Low Uptake Of Intermittent Preventive Treatment Of Malaria In Hiv-Infected Pregnant Women At An Urban Hospital In Accra, Ghana

Objectives: The clinical course and complications of malaria during pregnancy are exacerbated in HIV-positive women. Furthermore, malaria during pregnancy may increase the risk of mother to child transmission (MTCT) of HIV. We assessed the uptake of WHO recommended intermittent preventive treatment (IPT) for malaria and insecticide treated bed nets (ITN) during pregnancy among HIV-negative and HIV-positive pregnant women in a malaria endemic area. Methods: A cross sectional study of 151 women (96 HIV-negative and 55 HIV-positive) receiving antenatal and HIV care at an urban district hospital in Accra, Ghana from July to August, 2008. The women were interviewed to obtain demographic data and information on the use of IPT and insecticide treated bed nets (ITN) during their current pregnancy. Antenatal care cards were used to verify obstetric history and a record of IPT use. Results: HIV-positive pregnant women had significantly low uptake of all three doses of WHO recommended IPT compared to HIV-negative pregnant women. Dose 1: 70% and 47% p=0.019, Dose 2: 54.8% and 30.2%, p=0.018. Dose 3: 40% and 9.1% p=\u3c0.002 for HIV negative and HIV positive pregnant women respectively. For ITN use, 43.8% of HIV negative and 36.4% of HIV positive women reported having ITNs at home, p=0.375. Of the women who had nets, 45.2% of HIV negative and 70% HIV positive women reported having slept under a net the previous night, P=0.068. Conclusion: The low uptake of IPT among HIV-positive pregnant women is of concern in light of emerging evidence that malaria during pregnancy may increase the risk of MTCT of HIV. Comprehensive prevention of MTCT programs should include components aimed at increasing the uptake of IPT among HIV-positive pregnant women

The role of anti-corruption laws and institutions in curbing illicit financial flows from Kenya study

Magister Legum - LLMThe concept of the illicit movement of money aimed at concealing illegal activities and evading taxes is not new. However, the global community first used the term “illicit financial flows” (IFFs) in the 1990s and originally associated it with capital flight. The globalisation of financial markets and the increasing ease with which individuals and companies transact across borders have led to a substantial increase in IFFs. Despite their growing economic and political significance, academics and international institutions are yet to formulate an agreed definition of IFFs. One of the common definitions is that of Global Financial Integrity (GFI), which describes IFFs as the illegal movement of illegal or legal money meant for an illegal purpose. The Report of the High Level Panel (HLP) on IFFs from Africa estimates that the continent loses more than US$50 billion annually through IFFs. The HLP Report notes that abusive commercial practices, transnational criminal activities and corruption are the main causes of IFFs in Africa. It estimates that commercial activities account for 65 per cent of IFFs, criminal activities for 30 per cent and corruption for around 5 per cent. Kenya has lost substantial amounts of money to IFFs. In the period 2002-2006, the country lost an estimated US$686 million annually to IFFs

Assessing a novel point-of-care ultrasound training program for rural healthcare providers in Kenya

Background: A novel point-of-care ultrasound (PoCUS) training program was developed to train rural healthcare providers in Kenya on the Focused Assessment with Sonography for Trauma (FAST), thoracic ultrasound, basic echocardiography, and focused obstetric ultrasonography. The program includes a multimedia manual, pre-course testing, 1-day hands-on training, post-testing, 3-month post-course evaluation, and scheduled refresher training. This study evaluates the impact of the course on PoCUS knowledge and skills. Competency results were compared based on number of previous training/refresher sessions and time elapsed since prior training. Methods: Trainees were evaluated using a computer-based, 30 question, multiple-choice test, a standardized observed structured clinical exam (OSCE), and a survey on their ultrasound use over the previous 3 months. Results: Thirty-three trainees were evaluated at 21 different facilities. All trainees completed the written exam, and 32 completed the OSCE. Nine trainees out of 33 (27.3%) passed the written test. Trainees with two or more prior training sessions had statistically significant increases in their written test scores, while those with only one prior training session maintained their test scores. Time elapsed since last training was not associated with statistically significant differences in mean written test scores. Mean image quality scores (95% confidence interval) were 2.65 (2.37–2.93) for FAST, 2.41 (2.03–2.78) for thoracic, 2.22 (1.89–2.55) for cardiac, and 2.95 (2.67–3.24) for obstetric exams. There was a trend towards increased mean image quality scores with increases in the number of prior training sessions, and a trend towards decreased image quality with increased time elapsed since previous training. Forty percent of trainees reported performing more than 20 scans in the previous 3 months, while 22% reported less than 10 scans in the previous 3 months. Second and third trimester focused obstetric ultrasound was the most frequently performed scan type. Frequency of scanning was positively correlated with written test scores and image quality scores. Conclusion: This novel training program has the potential to improve PoCUS knowledge and skills amongst rural healthcare providers in Kenya. There is an ongoing need to increase refresher/re-training opportunities and to enhance frequency of scanning in order to improve PoCUS competency

The Relevance of audit report lag and its corporate governance determinants among listed companies in the East African Community States

Submitted in Partial Fulfillment of the Requirements for Degree of Master of Commerce of Strathmore UniversityThe objective of this study is to establish the relevance of audit report lag and its corporate governance determinants among listed companies in East Africa. Descriptive statistics were used to compare the different audit report lags in Kenya, Uganda, Tanzania, and Rwanda and to establish the relevance of ARL in investment making decisions. Pooled regressions were performed to identify the significant corporate governance factors in listed companies in East Arica. This study focused on a ten-year period from 2007 to 2016. The findings revealed that of the four countries Rwanda had the shortest average ARL, 86 days while Tanzania had the longest average, 103 days. The most significant corporate governance factors in Kenya were, gender diversity in the board of directors, frequency of audit committee meetings and the auditor type. In Uganda, the most significant corporate governance factor was the audit committee financial expertise while in Tanzania, the board size and auditor type were the most significant. There were no significant corporate governance factors influencing audit report lag in Rwanda. The analysis of Primary data revealed that most investors rely on published financials for investment decisions, suggesting that ARL could be relevant for investment making decisions. Further analysis of information collected from the questionnaires revealed that the competence of the clients’ finance team, completeness and quality of information provided to auditors and the type of the audit report (qualified or unqualified) highly influenced ARL. There is need for academic scholars to extend this research by examining other factors influencing ARL in East Africa. The various regulators and policymakers are invited ensure strict adherence to the codes of corporate governance to achieve high standards of governance in listed companies. The boards of directors’, management and external auditors are encouraged to focus on prompt financial reporting because investors in East Africa highly rely on published financial reports to make investment decisions. This study acts the foundation for future research by providing empirical evidence on the relevance of audit report lag and its corporate governance determinants among listed companies in East Africa

Influence of Human Resource Factors on Implementation of Strategic Plans Among Mission Hospitals in Kenya: A Case of Mission Hospitals in Nyeri County

In 2017 according to study done only 5% of the listed companies in Kenya were able to fully implement their strategic plans. Human resource have been argued as one the factors that hinders successful implementation of a strategic plan. Therefore, the main purpose of this study was to determine the influence of human resource on implementation of strategic plans among mission hospitals in Kenya, a case study of Nyeri County. The study used a descriptive and correlation research design. The target population of the study was 380 employees working in the mission hospitals in Nyeri out of which a sample of 114 employees was selected. The study used stratified random sampling to select samples in the hospitals while simple random sampling as used with the help human resource assistant was used to select the employees. Primary data was collected with the help of structured questionnaire. The questionnaires were administered using drop and pick procedure. The collected data was cleaned, edited and analyzed with the help of SPSS (23) analyzed using descriptive, correlation and regression analysis. The study revealed that human resource factors influenced implementation of strategic plan.  The correlational findings indicated that was a positive strong relationship between human resource and implementation of a strategic plan. It was concluded that human resource had a significant influence on implementation strategic plan among mission hospitals in Kenya. It was recommended that mission hospitals should come up with strategies that would help to attract and retain talented employees as staff turnover was identified as one of human resource factors that influenced implementation of strategic plan. It was also recommended that further studies to be done community based factors and individual workers to examine whether they influenced strategic plan implementation. Keywords: Strategic plan implementation, human resource, mission hospital

Feasibility of project ECHO telementoring to build capacity among non-specialist emergency care providers

The COVID-19 pandemic has led to global disruptions in emergency medicine (EM) teaching and training and highlighted the need to strengthen virtual learning platforms. This disruption coincides with essential efforts to scale up training of the emergency healthcare workforce, particularly in low-resource settings where the specialty is not well developed. Thus, there is growing interest in strengthening virtual platforms that can be used to support emergency medicine educational initiatives globally. These platforms must be robust, context specific and sustainable in low-resource environments. This report describes the implementation of Project ECHO (Extension for Community Healthcare Outcomes), a telementoring platform originally designed to extend specialist support to health care workers in rural and underserved areas in New Mexico. This platform has now been implemented successfully across the globe. We describe the challenges and benefits of the Project ECHO model to support a Point-of-Care Ultrasound (POCUS) training program for health care providers in Kenya who do not have specialty training in emergency medicine. Our experience using this platform suggests it is amenable to capacity building for non-specialist emergency care providers in low-resource settings, but key challenges to implementation exist. These include unreliable and costly internet access and lack of institutional buy-in

International Scope of Emergency Ultrasound: Barriers in Applying Ultrasound to Guide Central Line Placement by Providers in Nairobi, Kenya

Background: While ultrasound (US) use for internal jugular central venous catheter (CVC) placement is standard of care in North America, most developing countries have not adopted this practice. Previous surveys of North American physicians have identified lack of training and equipment availability as the most important barriers to the use of US. Objective: We sought to identify perceived barriers to the use of US to guide CVC insertion in a resource-constrained environment. Methods: Prior to an US-guided CVC placement training course conducted at the Aga Khan University Hospital in Nairobi, Kenya, physicians were asked to complete a survey to determine previous experience and perceived barriers. Survey responses were analyzed using summary statistics and the Rank-Sum test based on different specialty, gender, and previous US experience. Results: There were 23 physicians who completed the course and the survey. 52% (95% CI: 0.30–0.73) had put in \u3e20 CVCs. 21.7% (95% CI: 0.08–0.44) of participants had previous US training, but none in the use of US for CVC insertion. The respondents expressed agreement with statements describing the ease of the use and improved success rate with US guidance. There was less agreement to statements describing the relative convenience and cost effectiveness of US CVC placement compared to the landmark technique. The main perceived barriers to utilization of US guidance included lack of training and limited availability of US equipment and sterile sheaths. Conclusion: Perceived barriers to US-guided CVC placement in our population closely mirrored those found among North American physicians, including lack of training and limited availability of US machines and equipment. These barriers have the potential to be addressed by targeted educational and administrative interventions

Global point-of-care ultrasound education and training in the age of COVID-19.

The COVID-19 pandemic has disrupted traditional global point-of-care ultrasound (POCUS) education and training, as a result of travel restrictions. It has also provided an opportunity for innovation using a virtual platform. Tele-ultrasound and video-conferencing are alternative and supportive tools to augment global POCUS education and training. There is a need to support learners and experts to ensure that maximum benefit is gained from the use of these innovative modalities

The status and future of emergency care in the Republic of Kenya

Kenya is a rapidly developing country with a growing economy and evolving health care system. In the decade since the last publication on the state of emergency care in Kenya, significant developments have occurred in the country\u27s approach to emergency care. Importantly, the country decentralized most health care functions to county governments in 2013. Despite the triple burden of traumatic, communicable, and non-communicable diseases, the structure of the health care system in the Republic of Kenya is evolving to adapt to the important role for the care of emergent medical conditions. This report provides a ten-year interval update on the current state of the development of emergency medical care and training in Kenya, and looks ahead towards areas for growth and development. Of particular focus is the role emergency care plays in Universal Health Coverage, and adapting to challenges from the devolution of health care

Building focused cardiac ultrasound capacity in a lower middle-income country: A single centre study to assess training impact

Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment of a FoCUS training programme locally. Methods: This was a pre-post quasi-experimental study at a tertiary hospital in Nairobi, Kenya. Twelve novices without prior echocardiography training underwent FATE training, and their knowledge and skills were assessed. Pre- and post-test scores were compared using the Wilcoxon signed-rank test to establish whether the median of the difference was different than zero. Inter-rater agreement between expert and novice scans was assessed, with a Cohen\u27s kappa \u3e0.6 indicative of good inter-rater agreement. Results: Knowledge gain was 37.7%, with a statistically significant difference between pre-and post-test scores (z = 2.934, p = 0.001). Specificity of novice FoCUS was higher than sensitivity, with substantial agreement between novice and expert scans for most FoCUS target conditions. Overall, 65.4% of novice images were of poor quality. Post-workshop supervised practice was limited due to scheduling difficulties. Conclusions: Although knowledge gain is high following a brief training in FoCUS, image quality is poor and sensitivity low without adequate supervised practice. Substantial agreement between novice and expert scans occurs even with insufficient practice when the prevalence of pathology is low. Supervised FoCUS practice is challenging to achieve in a real-world setting in LMICs, undermining the effectiveness of training initiatives