Tobacco is consumed worldwide and has been cultivated in Africa since the end of the 16th century though commercial cultivation began around the 19th century. The expansion of tobacco farming has been encouraged and financed by major cigarette companies around the world especially in developing countries. In Kenya, tobacco is currently grown for commercial and non-commercial purposes in Nyanza, Western, Central and Eastern Provinces supported by BAT (K) and Mastermind K, which are the leading cigarette companies (Kibwage et al, 2009). While there are many advantages to tobacco farming such as salaries and wages for employees and farm workers, and government revenue through taxes; it may also have adverse effects. According to Effroymson and FitzGerald (2002), tobacco growing not only provides funds for basic existence but keeps the poor entrenched in a cycle of poverty. The objectives of this study was to identify socio-economic challenges faced by contracted smallholder tobacco farmers in Giaki, coping mechanisms employed by contracted tobacco farmers in dealing with tobacco farming challenges in Giaki and to establish contracted smallholder tobacco farmers who re willing to stop tobacco farming in Giaki. A total of 86 respondents were sampled from the study using snowball sampling. Structured interview schedules and focus group discussions were used to gather data. The main socio-economic challenges identified during processing and cultivation of the crop was tobacco pests and diseases, labour shortages and health problems. Among the problems faced during marketing of tobacco crop, the most mentioned problem was that the tobacco company charged exorbitant prices for farm inputs like seeds, fertilizers, chemicals and even firewood; delayed payments, low prices and poor tobacco leaf grading system. Tobacco farmers in this area engage in other off-farm activities to boost their tobacco cultivation earnings. Also, farmers have diversified their farming to enable them sustain food for the household. Most farmers would prefer to shift from tobacco farming and adapt other alternative crops as tobacco cultivation is both time and labour intensive. The study recommends that the contracting tobacco company should be encouraged to renegotiate the contract given to farmers so that farmers can purchase inputs for themselves. Also, farmers should be trained on better methods of processing and cultivation of tobacco crop to improve the grade of the harvested crop. As most farmers engaged in tobacco farming due to availability of loans and ready market, this study also recommends diversification for loan options for other businesses like small scale industries. More sociological research should be done on the extent to which Tobacco companies are willing to help smallholder tobacco farmers solve socio-economic challenges faced in Giaki. Impact of tobacco farming on livelihood of contracted tobacco farmers in comparison with nontobacco farmers in Giaki and the role played by the government in solving socio-economic challenges of small scale tobacco crop farmers in Giaki.

The fifth Millennium Development Goal calls for a reduction in the maternal mortality ratio by 75% between 1990 and 2015, with a key indicator being the proportion of births attended to by skilled health personnel (United Nations 2007). In Sub-Saharan Africa approximately 40% of women deliver with a skilled attendant. In Sub-Saharan Africa, little research has been carried out on the experience of quality in facility-based delivery care and factors associated with delivery care. This was a cross sectional descriptive study that focuses on experience and associated factors of delivery care by postnatal mothers in the Kenyatta National Referral Hospital in Nairobi, Kenya. The main objective was to describe the experience of quality in delivery care among women who delivered in the health facility; and their perception of the care. Systematic sampling was employed to recruit post-natal mothers who delivered in KNH labour ward and four postnatal wards. A total of 109 participants were recruited into the study, postnatal wards were purposely selected. Training of research assistant was done before data collection. Data was collected using structured and semi-structured questionnaires to respondents within 48 hours after delivery. Qualitative data was collected by use of case studies and key informant interviews. Data was analyzed using ANOVA. Research results were presented in frequency distribution tables, graphs and charts. P-values were used to calculate the statistical significance of the results obtained The average age of the participants was 26 years (SD 4.5), close to thirty eight percent (37.6%) of the participants had a parity of three. Most (95.4%) of the deliveries were uncomplicated and five (4.6%) participants had complicated births. Views and experiences of recently delivered women were elicited using a five-point Likert scale questionnaire focusing on four dimensions of participants’ intrapartumexperience. The participants attending KNH for second delivery viewed providers as respectful (p = 0.043), effective in explaining labor and delivery (p = 0.019) and seeking patient consent before procedures (p = 0.008). Most participants (87.7%) agreed that they were treated respectfully, accorded privacy and asked to consent to procedures, prior to the initiation of these procedures. Ninety percent of participants agreed that the health providers explained what to expect during labor, listened to participants concerns and clearly explained to clients their condition. However 8% of the respondents disagreed with this statement. Most participants (n = 102, 93.6%) said they would recommend delivery services at KNH to friends or family, although 6% of them said they would not recommend. In conclusion, the study showed majority of the participants rated most of the delivery care aspects highly and therefore had a good experience of delivery care though few aspects were rated poorly. There is need for the hospital management to increase the staff patient ratios in labour ward to care for women in labour especially with the increase in numbers of mothers delivering in the institution following provision of free maternity services by the government. The management also needs to plan on increasing the number of beds in labour rooms and also delivery rooms as well provision of privacy in these rooms.

This was a qualitative and quantitative study on opportunities and challenges faced by women with physical disabilities in accessing and utilizing public health services in Nairobi City County. The study sought to describe the difficulties encountered by women with physical disabilities while seeking healthcare services at public hospitals. It was guided by the critical disability theory which analysed disability issues and viewed the problems of disability explicitly as the product of unequal society. Data were collected through semi-structured interviews, key informant interviews, focus group discussions and observation. Analysis was done through thematic approach. The study findings suggest that the research subjects encounter several challenges as they approach public facilities for healthcare services. These challenges include lack of proper health facilities, poor infrastructure and insensitive medical personnel to concerns of PWDs. The findings also indicate that the main opportunities available for women with physical disabilities in accessing and utilizing services offered at public hospitals would be the building of more ramps, provision of wheelchairs, and provision of low beds. Other issues have to do with free medication, non-slippery floors and establishment of special wings for WWPDs. On the basis of these findings, the study concludes that lack of proper health facilities in public hospitals negatively affects women with physical disabilities in Nairobi City County. It is, therefore recommended that the administration in public hospitals should ensure facilities such as low beds and low toilets; special units for women with physical disabilities; ramps and floors that are adapted to disability; widen corridors and doorways and give priority services to the WWPDs in the public hospitals.

This study examined the implications of Strategic change of ownership on the strategic positioning of commercial banks in Kenya following the cross sectional study approach where six banks were sampled for the study. The study further examined the extent of change of ownership on the strategic positioning of the banks. The population of the study was banks in Kenya that have undergone strategic ownership change in the last five years (2008 to 2013). As provided by Central Bank Of Kenya website 6 commercial banks qualified for the study. The study was conducted through a cross sectional survey and there was no sampling since the population was small. The six commercial banks were Prime Bank Kenya Limited, CFC Stanbic Bank (K) Limited, Kenya Commercial Bank Limited, Jamii Bora Bank Limited, Equatorial Commercial Bank Limited and Ecobank Kenya Limited. Primary Data was collected from target respondents using a self-administered open ended interview guide. The guide is divided into three sections that had questions on bio data, strategic ownership changes in commercial banks and strategic positioning. The findings from the study revealed that indeed banks that had gone through change of ownership had made several internal adjustments that influenced the strategic positioning of the respective banks. The study further revealed that strategies preferred by banks for change of ownership are mergers or total acquisition. It further revealed the reasons that necessitated this ownership restructuring varied. Some respondents gave the need for improving capital base for ease of trade, while others preferred this avenue as a means to achieving their expansion strategy. The indicators applied to establish implications of change of ownership on the positioning of the firm are change in products and services, change in risk control measures and internal regulations, new approaches to customer recruitments and retention, changes in employee incentive schemes and changes in customer complaints handling mechanisms. The findings led to the conclusion that Strategic change of ownership has impacted positively on the strategic positioning of commercial banks affected by such changes.

Private universities in Kenya like other businesses operate in a competitive environment. Knowing how to satisfy their students who are their primary customers is important because it can lead to future business. The relationship between service quality and student satisfaction is important because if it is understood properly it can enable the right decisions to be made about service quality that lead to increase in student satisfaction. The study was carried out to find out whether there is a relationship between service quality and student satisfaction of private university students in Nairobi County. About 118 students were interviewed through a survey that was based on higher education service quality model HeDPERF. It was found that service quality is positively related to student satisfaction and that some of the most important aspects of an institution that students liked most were the reputation of the university and the nature of the programs offered. This means that universities have to improve on their service quality while at the same time improving on their reputation, variety and flexibility of programs offered in order to attract more students.

Background:There is pressure for hospitals to adopt tool that can help them address the challenges facing the delivery of health care services. Quality management systems (QMS) are being adopted for this purpose. However, there is limited studies’ on their effect on patient care. Objectives: To establish the determinants of quality management system uptake in hospital setting and effect of implementing QMS on patient care at MTRH, Eldoret. Methods: This was a cross sectional research which utilized quantitative and qualitative research methods. A sample of 96 nurses chosen by simple random and purposeful sampling and working in a surgical unit were involved. Data was collected using 5 point Likert scale questionnaires, key informants guide and documentary reviews. Results: The aim for ISO certification was to standardize (mean 4.47, p=0.000) and to improve the quality of care (4.25, p=0.000). Critical factors to consider were staff commitment (4.16, p = 0.000) and understanding of ISO standard (4.00, p=0.000). The main challenge faced was increased amount of documentation (4.11, p=0.000). Efficiency in provision of care had improved (mean 3.88, CI 3.75-4.02) especially retrieval of records (mean 4.26, p=0.00), clear work instruction (mean 4.24 p=0.000) and improved documentation (mean 4.13, p=0.00). Patient centered care improved through provision of feedback to clients (3.89, p=0.000) and responding to clients (3.73, p=0.000). Patient safety improved (3.77, CI 3.63-3.90), while there was reduction in medication errors (4.06, p=000) and surgical site infections (4.04, p=0.000). Accessibility (mean 3.27, CI 3.10-3.43) and equity (3.6, CI 3.47-3.75) in provision of care also increased. Documentary review indicated a consistentcustomer satisfaction of 75%, an increase in bed occupancy of 10% but no change in length of stay. Conclusion and recommendations: Quality Management system was implemented in a public hospital with the aim of improving service delivery. Understanding requirements of QMS are critical in its implementation, though one need to overcome increased documentation which is seen as a major challenge. Implementation of QMS improved aspects of care but others had not improved significantly. Use of performance indicators may provide reliable measure of the effect of QMS on quality of care. Key words: Quality management systems, ISO 9001; 2008, quality of care.

The gender dimension has become one of the most important and debated issues worldwide. This study was gender responsive focusing on the status of equity and equality in Technical, Industrial, Vocational and Educational Training (TIVET) Institutions in Nyanza Province in Kenya. Gender mainstreaming in TIVET institutions has become a challenge and teething problem. Over history of Education and development in Kenya, participation of girls had been problematic and this has been due to lack of gender mainstreaming in relation to the in and out of school factors. There had been issues related to inequalities, insufficiencies and disparities in the access of girls/women education, training and labour market. Enrolment of girls has been consistently low as compared to boys. The girls who had been retained in schools face a lot of challenges where some of them drop out of school or perform dismally as compared to boys. This reduces their transition rate to higher Institutions of learning such as in TIVET. Gender mainstreaming was one of the strategies embraced by schools to address gender parity in terms of schools to achieve much. Girls’ enrolment and participation in TIVET Institutions is still low. The purpose of the study was to investigate Determinants of Gender Mainstreaming in Public TIVET institutions in Nyanza Province in Kenya such as staffing related factors, facilities and equipment, curriculum instruction that influence gender mainstreaming and teachers attitudes towards gender mainstreaming. The study employed descriptive survey design. The study population was to comprise of 7 public TIVET institutions in Nyanza Province with a target population of 10,185. A total of 370 respondents were to be sampled. However, the study population comprised of 6 public TIVET institutions in Nyanza province with a target population of 8,631. A total of 364 respondents were sampled using simple random sampling technique. One principal from each institution was selected purposively. Questionnaires, interview and observation schedules were used to collect both qualitative and quantitative data that were analysed. After data collection the researcher organized it by assigning a questionnaire number 1 to Yes and 0 to No for closed ended items. Quantitative data analysis commenced at the field editing stage to minimize errors. Coding the open ended data entry, data cleaning information analysis and interpretation followed. Descriptive statistics was used to analyze and describe the information. Qualitative data analysis was done concurrently with data collection. Open and written question was used to create meaningful interpretations. The data was summarized on a daily basis where interim report was produced, analyzed and interpreted. The study confirmed that gender mainstreaming; strategies wrere used to set opportunity for gender equity and equality in public TIVET institutions. The study confirmed that the college or school is a social agent and therefore gender disparity was not encouraged. The study found out gender mainstreaming was available to some extent in these institutions in Nyanza province however recommendation was that the Ministry of Higher Education science and technology should take drastic measures to ensure that there were adequate lecturers to cater for the large number of students. All stakeholders in education should act to provide equality in education so that implementation is taken seriously to bring gender equality and opportunity in education.

Visceral Leishmaniasis or Kala-Azar is a chronic systemic disease characterized by fever, weight loss and weakness and, if left untreated, death. Diagnosis of KA is by direct visualization of the parasites in a culture medium or in host tissue; or by serological demonstration of antigen nuclear material or antigen-antibody reaction by way of a variety of laboratory tests. The research was a determination of technical efficiency of two most commonly used laboratory tests for screening and diagnosing Kala-Azar (KA) in Wajir County in North Eastern Province of Kenya in the year 2008 by way of a cost-effectiveness analysis. These tests were Direct Agglutination Test (DAT) and a rapid dipstick test called rK39™. The rK39, at the time of the study, was not recognized by Ministry of Health because there was inadequate information on its performance in the Kenyan context. However, in Wajir, rK39 was more available than DAT. Additionally, DAT was cumbersome to use in Wajir as it required that specimens be shipped to Nairobi where the actual testing was done. Hence, there was the need to recommend a diagnostic kit that was cost effectively suitable for use in Wajir. The study therefore sought to conduct cost effectiveness analysis on the use of DAT and rK39 as diagnostic kits for KA in Wajir, Kenya. A hospital-based, cross-sectional descriptive study was done. Quantitative secondary data of newly suspected Kala-Azar cases seen in Wajir County Hospital and subjected to both DAT and rK39 and splenic aspiration in the year 2008 was collected using specific data collection forms. Collected data comprised the study subjects’ Kala-Azar (KA) test results and monetary costs related to KA testing using DAT and rK39 tests. Data was analyzed using the computer based statistical software Statistical Package for Social Sciences (SPSS) version 14. A cost effectiveness ratio was calculated as the cost per morbidity averted relative to the obligatory morbidity associated with the absence of correct diagnosis and treatment of KA. Ease of test performance calculated as number of test steps and the requisite skills and equipment was used as adjunct measure of test suitability for Wajir. The study found the average cost-effectiveness ratio of DAT was 812 while that of rK39 was 57. The rK39 test was therefore found not only effective but also more cost effective and easier to perform compared to DAT. These findings correlated well with findings of other DAT and rK39 cost and effectiveness studies done in East Africa, Asia and South America where KA is endemic. The study thus recommended rK39 test for adoption by Ministry of Health as first line screening test for Kala Azar in Wajir. It was also recommended that more studies of the prevalence of KA in Wajir and other regions of Kenya be done so that tests for KA can be segregated by regional predictive value.

The link between financial deepening and economic growth has long received significant attention in economics, however, the waves of financial deepening cannot raise the tide of the economy without affecting bank profitability; it is against this background that this study was formulated to examine the effects of financial deepening on profitability of commercial banks in Kenya. The study targeted all the commercial banks in Kenya. Secondary data was collected from the Kenya National Bureau of Statistics, Central Bank of Kenya and websites of licensed Commercial banks in Kenya. The study used both explanatory research design and inferential statistics to investigate the effect of financial deepening on profitability of commercial banks. The findings of the study revealed that financial deepening affects bank profitability positively. The results of this paper therefore, present a strong argument towards increasing financial deepening as an important stimulator of greater banking profitability. While Kenya still exhibits relatively low levels of financial deepening, commercial banks profitability displays an increasing trend in recent years. An expansion of credit to the private sector may be an important determinant of further banking profitability increases in the future. Therefore, policy oriented measures in the country should take in consideration the positive causality between financial deepening and banking profitability change and try to increase the level of credit to the private sector as a stimulant of economic growth.

Male involvement has been blamed for the poor utilization of health care services across the globe. This study sought to establish the determinants of male involvement that influence the utilization of maternal and child health services in Lamu county. It was guided by five objectives: To establish the social cultural factors that influence utilization of maternal and child health services, to assess the economic factors that influence male involvement in the utilization of maternal and child health services, to assess the demographic factors that influence male involvement in the utilization of maternal and child health services, to establish how the attitudes of health workers affects male involvement in the utilization of maternal and child health services and to examine the opinions of community members as regards to male involvement in the utilization of maternal and child health services in Lamu county. The research employed a qualitative descriptive design. Data was collected in June 2013 through use of focused group discussions, key informant interviews and in depth interviews .Multi- stage sampling was used to sample the health facilities with a complete list of all health facilities as the first level and a list of the 10 busiest facilities as the second level. Purposive sampling technique was used to select 4 health facilities with the highest MCH visits in the county, the community leaders and to select the health workers for the study. Typical case sampling was used in selection of men accompanying their women to the MCH clinics. Homogeneous sampling was used in selection of men and women for the focus group discussions from the health facility catchment area.Tape recorded interviews were first transcribed verbatim before content analysis was undertaken. The study established that the community perceptions and the strong cultural and gender norms, coupled with financial constraints play a key role in men that prevent them and their families from utilizing the MCH services offered in the health facilities. In addition, health worker behavior and the long waiting time in health facilities bars men from such facilities. The study further found out that religion, age, level of education and profession of the men play a key role in determining their involvement in the utilization of MCH services in Lamu county.The study recommends that policy makers and stakeholders in generalshould strive to mainstream male involvement in MCH programming and move away from the traditional approaches of MCH which placed the man at the periphery of reproductive health programmes. This should be supported with stronger policies in place which will be implemented at all levels of health care, from the community to the higher levels of care for them to succeed