The government of Kenya has adopted the centralized textbook procurement of textbooks for schools in order to achieve recommended student to textbook ratio. The aim of this study is to determine the effects of centralized textbooks procurement on marketing strategies of textbook Publishers in Kenya a case of Kenya Literature Bureau. The study was anchored on marketing mix theory which encompasses careful selection of seven P’s in order for business organization achieve its objectives and the Ansoff Product-Market growth matrix theory which involves varying product growth and market growth for marketing forecasting process. The research was a case study since the unit of analysis was a single entity that had respondents from heads of departments of the organization that is, Business Development, Sales and Marketing, Finance and Administration, Procurement and Customer Relations departments were interviewed for the study. Primary data was utilized by the researcher, which was obtained by way of interview guide. Content analysis was used since data collected was qualitative in nature. The results in this study showed that effects of centralized textbook procurement within the Kenyan publishing industry are directed by government a direction which in turn changes market response thus the affecting marketing strategies of players .Proper communication, dissemination of market information, intensive market research among others are very key during external business environment change.

This work aimed at improving the small ruminant livestock value chains in Machakos by establishing interventions in animal health and women empowerment through their opportunities in vaccine value chain (VVC).The study evaluated the roles, constraints and opportunities for women and men, along the Contagious Caprine Pleuropneumonia vaccine value chain (CCPP_VVC). Focus Group Discussion (FGD), Outcome mapping (OM), focus meal (FM), and key informant interviews (KII) were used to appreciate the context of vaccination in the area. 228 participants were consulted including VVC stakeholders and model farmers. Principal takeholders identified included the vaccine manufacturers, vaccine importers, distributors, agro vets, public veterinary services, private veterinarians, local leaders and farmers. Woman Empowerment in Livestock Index survey was calculated from 300 households whose data was selected from 398 interviewees(KEVEVAPI, distributors in Machakos County agro-vets, vaccinators and, mostly small-scale women farmers). 8% of farmers were found to have access to vaccine but only 1% of them had easy access. 84% of farmers had low access to the vaccine suppliers. The findings revealed that among barriers for access to vaccine are lack of awareness, knowledge about vaccine, lack of finance, government inability to meet the demand and low veterinarians (particularly women) /farmer ration in the public sector. The conclusion was a need to develop an understanding gender disaggregated level of contribution by men and women to the value chain and how the benefits of contribution areshared. Such knowledge is important to empower women’s participation in the VVC and also to increase vaccine access to smallholder farmers and consequently improve goats’ production and the wellbeing of farmers’ families. URI

Health workers and managers planning and budgeting practices are unknown, yet they are key influencers of the processes. However, they rarely have the knowledge or participate in the process. This study investigated the relationship between health worker and managers knowledge on planning and budgeting, and participation in the county health planning and budgeting processes. Few studies have focused on assessing health worker knowledge and application in the planning and budgeting processes. This was a descriptive cross-sectional study that employed mixed-method approach using both quantitative and qualitative data. The sampling frame from which the study participants were drawn was N=2,229 as at June 2016. Semi-structured questionnaires were administered to the health workers and purposively selected health managers. The study sample comprised of n=257 health care workers in Nairobi County, while the health managers were 25. Data was coded and analysed using SPSS. Descriptive statistics were used to describe the relationships between knowledge and participation in health planning and budgeting. Logistics regression analysis was used to determine the relationship between knowledge and participation in health planning and budgeting. The findings of the study established that 47.5% of the health workers were not trained on planning, and slightly over a half 51.8% had not been trained on health budgeting. Among those trained on health budgeting only 23% (29) had been trained with the relevant budget training in relation to the PFM system, which is important for county health planning and budgeting. The study findings also established that 69.6% of the health workers were participating in the planning and budgeting higher than those that had actually been trained. Among the purposively selected health managers, 32% had been trained on budgeting. The health workers and managers shared “low satisfaction” with the

Background: Treatment of infertility is a major global problem which has remained a challenge in many ways. The cornerstone of in vitro fertilization (IVF), which forms the end point in care of infertile couples, is controlled ovarian stimulation (COS). However, predictability of outcomes has remained elusive despite identification of several biomarkers. Metaphase II (MII) oocytes are the mandatory prerequisite to IVF. However, there appears to be no relevant studies that focus on prediction of MII outcomes as an indicator of the potential for fertilization in patients that are undergoing IVF. This study focuses on the value of serum AMH in predicting MII oocyte outcomes in women undergoing COS. Objective: To determine the role of serum AMH as a predictor of Metaphase II (MII) oocyte yield during controlled ovarian stimulation in a private fertility clinic in Nairobi. Methodology: Retrospective descriptive cohort study that compared the processes in ovarian stimulation (OS) that culminate in production of MII oocytes in subjects with normal and low serum AMH. It was done at a private fertility clinic in Nairobi. Odds ratios (OR) and p values were used to compare the outcomes of OS between the two groups. Results: Among those who had normal serum AMH levels, 17(28.2%) were aged more than 35 years as compared to19 (73.1%) among those who had low serum AMH (OR 0.1, 95%CI 0.1-0.4, p value <0.001). Normal response (5 to 14 follicles) on day 5 predominated in both groups but it was more preponderant among those with low AMH (normal AMH with 34 (57.6%) of the patients compared with 17 (65.4%) among those with low AMH, OR 0.7, CI 0.3-1.9, p<0.001). However, hyper response (>15 follicles) occurred in 23 (39.0%) and 1 (3.8%) respectively (OR 15.9, CI 2.0-126.1, p<0.001) for normal and low serum AMH respectively. The pattern was similar on day 7 follicular count. Normal total oocyte harvest (5 - 14) occurred in 24 (40.7%) of patients with normal serum AMH compared to 9 (34.6%) among those with low AMH (OR 1.3, 95% CI 0.5 – 3.4, p value 0.597); while 24 (40.7%) and 1 (3.8%) of those with normal and low serum AMH respectively had > 15 oocytes (OR 17.0, 95% CI 2.2 – 135.2, p value <0.001). There were 19 (73.1%) of patients with low serum AMH who had low MII oocyte yield compared to 16 (27.1%) in patients with normal serum AMH (OR 0.3, 95% CI 0.1-0.8, p value 0.014) and this difference persisted after controlling for age. Among those with normal serum AMH, 30 (50.8%) had MII oocyte yield between 5 to 14 oocytes compared to 7 (26.9%) of patients with low serum AMH (OR 2.8, 95% CI 1.0-7.7, p value 0.040) whereas 13 (22.1%) of patients with normal serum AMH had MII oocyte yield of more than 15 oocytes compared to none in patients with low serum AMH. The sensitivity, specificity, positive and negative predictive values of serum AMH as a predictor of MII oocyte yield were 86.0%, 54.3%,72.96% and 73.1% respectively. The trend was similar for total oocyte harvest. Conclusion: Serum AMH is a qualitative and quantitative predictor of MII oocyte yield as well as the preceding total oocyte harvest and follicular count. Hence, the levels of serum AMH can be used to provide counselling on possible outcomes of COS.

QUALITY OF ANTENATAL CARE SERVICES AND PREGNANCY OUTCOMES AMONG PATIENTS WITH PRE-ECLAMPSIA WITH SEVERE FEATURES MANAGED AT KENYATTA NATIONAL HOSPITAL Introduction. Hypertensive disorders in pregnancy are the second most common cause of maternal mortality after obstetric hemorrhage and occur in 6-8% of all pregnancies Pre-eclampsia with severe features (PES) still remains a major medical and public health concern. High quality of antenatal care (ANC) is associated with improved maternal, fetal and neonatal outcomes. Globally although 86% of pregnant women access ANC with skilled health personnel at least once, only 3 in 5 (62%) receive ≥ 4 ANC visits (UNICEF, 2016). In Kenya, 60% of pregnant women had ≥ 4 ANC visits (KDHS 2014) Objective: The primary objectives were to determine the association between the quality of ANC services, pregnancy outcomes, the types of health facilities and the patients’ perception of ANC services among patients with PES managed at Kenyatta National Hospital. Methodology This was a descriptive cross-sectional study in which postpartum patients who were diagnosed with PES at a gestation period of 28 weeks or higher and who had delivered within the first 72 hrs were consecutively sampled. The study was conducted at the Post Natal Wards (GFA, GFB, 1A) of Kenyatta National Hospital. Quality of care was defined as presence of all parameters of the 2016 ANC World Health Organization (WHO) recommendations and Ministry of Health guidelines which were; appropriate ANC visits by gestation, prescription of prenatal vitamins, a complete antenatal profile (HIV/VDRL/HB/Urinalysis/Blood Group/Blood sugar/), discussion of a delivery plan, weight measurement, counseling on fetal movements, assessment of uterine fundal height and fetal heart rate, nutritional counseling and information on progress of antecedent pregnancy. Hypertension related parameters that were assessed during ANC included: blood pressure, administration of antihypertensive drugs, counseling on danger signs, and administration of MgSO4. These parameters were assessed using the patients file, ANC booklet, and interviewer questionnaires. Pregnancy outcomes were adverse or good maternal, fetal and neonatal outcomes. Data was entered into and analyzed using of SPSS® version 21. Categorical data was analyzed and presented as frequencies and proportions; continuous data was summarized and presented as means and standard deviations and compared using the chi-square test. Continuous variables were calculated using mean and SD or median and inter-quartile range and compared using Independent t- test. Chi square test was used to assess factors associated with adverse outcomes. Results: Between April and July 2019, 240 postpartum women with PES were screened and 161 (67%) who were eligible enrolled. About one third (n=56, 35%) of study participants received good quality of ANC. The most performed general ANC parameter was prescription of prenatal vitamins (70.2%) while the least performed was discussion of a delivery plan during ANC (55.3%). The most performed hypertension related ANC parameter was weight measurement during ANC (68.3%) while the least was administration of MgSO4(38.5%) There were more adverse maternal and neonatal xvi outcomes in women who had poor (61%) compared to those who had good (31%) quality of ANC, however this was not statistically significant (p=0.085). Majority (61%) of patients who had poor quality of care, received ANC from government health facilities. Patients who received poor quality of ANC ranked their care at 75% compared to those who received good quality ANC who ranked their care at 85% Conclusion: Overall poor quality of ANC services was offered to patients with PES. Poor quality of ANC services was associated with adverse outcomes (maternal/fetal/neonatal). Patients with PES were more likely to receive poor quality of ANC services in a government facility as compared to a non-government facility. There was no difference between perceived and received quality of care. Recommendation: Antenatal clinics especially those at government facilities should improve the quality of care overall and for patients with preeclampsia. Patients with PES who attend ANC should be given prenatal vitamins, have a complete antenatal profile, be counseled on fetal movements, undergo fetal surveillance (detection of fetal heart), be informed on the progress of their ongoing pregnancy, have nutritional counseling and have discussed and agreed on a delivery plan. Under hypertension related parameters all patients with PES should have their blood pressures monitored, be given the necessary antihypertensives, be counseled on danger signs in pregnancy and be given MgSO4. ANC clients should be educated and encouraged to demand better quality of ANC services offered to them by healthcare workers.

Background- Decompression Sickness is the greatest danger to the health and wellbeing of diving fishermen, potentially rendering them permanently disabled or dead. Published prevalence of decompression sickness in professional and military divers stand at 3.4% and 2.9% respectively. Artisanal diving fishermen suffer disproportionately more, with prevalence ranging from 20 to 94%. There is paucity of data on the prevalence of decompression sickness in Kenya, on knowledge, attitude, and practices of diving fishermen in Kenya. Study Design- A cross sectional study of a fishing community in Vanga, Kwale County was undertaken from June 2019. Data collection was conducted between July 7th and August 30th, 2020. Methods- Eligible study subjects were identified from the Beach Management Unit register and screened by administration of an adapted Kenya Navy survey tool. A total of 246 randomly sampled diving fishermen were included in the study. Anonymised sociodemographic data was collected, in addition to data on predictor variables of decompression sickness- knowledge, attitudes and practices of diving fishermen. Categorical data analysis was used. R statistical software was used for data analysis and visualisation. Results- All study participants (N=246) were male, the median chronological age being 36, range from 19 to 76 years. Nearly all the study participants (99.2%, n=244) had either no formal education or incomplete primary education. Apprenticeship was the main method knowledge was imparted to majority (66.3%, n=163) of diving fishermen. Significant associations between knowledge and decompression sickness, and attitude of diving fishermen and decompression sickness were found. The prevalence of decompression sickness in this community was 28%. Lack of a local health care worker and distance to Kenya Navy recompression chamber were found to be barriers to healthcare access. Conclusion- This study gives credence to the idea that diving accidents are preventable through training and establishing of standards of safe diving practices. Recommendation- Continuous skills upgrade with a recertification system developed by Kwale County with assistance from Kenya Navy to address dangerous diving practices.

Background: Road traffic crash injuries constitute a major public health burden and has led to an increase in morbidity, disability and mortality for the victims. Motorcycle crashes (MCC) contribute a large proportion of road traffic crashes (RTC) in Kenya. Use of motorcycles as a means of transport has increased explosively in the last decade due to their affordability and convenience. Road traffic crashes due to MCC have also concomitantly increased, with an increased burden in trauma management at hospitals and the health care system in Kenya as a whole. The injuries include musculoskeletal trauma which result in debilitating and life threating injuries to the victims. MCC-related musculoskeletal injury distribution, fracture patterns, severity as well as mechanisms of injury are not well described in Kenya and local studies describing the injuries are scarce. Study objective: To determine the distribution, patterns and severity of musculoskeletal injuries among motorcycle crash victims at Kenyatta National Hospital. Study design and setting: Descriptive prospective cross-sectional study at Kenyatta National Hospital. Study population: All motorcycle riders, pillion passengers and pedestrians involved in motorcycle crashes presenting at KNH A&E Department, admitted in Orthopaedic wards and ICU with musculoskeletal injuries between April and June 2021. Methods: One hundred and twenty six consecutive patients with motorcycle crash-related musculoskeletal injuries were prospectively studied. Data were obtained by interviews, physical and radiological examination and recorded in a pre-designed questionnaire. The data were stratified and analyzed on age, sex, anatomical fracture distribution, mechanism of injury, pattern and severity of fractures classified under AO/OTA classification and Gustilo-Anderson open fracture classification, associated injuries and type of protective gear used by the operators and the pillion passengers. Data analysis was done using Statistical Package for Social Sciences (SPSS®).

Introduction: Major cause of cause of death globally in children below the age of 5 years is attributed to prematurity. Intrauterine infection during pregnancy contributes significantly to preterm labor, PPROM and finally preterm birth. Approximately 40% cases of spontaneous preterm labor and birth are attributed to infections. The bacteria infecting the placental bed thus have the potential of causing adverse pregnancy outcomes like preterm premature rupture of membranes, chorioamnionitis, preterm labor and birth with resultant neonatal morbidity and mortality. Study Objective: To determine the prevalence of bacterial infections at the placental bed in patients with preterm births at KNH through placental bed bacterial culture and histopathology. Methodology: It was a descriptive cross-sectional study, that involved 116 pregnant women who presented for delivery between 28 and 37weeks‟ gestation at KNH obstetric unit. Informed consent was obtained. Pretested questionnaire was used to collect demographic and obstetric data. Immediately upon delivery, the placenta was placed in a sterilized container and refrigerated at a temperature of 2-8 0C at KNH Morgue. Using CHAMPS protocol for minimally invasive tissue sampling (MITS) Standard Operating Procedure (SOP) protocol v1.1 November 2017, placental cuts were made within 24 hours of specimen collection and submitted to microbiology laboratory for culture and sensitivity analysis. The rest of the placenta was fixed in 10% formalin, standard cuts made into cassettes and submitted to histology laboratory where they were processed into slides. Histological diagnosis was then made using Amsterdam Criteria. Results: From a sample of 116 placentas, the prevalence of placental bed bacterial infection was found to be 47.4%. The most commonly isolated microbes include E.coli(27.3%), Staphylococcus haemolyticus(7.3%),Klebsiella pneumonia(10.9%), Enterococcus faecalis(9.1%) and Acinetobacter baumanni(7.3%). Nitrofurantoin and ciprofloxacin were the most sensitive antibiotics. Histological chorioamnionitis was present in 40.5% of placentas. However, it was found in 40% of placentas that also had positive bacteria culture compared to 41% of placentas that had negative bacteria culture and was negative in 60% of placentas that had positive bacteria culture. There was absent bacterial culture growth and histological chorioamnionitis in 59% of the placentas. Other histological profiles identified include maternal vascular malperfusion, funisitis, fetal vascular malperfusion, Chorangiosis, fetal thrombotic vasculopathy and delayed villous maturation. Conclusion and Recommendations: There is need to update our guidelines to culture sensitive antimicrobials for treatment of patients presenting with preterm labor and PPROM. Molecular techniques of microbe isolation are recommended to supplement culture.

Rastrineobola argentea (Omena) is the second important fish catches after Nile Perch in Lake Victoria. Although rich in nutrients, huge postharvest losses are mainly reported during rainy seasons when large catches are made. This could be due to poor handling, processing and packaging practices causing infestation by fungi and subsequent production of aflatoxin under favourable conditions. Despite the economic importance, there are no studies in Kenya to quantify the aflatoxin associated with Rastrineobola argentea and its effects on micronutrient content. This study was therefore undertaken to determine public knowledge, diversity and content of aflatoxins in sun dried Rastrineobola argentea and assess its relationship with the moisture, calcium and iron content. To assess the public knowledge, a survey was carried out around Lake Victoria landing beaches in Kisumu, Migori and Siaya counties and fish markets in Nairobi. A total of 252 samples were collected in dry and wet seasons. The samples were blended and sub-sampled for proximate calcium and iron analysis as well as aflatoxin and moisture content determination. Iron and calcium levels were determined using Atomic Absorption Spectrometry. Total aflatoxin quantification was determined using fluorescence detector in High Performance Liquid Chromatography in reverse phase. Moisture content was quantified using an oven at 130 °C. There was female dominance in fish processing in the study sites. Illiteracy levels was high with majority of the respondents having attained only primary education. Sun drying was the most widely practiced method of fish preservation. There was a wide knowledge gap with 65.59 % unaware of aflatoxins contamination and its health implications. Proximate calcium levels ranged from 1,872.21 to 2,940.90 mg/kg compared to the recommended adult’s daily intake of 1,000 – 1,300 mg. Proximate iron content ranged from 5.62 to 15.64 mg/kg. The total aflatoxin detected in singular samples ranged from 0.44 μg/kg – 4.42 μg/kg signifying Omena aflatoxin contamination. Moisture content was from 10.13 to 14.40 %. Although, total aflatoxin levels were within the accepted limits in Kenya, continued consumption can lead to chronic aflatoxicosis making one vulnerable to liver cancer, neurological area impairment, immunosuppression, and micronutrients deficiencies, stunted growth, child mortality and spontaneous abortion. Hazard analysis of critical control point and good hygiene ought to be operationalized from harvesting through processing and distribution channels of sun dried Rastrineobola argentea to reduce the moisture content as well as the levels of aflatoxin contamination. The national and county Governments of Kenya should educate the general public on health hazards associated with consumption of contaminated Omena. The findings have contributed to science of analytical chemistry in mitigation of aflatoxin challenges while high calcium and iron content in omena helps in improved diet. The negative correlation of aflatoxin and moisture in Omena merits a further research study.

Introduction Poor aqueous solubility presents a major formulation challenge for many active pharmaceutical ingredients. The use of surface-active agents is a common strategy to address poor drug solubility. Griseofulvin has previously been studied as a model of poorly soluble drugs, shown to posses improved solubility in the presence of surfactants. This study seeks to evaluate the effect of selected surface-active agents on the dissolution of griseofulvin granules prepared by melt granulation. Methodology Griseofulvin granules were prepared by melt granulation technology. The molten binder mimicked the granulating liquid and no additional liquid added. Polyethylene glycol 4000 was incorporated as the melt binder. The surfactants studied were Gelatin, Tween 80 and Sodium lauryl sulphate (SLS), at concentrations of 0.5%, 1% and 2% w/w. Dissolution was performed and sampling done at 5, 10, 20, 30 and 45 min. The griseofulvin released was quantified using Ultraviolet spectrophotometry and its assay in all formulations performed in accordance to the British Pharmacopoeia (2019) specifications. Griseofulvin tablets from Universal Corporation Ltd in the market were subjected to dissolution; sampling was done at 45 minutes. Results and Discussion Formulations containing SLS recorded the highest drug release of 96.7% at a concentration of 2% w/w whereas Tween 80 recorded its highest release of 79.9% at a concentration of 2% w/w. Gelatin formulations recorded the lowest release at all time points. The control formulation that did not have any surfactant had insignificant release at all time points confirming that the surfactants played a critical role in enhancing the dissolution. In all the formulations containing