Managing extension staff: Two experiments in Kenya

This paper focusses on techniques for managing agricultural extension staff. A system of staff meetings, recording and reporting is described, which was tested in the Mbere Special Rural Development Programme area. The purpose of this system was to provide closer supervision of the routine activities of agricultural extension staff, and its achievements and limitations'in meeting this goal are discussed here. A system of inservice training and planning workshops associated: with new and/or more comprehensive extension activities was tested in Kisii and Homa Bay. This is basically a management system for extension planning which provides a tool for the effective participation of grassroots level field staff. The two management systems are considered complementary, and it is proposed that they be combined to form a useful management tool for agricultural extension

User fees in private non-for-profit hospitals in Uganda: a survey and intervention for equity

BACKGROUND: In developing countries, user fees may represent an important source of revenues for private-non-for-profit hospitals, but they may also affect access, use and equity. METHODS: This survey was conducted in ten hospitals of the Uganda Catholic Medical Bureau to assess differences in user fees policies and to propose changes that would better fit with the social concern explicitly pursued by the Bureau. Through a review of relevant hospital documents and reports, and through interviews with key informants, health workers and users, hospital and non-hospital cost was calculated, as well as overall expenditure and revenues. Lower fees were applied in some pilot hospitals after the survey. RESULTS: The percentage of revenues from user fees varied between 6% and 89% (average 40%). Some hospitals were more successful than others in getting external aid and government subsidies. These hospitals were applying lower fees and flat rates, and were offering free essential services to encourage access, as opposed to the fee-for-service policies implemented in less successful hospitals. The wide variation in user fees among hospitals was not justified by differences in case mix. None of the hospitals had a policy for exemption of the poor; the few users that actually got exempted were not really poor. To pay hospital and non-hospital expenses, about one third of users had to borrow money or sell goods and property. The fee system applied after the survey, based on flat and lower rates, brought about an increase in access and use of hospital services. CONCLUSION: Our results confirm that user fees represent an unfair mechanism of financing for health services because they exclude the poor and the sick. To mitigate this effect, flat rates and lower fees for the most vulnerable users were introduced to replace the fee-for-service system in some hospitals after the survey. The results are encouraging: hospital use, especially for pregnancy, childbirth and childhood illness, increased immediately, with no detrimental effect on overall revenues. A more equitable user fees system is possible

Health care seeking behavior for diarrhea in children under 5 in rural Niger: results of a cross-sectional survey

Diarrhea remains the second leading cause of death in children under 5 years of age in sub-Saharan Africa. Health care seeking behavior for diarrhea varies by context and has important implications for developing appropriate care strategies and estimating burden of disease. The objective of this study was to determine the proportion of children under five with diarrhea who consulted at a health structure in order to identify the appropriate health care levels to set up surveillance of severe diarrheal diseases

Socio-economic differences and health seeking behaviour for the diagnosis and treatment of malaria: a case study of four local government areas operating the Bamako initiative programme in south-east Nigeria

BACKGROUND: Malaria is one of the leading causes of mortality and morbidity in Nigeria. It is not known how user fees introduced under the Bamako Initiative (BI) system affect healthcare seeking among different socio-economic groups in Nigeria for diagnosis and treatment of malaria. Reliable information is needed to initiate new policy thrusts to protect the poor from the adverse effect of user fees. METHODS: Structured questionnaires were used to collect information from 1594 female household primary care givers or household head on their socio-economic and demographic status and use of malaria diagnosis and treatment services. Principal components analysis was used to create a socio-economic status index which was decomposed into quartiles and chi-square for trends was used to calculate for any statistical difference. RESULTS: The study showed that self diagnosis was the commonest form of diagnosis by the respondents. This was followed by diagnosis through laboratory tests, community health workers, family members and traditional healers. The initial choice of care for malaria was a visit to the patent medicine dealers for most respondents. This was followed by visit to the government hospitals, the BI health centres, traditional medicine healers, private clinics, community health workers and does nothing at home. Furthermore, the private health facilities were the initial choice of treatment for the majority with a decline among those choosing them as a second source of care and an increase in the utilization of public health facilities as a second choice of care. Self diagnosis was practiced more by the poorer households while the least poor used the patent medicine dealers and community health workers less often for diagnosis of malaria. The least poor groups had a higher probability of seeking treatment at the BI health centres (creating equity problem in BI), hospitals, and private clinics and in using laboratory procedures. The least poor also used the patent medicine dealers and community health workers less often for the treatment of malaria. The richer households complained more about poor staff attitude and lack of drugs as their reasons for not attending the BI health centres. The factors that encourage people to use services in BI health centres were availability of good services, proximity of the centres to the homes and polite health workers. CONCLUSIONS: Factors deterring people from using BI centres should be eliminated. The use of laboratory services for the diagnosis of malaria by the poor should be encouraged through appropriate information, education and communication which at the long run will be more cost effective and cost saving for them while devising means of reducing the equity gap created. This could be done by granting a properly worked out and implemented fee exemptions to the poor or completely abolishing user fees for the diagnosis and treatment of malaria in BI health centres

The impact of social media on consumers' acculturation and purchase intentions

YesSocial media has emerged as a significant and effective means of assisting and endorsing activities and communications among peers, consumers and organizations that outdo the restrictions of time and space. While the previous studies acknowledge the role of agents of culture change, it largely remains silent on the role of social media in influencing acculturation outcomes and consumption choices. This study uses self-administered questionnaire to collect data from 514 Turkish-Dutch respondents and examines how their use of social media affects their acculturation and consumption choices. This research makes a significant contribution to consumer acculturation research by showing that social media is a vital means of culture change and a driver of acculturation strategies and consumption choices. This study is the first to investigate the role of social media as an agent of culture change in terms of how it impacts acculturation and consumption. The paper discusses implications for theory development and for practice

Evaluation of Microbial and Nutritional Quality of Fermented Dried Roasted Thick Porridge (Mkarango)

Most of the products of maize flour fermentation in Kenya undergo wild fermentation in a natural process. One of these is locally roasted maize flour commonly known by its local name Mkarango which is popular in the Western region of Kenya where it is used in different ways. Mkarango is mostly made through wild fermentation which is known to pose health risks as it is unhygienic and time-consuming, with the quality of the resultant product being inconsistent. The aim of this study was to evaluate the population of lactic acid bacteria, and sensory characteristics of dried roasted thick porridge (mkarango). Six different mkarango products made with addition of Lactobacillus plantarum and Lactobacillus brevis in different ratios were studied for microbial quality, mineral element content and sensory characteristics. Titratable acidity and pH properties of the products were also determined. These were done following recommended standards. After 24 hours of fermentation, products with Yeast+ L. plantarum+ L. brevis (1:2) and Milk+ L. plantarum+ L. brevis (1:2) had the highest pH values (5.12) while products with Milk+ L. plantarum+ L. brevis (2:1) had the lowest pH values (4.8). Yeast, molds, and Lactic Acid Bacteria had the highest in all the samples tested while Enterobacteriaceae the least. The overall acceptability of the product of the product prepared from Milk + L. plantarum + L. brevis (2:1) had the final score of 4.7 on the 5-point hedonic scale. The results of the trace elements zinc and iron ranged from 2.7 mg/100 g to 3.9 mg/100 g and 2.7 mg/100 g to 16.9 mg/100 g on the product respectively. Fermentation creates an environment that is conducive for the population of lactic acid bacteria. This results in increased volume of lactic acid that is responsible for improved nutritional quality of Mkarango

Piloting post-exposure prophylaxis in Kenya raises specific concerns for the management of childhood rape

Thika District, Kenya, is the site of an operational research study on the provision of comprehensive post-rape care, including the free provision of HIV post-exposure prophylaxis (PEP). It is a typical rural Kenyan district in terms of resources and patient throughput. The high rate of children attending for post-rape services was unexpected and had significant programming implications. An age-disaggregated analysis of existing quantitative data from the first 8 months of service provision was conducted. Ninety-four case records were reviewed, of whom 48 (51%) were in the age range 1.5-17 years inclusive. All three cases of mate rape were in children. Children were more likely to know their assailant than adults and were more likely to be HIV-negative at baseline. The majority (86%) of children presented in time for PEP, with adherence and completion rates similar to adults but lower rates of 6-week follow-up. The use of weight bands to determine drug dosages greatly simplified the appropriate and early administration of paediatric PEP. The high rates of childhood rape and demand for post-rape services were an enormous challenge for service providers and policy-makers. (c) 2005 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved