The Community Health Fund:Assessing Implementation of New Management procedures in Hanang District,Tanzania

A key obstacle to the success of community-based health insurance initiatives in Africa is the dearth of well-trained health managers who can design and run the insurance schemes in a viable manner. Internal management controls are often not adequate to ensure the fund is protected from misuse and fraud carried out by members or its own staff. The Community Health Fund in Hanang district in Tanzania has introduced management procedures that help it to exercise control over revenue collection and reporting and provide management with sufficient information to assess the Fund’s performance. This report looks at the implementation of the new management procedures, identifies successes and shortcomings in fulfilling record keeping and reporting requirements in particular, and recommends steps to improve record keeping at health care facilities, reporting of data to the district level, and use of the new data by the district.\u

Hidden Facts and the Role of Truthfulness in Academic Dishonesty

Background: Academic dishonesty is widespread across the world and studies done have largely relied on self-reporting to establish the extent and factors contributing to the practice. This demands of researchers to take at face value what people who may not be entirely truthful are saying. It is not a surprise, therefore, that varied interesting findings have been made in different studies. This paper delves into the complexity of determining the key components of academic dishonesty and brings into focus the role of truthfulness in understanding the elicited data. The objective of this study was to establish the role of truthfulness in understanding various components of academic dishonesty. Methods: This was a Cross sectional study using self-administered questionnaire. The Setting was the School of Medicine, Moi University, Eldoret - Kenya. The study subjects were 156 students in the clinical (4th, 5th and 6 th) years of study. They anonymously filled a 20-item self-administered questionnaire. The questionnaire captured the demographic data and the views of the students on various aspects of academic dishonesty ranked in a Likert scale of six levels starting with strongly agree to strongly disagree. Results: The overall level of truthfulness among these medical students was 55.8%. While more males had prior experience with academic dishonesty in secondary school and involvement at College, they were also more truthful than the females. The untruthful were 2.2 times as often involved in academic dishonesty as the truthful and were also less likely to report on their classmates. Conclusion: There are hidden facts in academic dishonesty that can only be revealed by subjecting gathered data to a scrutiny on how truthful the respondents are. Truthfulness is an inversely proportional surrogate predictor of academic dishonesty.Key words: Role. Thruthfulness, academic, dishonest

Correlation between patient understanding of health information on prostate diseases and health status on presentation to hospital

Background: Many countries have poor patient health education and understanding of prostate diseases. The Kenyan situation has not been adequately documented. Objective: To establish the relationship between sources of health education on prostate diseases and patient health status at presentation to hospital. Methods: A hospital-based census study was conducted using interviewer-administered questionnaire after ethical approval. Patients who presented to a urology clinic for the first time with prostatism were recruited after they provided informed consent. Collected data were analyzed using the Statistical Package for Social Sciences version 20.0 and statistical significance was set at p≤0.05. Results: A total of 126 patients were recruitedfrom July 2016 to June 2018. The three sources of information were Informal sources such as friends and relatives (81%), the Internet (8.7%), and Health Workers (10.3%). Thirty-two (25.4%) patients had health information on prostate and its diseases. The duration of symptoms ranged from 1 month to 4 years. The difference in the proportions of those who presented within the first year of symptoms was statistically significant (p<0.001) for those whose sources were Health Workers (76.7%), the Internet (72.7%), and Informal sources (43.1%). Conclusion: Health education on prostate diseases is positively correlated with the health status at presentation

Post-Anastomotic Enterocutaneous Fistulas: Associated Factors and Spontaneous Closure at a Tertiary Centre in Western Kenya

Objective To determine the factors associated with the occurrence and spontaneous closure of enterocutaneous fistulas. Design A retrospective, hospital-based study of patients who developed enterocutaneous fistulas after resection and anastomosis. Setting The general and paediatric surgical wards of Moi Teaching and Referral Hospital (MTRH), a 550 bed tertiary teaching and referral hospital in the Western region of Kenya. Subjects Two hundred and twenty patients of all ages who underwent gut resection and anastomosis for varied reasons between 2002 and 2006. Main outcome measures The primary outcome measures were variables associated with development and spontaneous closure of fistulas while the secondary outcome measures were morbidity and mortality associated with enterocutaneous fistulas. Results Enterocutaneous fistulas formed in 22 of 220 patients and constituted 44% of all the complications after gut resection and anastomosis. Age younger than 20 years (p=0.04), female gender (p=0.032), duration of symptoms greater than one day prior to presentation to hospital (0.032), deranged electrolytes (p=0.042), delay in surgery after admission (p=0.043) and the use of ileal segment in the anastomosis (p=0.018) were significantly associated with occurrence of fistulas on univariate analysis. The use of ileal segment in the anastomosis (p=0.033), deranged electrolytes (p=0.045) and duration prior to surgery (p=0.045) were also found to be predictive of fistula formation on multivariate analysis. The spontaneous closure rate was 45.5%. Factors significantly associated with spontaneous closure were age greater than 20 years (p= 0.027) and occurrence of the fistula in an ileal segment (p=0.031). Enterocutaneous fistulas had a case specific mortality rate of 50%.The factor most significantly associated with mortality was re-operation (

The morbidity and mortality of surgically treated urological patients in a tertiary centre in western Kenya

Objective: To determine the morbidity and mortality of surgically treated urological patients at Moi Teaching and Referral Hospital (MTRH) and compare them with those of other tertiary centres.Design: A fi ve year hospital based, retrospective study reviewing files of patients who underwent surgery for urological problems in MTRH for the period 1st January, 2005 to 31st December, 2009.Setting: The records department of Moi Teaching and Referral Hospital, a 750 bed capacity hospital in the Western region of Kenya.Subjects: Four hundred and twenty patients whose fi les were complete for the sought data.Main outcome measures: The primary outcome measures were the morbidity and mortality rates. Morbidity was depicted by the postoperative complications and hospital length of stay. The secondary outcome measures were patient demography, the type of surgery and the duration of surgery.Results: The male to female ratio was 13.5:1 with 49% of all the patients being older than 50 years. Seventy-seven patients (18.3%) had co morbid diseases with hypertension (22.5%), diabetes mellitus (14.3%) and Human Immunodefi ciency Virus (HIV) infection [7.8%] as the top three conditions. The top three procedures were prostate, urethral and bladder surgeries. The morbidity and mortality rates were 5.5% and 1.2% respectively.Conclusion: While prostate disease remains the leading urological problem, urethral strictures are signifi cantly higher than in the other reviewed regions. Co morbidities amenable to preoperative interventions and a relatively younger population make our morbidity and mortality rates acceptably low compared to other tertiary centres

Academic Dishonesty in Medical Schools

Background: Dishonesty can be found in all aspects of human interaction and is known to be rampant in educational institutions. Little is known about it in medical training and the characteristics of those involved. This study explores the factors that drive academic dishonesty among aspiring doctors.Objective: To establish the factors driving academic dishonesty among senior medical students.Design: Cross sectional survey using self-administered questionnaire.Setting: The School of Medicine, Moi University.Subjects: One hundred and fifty-six students in the clinical years of study.Results: Those who had past experience with academic dishonesty had a 70.4% chance of cheating in university compared to 58.9% for those not previously exposed. The odds ratio was 3.6 for males to be involved in academic dishonesty than females. Being aware of academic dishonesty in the Medical School made it 86.3% likely that a student would participate. Having witnessed academic dishonesty in progress was the strongest predictor of likely involvement in cheating.Conclusion: The cheating medical student in the clinical years is likely to be a male in the early part of the study with similar previous experience, has witnessed cheating and believes that the classmates are actively equally involved.Key words: Academic Dishonesty, Medical Training, Medical Student

The Profile and Urological Service Needs of Outpatients Attending a Tertiary Centre in Western Kenya

Background: Urological service needs cut across varied ages and related conditions. The outpatient attendance is a reflection of the common conditions constituting the urological burden of a given population (1). The urological burden in turn has implications on access to care and treatment (2) since it will determine the skills needed, mode of treatment, amount of time and other resources required to meet these needs. There is,  therefore, a need to have a local data base on the profile of our urologicalpatients and their needs with regard to modes of treatment. This study strives to and meets this important objective.Objective: To establish the epidemiology of outpatient urology patients and their service needs as seen in a tertiary centre in the Western region of Kenya.Design: Hospital based observational, descriptive, prospective, cross sectional study.Setting: The Urology Outpatient clinic of Moi Teaching and Referral Hospital (MTRH), a 750 bed tertiary centre in the Western region of Kenya catering for approximately half of the Kenyan population.Subjects: Ninety-four first time attendees to the urology clinic seen in the year 2011.Main outcome measures: The primary outcome measures were the demographic data and diagnosis while the secondary outcome measure was the urological service needs of the patients in terms of treatment as to whether surgical or medical at presentation.Results: Ninety-four patients attended the urology clinic for the first time in the year of study. The male to female ratio was 14.7: 1. Age ranged from one year to 97 years with a mean ± standard deviation of 48.0 ± 25.3 years. Half were below and half were above 50 years of age. Males had longer durations of symptoms compared to females but the difference was not statistically significant (p = 0.131). The top three urological problems were urethral strictures, prostate diseases and Urinary Tract Infections. There was an overall 70.2% need for surgical interventions with twenty-six point one percent of the prostate disorders being managed medically while all urethral strictures were planned for surgery. The odds ratio for surgery after one year compared to within first year of symptoms was two.Conclusion: The urological patients attending this tertiary outpatient clinic are predominantly males and are widely spread out in terms of age and diagnosis. The clinical burden of urethral strictures has overtaken that of prostate diseases in this tertiary centre

Modeling Alternatives to Exponential Discounting

One area that is often overlooked by economists and social scientists is discounting. Most economic models of intertemporal choice make use of Samuelson's (1937) DU model which leads to an exponential discount function. Divergences from what economic modelling predicts and empirical findings are on the most part attributed to factors other than the discount function employed. We review the literature on the DU model and identify its behavioral anomalies. We look into suggested quasi-hyperbolic and hyperbolic models that in part account for these anomalies. We analyze an infinite IPD game and demonstrate that under quasi-hyperbolic discounting, cooperation emerges as an SPE at a higher level of the discount factor. We further demonstrate that the unemployment equilibrium in the Shapiro & Stiglitz (1984) Shirking model is not static under both hyperbolic and quasi-hyperbolic discounting.intertemporal, exponential, quasi-hyperbolic, hyperbolic.

An investigation on gender perceptions in credibility of male and female news anchors in Kenya.

The success and survival of media houses is based on viewership as informed on audience loyalty that is pegged on perceived credibility of the news items, news anchors and media houses. But, extent of credibility perception as influenced by gender under the gender disparity concept has not been assessed within the Kenyan media space; which forms the focus of this study. The main objective was to investigate gender perceptions in the credibility of male and female news anchors in Kenya. Specifically, the study assessed the perceived credibility of male news anchors in presenting hard news items in Kenya and examined female news anchors perceived credibility in presenting soft news items in Kenya. The study was anchored on social role and social credibility theories and there was use of mixed method approach in obtaining qualitative and quantitative data. The survey involved respondents watching a hard and soft news clip presented by male and female news anchors and answering the research questions by filling the online Google form. Content and thematic analysis was used for the qualitative data, descriptive analysis for quantitative data and independent t-test was for checking the hypothesis. Findings showed that credibility perceptions on presentation of soft or hard news by male and female anchors was not based on gender. The conducted t-tests, thus rejected the null hypothesis based on indiscriminate values for male and female news anchors in presenting hard news. The study concluded that other factors including comprehensiveness and completeness of the information, citing information sources, trustworthiness, factual and knowledgeable news anchors influenced the credibility perception of the news item and anchors. The study recommended use of double pairing anchoring, training programs and involvement of news anchors in the sourcing, scripting, editing and production of news items to improve credibility perception