Background: Cesarean section (CS) is one of the most common major surgical procedures in Obstetrics. It is an effective lifesaving procedure in preventing maternal and perinatal mortality and morbidity when medically indicated(8). The rate of CS has been on a rising trend globally(9). Readmission rate is a recognized metric used to measure the quality of healthcare in surgical and medical specialties; the primary goal of this evaluation is to prevent morbidity. Women who deliver through CS are at a higher risk of readmission than those who have had spontaneous or assisted vaginal delivery (13)(14)(15). No studies in sub-Saharan Africa including Kenya have evaluated the risk factors for readmission after cesarean section (CS) which is essential in designing effective readmission prevention interventions. Objective: To determine the risk factors, indications, and outcomes of post-CS readmission at Kenyatta National Hospital (KNH), from January 2014 to December 2019. Methodology: This was an unmatched case-control study in which 107 records of post-CS patients readmitted within 6 weeks postpartum (cases) and 213 records of post-cesarean section patients who were not readmitted (controls), in a ratio of 2 controls to 1 case, after cesarean sections performed at KNH from January 2014 to December 2019. The socio-demographic, intrapartum, postpartum factor and comorbidities were summarized as frequencies or means and compared using Chi-square or student t-test for categorical data and continuous data respectively. Univariate and multivariable logistic regression adjusted for confounding factors were conducted to determine crude and adjusted odds ratios (aOR) and their 95% confidence intervals. Statistical significance was based on a p-value < 0.05. The indications for readmission and outcomes were tabulated and presented as frequencies (percentages) for the cases. The data was analyzed using the STATA version15. Results: Between January 2014-December 2019, 25,449 patients underwent CS at KNH. Of these, records of 107 out of 166 cases and 213 out of 334 controls were eligible. The main risk factors for readmission post CS in KNH were unemployment (aOR 1.87, 95% CI [1.00 - 3.49], P<0.05), referral from another facility for CS at KNH (aOR 2.23, 95% CI [1.14 - 4.33 P<0.05]), induction of labour (aOR4.27, 95% CI [1.94 - 23.34], P<0.05) and intraoperative hemorrhage (aOR11. 50, 95% CI [1.19 - 111.18], P<0.05). The most common indication for readmission was viiidue to surgical site infections (72.89%). Fifty-eight percent of the readmitted patients were managed conservatively post-CS while 42.1% had surgical interventions. The median length of stay post-discharge was 3 days. All readmitted patients were discharged home. Conclusion: Main risk factors for post-CS readmission were patients who had been managed at peripheral facilities then referred to KNH for CS, and induction of labour. The most common indication for readmission was due to surgical site infections (72.89%). The average length of stay during readmission was 3 days. Fifty-eight percent of patients were managed conservatively while 42.1% of the readmitted patients required surgical intervention. All patients were discharged home. Recommendations: To reduce readmission post-CS, infection reduction and surveillance should be instituted especially among those with risk factors which include the unemployed, referrals to KNH for CS, and induction of labour. Keywords: readmission, cesarean section, postpartum

Background: Congenital heart diseases (CHD) are common congenital anomalies that account for a significant proportion of mortality and morbidity in children. Presentation of CHD varies from asymptomatic discovered accidentally to severe and debilitating complications and death. Early diagnosis and treatment have great effects on prognosis. Inadequate knowledge on the patterns of CHD, associated risk factors and its treatment outcomes impede the development of appropriate interventions. Objective: This study evaluated the patterns and risk factors of congenital heart disease and treatment outcomes during acute phase hospitalization among children aged under 5 years at Kenyatta National Hospital (KNH). Methods: This was a retrospective case-control study, involving children aged below 5 years admitted to KNH’s Pediatric Unit between 1st January, 2017 and 31st December, 2021 who had CHD. A total of 2,450 medical records of pediatric patients were reviewed. A similar number of health records (matched for age) without CHD was used as a control group. The researcher used census method whereby all pediatric patients’ health records with documented CHD case and their matched controls, under the specified period, were reviewed. The data was extracted from the pediatric patients’ medical records, kept at the hospital’s Records department, using a data abstraction form. The outcome of interest included mortality and recovery rates. The study data was analyzed descriptively using SPSS version 25 and presented in form of frequencies and percentages. In addition, chi-square test statistic and odds ratios were utilized to analyze the study variables’ association at 5% significance level. Findings of the study were summarized in tables and figures. Results: Over the period 2017 to 2021, ventricular septal defect cases rose from 74 to 116 (a 56.8% rise); atrial septal defect cases rose from 45 to 74 (a 64.4% rise); patent ductus arteriosus cases rose from 61 to 85 (a 39.3% rise) while pulmonary valve stenosis cases rose from 31 to 47 (a 51.6% rise). Ventricular septal defect (27.4%), was the most prevalent CHD. Risk factors of CHD included multiple pregnancy (Chi square p = 0.002); lack of access to prenatal care during pregnancy (Chi square p = 0.000); maternal diabetes mellitus (Chi square p = 0.000); maternal medications use during pregnancy (Chi square p = 0.019) and prematurity (Chi square p = 0.000). The risk factors of CHD established to have a statistically significant association with poor treatment outcomes among the children included; infants’ down syndrome (Chi square p = .000; OR = 4.52) and prematurity (Chi square p = .007; OR = 2.21). Recovery rate in the CHD group was 87.3% while the mortality was 12.7%. Conclusion: There was an increasing trend of prevalence of the CHD defects in children in KNH over the five-year period. Children with cyanotic CHD, on average, had 3 times higher odds of dying from CHD compared to those with acyanotic CHD. Infants’ down syndrome and prematurity were the risk factors related to poor treatment outcomes of CHD among children admitted at KNH. Recommendations: The increasing trend of CHD needs further evaluation. Staff sensitization on diagnosis of CHD, since the most common CHDs are acyanotic which are not easy to identify. Infants’ down syndrome and prematurity require more attention and specialized care.

This study's goal was to find out how English performance in public secondary schools in Kenya's Makindu Sub-County was impacted by the physical environment of the classroom. The following goals served as the study's guiding principles: to determine the degree to which visual and acoustic factors affect students' performance in English language in public secondary schools in Makindu sub-county; to ascertain the degree to which spatial factors affect students' performance in English language in public secondary schools in Makindu sub-county and to ascertain the ways in which these factors interact. The research design used in the study was descriptive. The study's explanation of the relationship between the independent and dependent variables was based on environmentalist learning theory. 60 English professors and 2260 pupils made up the study's target group of 2320 respondents. A sample size of 286 was employed in the proportionate random sampling procedure to choose the respondents. The primary data was gathered using self-administered questionnaires that included both closed-ended and open-ended questions. The study discovered that when learning takes place in a well-lit classroom with pertinent charts, flashcards, and photos, pupils are more engaged. Additionally, during English sessions, outside noise interferes with the teachers' ability to communicate the lesson's topic. It was further shown that hot weather makes students less attentive when learning English in the afternoon. The study concluded that using learning aids in public secondary schools in Makindu Sub County helps students' grammar and vocabulary. It also came to the conclusion that classroom noise, both internal and external, hinders students' performance in English reading, comprehension, and writing assessments. Improving the classroom environment, including the desks and chairs, will increase English performance, and conversely. Furthermore, it concluded that hot classrooms significantly hinder students' ability to perform well in English. The study recommends that school boards of administration make sure that classrooms are illuminated and that English teachers are incentivized to use a variety of teaching tools, charts, and other displays to help pupils with their grammar and vocabulary during lessons. Around the classroom spaces, internal and exterior noise should be kept to a minimum. According to the study, classrooms might as well have adequate area for teachers and students to walk around freely during lessons, form groups, and engage in other educational activities. It was suggested that all classrooms have big, glass-covered windows, good ventilation, and fresh air circulation.

Life around the world has been significantly disrupted by the corona virus.The impact of the pandemic has been felt by different sectors including the education sector. The pandemic, like any other, had a wide-ranging impact on education. Government decisions have been directed toward a common goal of reducing the spread of the virus by instituting socializing regulations. Many countries suspended face-to-face teaching. This study intended to ascertain how the academic performance of children in public primary schools in Vihiga Sub-County, Vihiga County, Kenya, was impacted by school closures related to COVID-19,determine how pupils' lesson attendance in public primary schools in Vihiga Sub-County, Vihiga County has been impacted by the shutdown of schools due to the COVID-19 pandemic, determine how students' self-guided study has been affected due to COVID-19 pandemic in public primary schools in Vihiga Sub-County, Vihiga County, and determine the effects of the COVID-19 pandemic-related school closure on students' performance in continuous assessment tests in public primary schools in Vihiga Sub-County, Vihiga County.The research used a descriptive survey design, and 145 participants,who included head teachers, class 8 teachers, class 8 students, and Sub County MoE officials, were handed questionnaires using the Likert scale. The respondents were randomly picked for the study and the data was analyzed using SPSS 23. The research revealed thatit was difficult for the students to learn well at home. It was found that the pandemic had endangered students' education since many of them lacked the necessary skills for self-directed study. The studies established that the emergence of COVID-19 pandemic had a significant detrimental impact on learners' academic performance, particularly those who attend public primary schools in rural and low-income areas. At the same time, precise actions that could lessen these harmful impacts were identified. Most learners have been out of the classroom for more than roughly half duration of a typical school year due to school closures. Given the extent to which school-based instructional time have been lost with the reopening of schools, determining the true degree of learning losses and implementing corrective actions are essential to prevent the establishment of medium and long-term educational issues. While there may be a high possibility to continue ceding decisions about syllabus coverage and appraisal tests to teachers, the study recommends a more diverse approach, including consideration of accelerated learning and additive remote strategies, as well as prospective endeavors to shore up as much learning time as possible.

The importance of monitoring and evaluation as a key instrument for program performance has grown. Continuous project progress monitoring seems to increase, among other things, the likelihood of project success. In order to improve project performance, several businesses have worked to incorporate an M&E system. Many nations have created laws and regulations to safeguard the environment and make sure that human activities have as little influence as possible on it in reaction to the growing environmental deterioration. This9 study9 aimed9 to9 determine9 the9 influence9 of9 monitoring9 and9 evaluation9 on9 the9 performance9 of9 environmental9 projects9 in9Kenya, and specifically on a selected project at the Institute for Law and Environmental Governance. The study set out to answer the following questions on the impact of M&E expertise, stakeholder participation, project budget, and M&E structure on the success of environmental projects at the Institute of Environmental Studies (IES) in Kenya. A descriptive survey method was used for this investigation. The target population was 40 and included project managers, project assistants, monitoring and evaluation officers, project field officers, and other personnel involved in implementing environmental projects at the Institute for Law and Environmental Governance. Additionally, the sample included 40 personnel, and ethical considerations in research were considered. The data was collected with the use of a questionnaire and an interview guide, and it was afterwards analyzed9 using9 descriptive9 statistics9 and9 the9 software that comes with the Statistical Package for the Social Sciences (SPSS). These measurements included the central tendency and the percentages as well as frequency distributions as well as measures of dispersion. According to the study findings, employees in Kenya at the Institute for Law and Environmental Governance had the necessary experience to collect primary M&E data from environmental projects within the required time, stakeholder participation in monitoring and evaluation is essential for positive project outcomes to be realized, M&E activities should be budgeted for so that the resources needed to carry them out are made available and that an M&E structure enhances completion and success of environmental projects. The study concluded that expertise in M&E, Stakeholders’ participation, Project budget and M&E Structure affect all performance of environmental projects in Kenya at the Institute for Law and Environmental Governance. The study recommended that the management at the Institute for Law and Environmental Governance should ensure that all the individuals involved in M&E exercise undergo continuous capacity development, all environmental projects have an efficient stakeholder engagement framework, M&E activities for environmental projects are budgeted for in advance so that the resources needed to carry them out are made available, and that the established M&E structure is based on best practices that promote evidence-based public trust and decision-making.

Malaria Transmission Blocking Vaccine (MTBV) candidates capable of eliciting effective and long-lasting protection, thereby blocking or reducing community Plasmodium falciparum transmission rates are becoming more fashionable. Domain 1 of pre-fertilization P. falciparum surface protein 230 (Pfs230 D1), Pfs48/45 D3, and post-fertility protein Pfs25 are key fronted vaccine candidates. Aside from eliciting a strong antibody response, their candidacy's success will be determined by their ability to overcome obstacles such as antigenic variations that may affect their functionality, resulting in strain transcendence or allele-specific immunity, or loss of antigenicity due to conformation of antibody binding epitopes or antigen structure. This study determined polymorphisms with functional significance on the immunodominant domains of the three antigens in P. falciparum populations from different rural parts of western Kenya with varying transmission intensities. Clinical blood smears, dry blood spots and patients’ demographic data were collected at health facilities in Malaria-endemic Homa Bay (endemic area with ongoing indoor residual spray), Kisumu (endemic area without IRS), and Kisii (epidemic prone highland). Microscopy and real-time polymerase chain reaction were used to detect microscopic and submicroscopic infections, respectively. On parasite positive DNA samples, each target gene was genotyped and genetic computations were performed. In epidemic-prone rural area of Kisii highland, there were 231/1115 (20.7%) positive malaria cases. Morara and Nyabikondo village had the most microscopic infections (24/57, 42%). Submicroscopic infections were uncommon (14.7%) and more common in females (19.7%) and adults (21.1%). In malaria endemic zone of Homa Bay, clinical microscopic infections were low (14.7%). The majority of positive clinical cases (36%, 112/313) were submicroscopic, resulting in an overall prevalence of 45.2%. Submicroscopic infections were more prevalent in females (35.6%, 72/202) than in males (24.2%, 40/165). Among 156 iiigenotyped samples, the Pfs230 D1 had low nucleotide diversity (π=0.15×10-2), with variation observed per study site. Six segregating sites (1616, 1813, 1955, 1964, 1967, and 1983) were identified, each resulting in nonsynonymous mutations (I539T, G605S, T652R, E655V, T656N, and K661N) and eight haplotypes. Recombination, inbreeding, purifying and balancing selection were key drivers of these mutations. The Pfs48/45 D3 sequences of the 118 clinical isolates had a high conservation index and low nucleotide diversity (0.063×10-2). Three polymorphic sites were identified: 911, 940, and 979, which resulted in nonsynonymous mutations (V304D, L314I, and C327G). C327G polymorphism occurred on one of the cysteine residues involved in structural conformation. Except for recombination, the drivers for these mutations were similar to those for Pfs230 D1. On the 177 Pfs25 sequences, low mutation frequencies (1.3% to 7.7%) were observed, resulting in a low nucleotide diversity (0.04×10-2). Ten dimorphic codons were discovered (H41H, L42M, I83I, C110C, C115W, L122L, T124T, T130T, V132I, and V143G), nine of which were novel (H41H, L42M, I83I, C110C, C115W, L122L, T124T, T130T, V132I, and V132I). Two polymorphic codons (C110C and C115W) were of functional importance and occurred on cysteine residues. There was strong purifying selection at all polymorphic loci, as well as a high level of inbreeding. This study established that there are a high number of clinical malaria cases in epidemic-prone zone of Kisii highland, and two villages are potential sentinel sites for future public health intervention if a malaria epidemic occurs. Despite low levels of microscopic infection in malaria endemic zone (Homa Bay), a high proportion of positive (submicroscopic) malaria cases are missed in health facilities; a more sensitive diagnosis test should be used to supplement microscopy. This will help to reduce the fraction of false negative results, potentially lowering the risk of escalating or maintaining residual P. falciparum community transmissions. With the presence of polymorphic sites of functional significance in Pfs230 D1, Pfs48/45 D3, and Pfs25, there is a need for further immunological investigation of the effect ivof these polymorphisms when designing TBVs based on the sequences of these genes and their potential impact on antibody binding epitopes

The primary objective of this project was to examine the Influence of Digital Marketing Platforms on the performance of Small Business Retailers in Kamukunji Market, Nairobi, Kenya. The projects main objectives included to establish the digital marketing platforms used by small businesses in Kamukunji market, Nairobi, Kenya and also to determine the influence of the digital marketing platforms on productivity of SMEs. The study reviewed related research on SMEs issues in embracing technology, the growing social-media marketing, and the components of the take-up. The study employed the use of a descriptive, cross-sectional survey research design. This technique involves collecting data across many research units simultaneously, primarily through questionnaires (Gujarati, Porter & Gunasekar 2013). The study population included approximately 7000 jua kali entrepreneurs in the Kamukunji market in Kenya and used a systematic random sampling technique to select a sample of 250 participants for the data collection. Data was collected from business owners and shop attendants by using questionnaires. Subsequently, data was analyzed using quantitative analysis techniques comprising of descriptive statistics for the univariate variables and bivariate analysis conducted via Pearson's correlation test and also applied the Kruskal-Wallis’s test. The project noted that the retail industry is a vital employer, whether directly or not. The study on the Influence of Digital Marketing Platforms on the performance of Small Business Retailers in Kamukunji Market, Nairobi, Kenya was premised on various theories that include the social network theory, the theory of collective intelligence and the generational theory. The main findings of the study indicated that most of the entrepreneurs at Kamukunji market do not actively use email marketing despite its relative significance on the growth of the business. Secondly, mobile marketing was the second-best used strategy behind social media marketing which was largely used by a larger population in the study. Social media marketing was best preferred because of its affordability and the large number of social media users across the nation. The project noted that the retail industry is a vital employer, whether directly or not. The study on the Influence of Digital Marketing Platforms on the performance of Small Business Retailers in Kamukunji Market, Nairobi, Kenya was premised on various theories that include the social network theory, the theory of collective intelligence and the generational theory

Depending on how effectively disposable resources are managed and how cautious a firm is when it comes to resolving operational concerns, the skill of striking a balance between firm working capital and dividend payments frequently determines business success or failure. The unfavorable effects of both overinvesting and underinvesting in working capital have encouraged research on the most effective policy for managing working capital. Efficient WCM leads to availability of free cash flows which then act as a catalyst to dividend payout. The main intention of this study was to examine WCM impact on dividend payout of listed non-financial firms in Kenya. The Keynesian liquidity preference theory, the free cash flow theory and the transaction cost theory were adopted to anchor the study. A descriptive research design was utilized in this research. The target population was the 42 listed nonfinancial firms in Kenya. Secondary data was gotten from the CMA and specific listed non-financial firms annual financial statements for a 5year period (2017 to 2021). Upon collection of the data, inferential as well as descriptive statistics generated included frequencies and percentages and simple and multiple linear regression respectively. The regression results produced a 0.154 R square which implies that 15.4% of the changes in dividend pay-out among listed non-financial firms can be described by the six selected variables for this research. The overall model was found to be statistically significant as exhibited by a 0.000 p value that was below 0.05. The study further revealed that individually, DIO, DSO and DPO do not have a significant impact on dividend payout of non-financial firms listed at the NSE (β=0.081, p=0.232); (β=0.-101, p=0.133); (β=-0.026, p=0.822). Both firm size and profitability positively affected dividend payout as shown by (β=0.261, p=0.000) and (β=0.214, p=0.000) respectively. Financial leverage exhibited a negative and significant dividend payout influence as shown by (β=-0.202, p=0.008). The research recommends management of listed non-financial firms ought to focus on enhancing their asset base and their profitability as this will enhance dividend payout. The study further recommends the need to for listed non-financial firms to set debt limits as high debt levels might have a negative impact on dividend payout. The research recommends the necessity for further researchers to focus on other dividend payout determinants.

Business alliances are seen as stepladders to lessen the threats associated with foreign market expansion. Through alliances, foreign firms get easily accepted by foreign governments and the people. Due to the diverse nature of alliances, organizations joining tend to access diverse views of business operational approaches that boost chances of profitability. This research aims to determine the influence of SkyTeam alliance on the performance of Kenya Airways limited. The study has set out two objectives: to determine the nature of the alliance between SkyTeam and Kenya Airways Limited and to determine how the alliance between Kenya Airways Limited and SkyTeam Alliance has influenced the performance of Kenya Airways Limited. The study was anchored on three theories; Business Alliance theory, Stakeholder theory, and Resource dependence theory. The study targeted the senior management of Kenya airways limited who are the Chief Executive Officer, Chief information officer, Non-executive director, Chief financial officer, Fleet and asset development director, and The Kenya Airways Limited section heads as informants. A case study design was used for this study and interview guide as the data collection instrument. Content analysis was used to analyze the primary data obtained. The research established that the involvement of Kenya Airways limited with SkyTeam alliance was a strategy by the airline to open up international hubs, reduce cost of operation and increase profitability through the avenues provided by the alliance. The respondents recounted that Kenya airways adopted the business policy and procedures for SkyTeam alliance. These included the codeshare agreement, share of airport lounges with member alliances and round the world ticket policy. The benefits derived from the consortia included; venture for international growth, economies of scale, economies of density, economies of scope, branding and marketing benefits and controlled barrier of entry. The respondents also observed the negative influences of the alliance to the operation of Kenya airways which included domination in decision making by well-established airlines that are in the alliance and being that Kenya airways joined the alliance after it had formed and it tends to tow in to the original strategy of the alliance rather than operate within its organization strategy. The study found out that Kenya Airways Limited had gained a competitive advantage through its association with Sky Team alliance through the enhancement of its operations. It was concluded that Sky Team alliance had in fact positively influenced the performance of Kenya Airways Limited

Corporate governance is a critical area in every organization that influences the strategic planning practices adopted by a firm. Good corporate governance helps in the formulation of strategic decisions such as strategic planning which are effective and thus leads to performance of the business. This study therefore envisioned to establish the effect of corporate governance on strategic planning practices. To find out the effect of corporate governance on strategic planning practices the researcher collected primary data using questionnaire method which added up to 94.2 % response rate. Data collected was on strategic planning practices which were the dependent variable, corporate governance and organizational culture which were the dependent variables. This data was collected from Equity bank branches that are within Nairobi County due to accessibility and cost. The study conducted descriptive and inferential analysis to the data collected. The descriptive analysis indicated that the bank is doing very well in adopting strategic management practices given that its overall mean ranged between 3.57 and 4.04, although, the results indicated that improvement is required for better performance. Descriptive statistics indicated that the strategic planning practices adopted can be attributed to the corporate governance whose performance was found to be good, indicated by an overall mean ranging between 3.43 and 4.08. The organizational culture which was the second independent variable indicated a lower performance than corporate governance which implied that it was less practiced compared to corporate governance. Its overall performance of organizational culture was slightly above average as the means of statements under organizational culture ranged between 3.01 and 4.2. The study as well conducted regression analysis and revealed that the model account 68.1% of the changes in the strategic planning practices indicated by R squared value of 0.681. Adjusted R squared is slightly below the coefficient of determination with a value of 0.675 indicating presence of some few elements in the model that did not help to improve the model. The effect of corporate governance was discovered to be statistically significant on strategic planning practices as shown by a p-value of less than 0.05. The regression coefficients indicated that the effect of corporate governance on strategic planning practices was statistically significant but the p- value of organizational culture was 0.085 which was greater than 0.05 indicating a statistically insignificant impact on strategic planning practices.