibility in terms of distance and time to reach cancer care services located at county or national referral facilities was reported as a challenge for many. Communication, including lack of clarity, mis-diagnosis and non-disclosure of relevant information emerged as an appropriateness concern. It is important to note that the six access dimensions interact and therefore, may not be addressed separately. When these aspects of access to cancer care are facilitated, then access can be improved. Hence, a holistic health system approach to access is desirable, while emphasis should be put on enhancing diagnostic capabilities at lower levels of care in line with the objective of Universal Health Coverage. Mutually supportive interventions to strengthen access can include wider insurance coverage, extended staffing and improved information. When challenges to any of the access dimensions remain, then access to cancer care is undermined

Identification of malaria transmission and epidemic hotspots in the western Kenya highlands: its application to malaria epidemic prediction

<p>Abstract</p> <p>Background</p> <p>Malaria in the western Kenya highlands is characterized by unstable and high transmission variability which results in epidemics during periods of suitable climatic conditions. The sensitivity of a site to malaria epidemics depends on the level of immunity of the human population. This study examined how terrain in the highlands affects exposure and sensitivity of a site to malaria.</p> <p>Methods</p> <p>The study was conducted in five sites in the western Kenya highlands, two U-shaped valleys (Iguhu, Emutete), two V-shaped valleys (Marani, Fort-Ternan) and one plateau (Shikondi) for 16 months among 6-15 years old children. Exposure to malaria was tested using circum-sporozoite protein (CSP) and merozoite surface protein (MSP) immunochromatographic antibody tests; malaria infections were tested by microscopic examination of thick and thin smears, the children's homes were georeferenced using a global positioning system. Paired t-test was used to compare the mean prevalence rates of the sites, K-function was use to determine if the clustering of malaria infections was significant.</p> <p>Results and Discussion</p> <p>The mean antibody prevalence was 22.6% in Iguhu, 24% in Emutete, 11.5% in Shikondi, 8.3% in Fort-Ternan and 9.3% in Marani. The mean malaria infection prevalence was 23.3% in Iguhu, 21.9% in Emutete, 4.7% in Shikondi, 2.9% in Fort-Ternan and 2.4% in Marani. There was a significant difference in the antibodies and malaria infection prevalence between the two valley systems, and between the two valley systems and the plateau (P < 0.05). There was no significant difference in the antibodies and malaria infection prevalence in the two U-shaped valleys (Iguhu and Emutete) and in the V-shaped valleys (Marani and Fort Ternan) (P > 0.05). There was 8.5- fold and a 2-fold greater parasite and antibody prevalence respectively, in the U-shaped compared to the V-shaped valleys. The plateau antibody and parasite prevalence was similar to that of the V-shaped valleys. There was clustering of malaria antibodies and infections around flat areas in the U-shaped valleys, the infections were randomly distributed in the V-shaped valleys and less clustered at the plateau.</p> <p>Conclusion</p> <p>This study showed that the V-shaped ecosystems have very low malaria prevalence and few individuals with an immune response to two major malaria antigens and they can be considered as epidemic hotspots. These populations are at higher risk of severe forms of malaria during hyper-transmission seasons. The plateau ecosystem has a similar infection and immune response to the V-shaped ecosystems. The U-shaped ecosystems are transmission hotspots.</p

Surveillance of malaria vector population density and biting behaviour in western Kenya

BACKGROUND: Malaria is a great public health burden and Africa suffers the largest share of malaria-attributed deaths. Despite control efforts targeting indoor malaria transmission, such as insecticide-treated bed nets (ITNs) and deployment of indoor residual spraying, transmission of the parasite in western Kenya is still maintained. This study was carried out to determine the impact of ITNs on indoor vector densities and biting behaviour in western Kenya. METHODS: Indoor collection of adult mosquitoes was done monthly in six study sites in western Kenya using pyrethrum spray collections from 2012 to 2014. The rotator trap collections were done in July–August in 2013 and May–June in 2014. Mosquitoes were collected every 2 h between 18.00 and 08.00 h. Human behaviour study was conducted via questionnaire surveys. Species within Anopheles gambiae complex was differentiated by PCR and sporozoite infectivity was determined by ELISA. Species distribution was determined and bed net coverage in the study sites was recorded. RESULTS: During the study a total of 5,469 mosquito vectors were collected from both PSC and Rotator traps comprising 3,181 (58.2%) Anopheles gambiae and 2,288 (41.8%) Anopheles funestus. Compared to all the study sites, Rae had the highest density of An. gambiae with a mean of 1.2 (P < 0.001) while Kombewa had the highest density of An. funestus with a mean of 1.08 (P < 0.001). Marani had the lowest density of vectors with 0.06 An. gambiae and 0.17 An. funestus (P < 0.001). Among the 700 PCR confirmed An. gambiaes.l. individuals, An. gambiaes.s. accounted for 49% and An. arabiensis 51%. Over 50% of the study population stayed outdoors between 18.00 and 20.00 and 06.00 and 08.00 which was the time when highest densities of blood fed vectors were collected. Anopheles gambies.s. was the main malaria parasite vector in the highland sites and An. arabiensis in the lowland sites. Bed net ownership in 2012 averaged 87% across the study sites. CONCLUSIONS: This study suggests that mass distribution of ITNs has had a significant impact on vector densities, species distribution and sporozoite rate. However, shift of biting time poses significant threats to the current malaria vector control strategies which heavily rely on indoor controls