After the cold war, there was an increase in intra-state conflicts in many African countries. The proliferation of weapons into these countries led to conflicts over both scarcity and abundance of natural resources in many states. This study looks at the horn of Africa conflict region which falls under IGAD framework. The formation of IGAD partly was to find solutions for conflict management in its framework. Somalia in particular, is the concern in this study. The research is singling out the role of women in conflict management in this country which has experienced protracted violence for the last two decades. Many scholars have argued that, conflicts are endemic and they cannot be done away with. They can only be managed. In the decision-making on management of these conflicts, women have been largely left out and only viewed as victims. The feminist theorists, claim that women have an active role in conflicts, for this reason, this study strives to analyze and determine the extent to which women have participated in conflict management strategies in the framework of IGAD and Somalia in particular. The traditionalists have viewed conflict management as a reserve for men. Women have been out of the limelight and only viewed as victims. Somali community is known to be patriarchal and therefore their women have had minimum participation in conflict management in their country. Guided by the feminist theorists this study argues that women are both victims and actors of conflict. They hold that women just like men are potential makers and breakers of peace. Feminism embodies a variety of dissatisfactions with things – as they are - and a variety of visions about how they could be improved. This study seeks to establish the extent to which women in Somalia have been involved in peace processes. In this connection, the study examines the role of IGAD in facilitating women’s participation in advancing the regional agenda for peace.

Organisations are environment serving and dependent. They operate in an environment that constantly experiences changes and have to monitor the external environment closely enough to know when to respond. They have to know the business well enough to know the kind of changes to initiate. As the effectiveness of a firm is measured by the degree to which the products or services respond to the needs of their consumers and relevant stakeholders, firms must apply appropriate responses as changes occur in the external environment in order to survive. In order to continuously meet the needs of their market, organisations need to identify the challenges that would lead to failure to meet their objectives and respond appropriately by adopting timely strategic responses. The purpose of this study was to establish the strategic responses adopted by textbook publishers in Kenya to the environmental challenges facing them. The objectives were two. First was to establish the environmental challenges experienced by textbook publishers in Kenya. Second was to establish the strategic responses they adopt in response to the environmental challenges. The research design was a cross-sectional survey. The population was all the textbook publishers who are members of KPA. Primary data was collected by use of questionnaires which were administered to the senior administrators of the firms through the drop-and-pick method. In addition to the primary data, the researcher relied on secondary data mainly collected from the firms’ websites and publications. Results of the study indicate that all the firms monitored the external environment for factors necessitating their response. The results also indicate that all the firms responded to the challenges posed by the external environment. Challenges in the external environment included stiff competition, government policies, inconsistent release of funds for free schooling by the government, high cost of printing, a poor reading culture, book piracy, corruption, changes in the curriculum, high cost of credit facilities, lack of competent authors, technological advancements, and high standards by the KICD in approving books into the orange book. Responses that textbook publishers adopted included aggressive marketing, diversification of publications, entry into regional markets, promotion of a reading culture amongst Kenyans, acquisition of competent authors, competitive tendering to cut costs, outsourcing of non-core services, lobbying the government for favourable legislation, and adoption of technology by digitizing books. Based on the findings of this study, the researcher recommends that the government improves the system of disbursing funds to schools in order to make it more timely and predictable. Given the crucial role that the textbook plays in education, the government should also closely consider the effects of its policies, such as on taxation of school books. It also has a role to play in ensuring that quality of publications is maintained, by enforcing approval of all textbooks by KICD. The publishers currently face very stiff competition amongst themselves as the market is served by many players. This may be addressed by mergers and acquisitions, as well as co-publishing.The researcher faced various limitations in conducting this study. The researcher faced various limitations in conducting this study. First, only publishers who are members of KPA were covered, which limits the generalization of the results to the established publishers only. The second limitation arose from the data collection method that was used, as only questionnaires were used due to the limited time.

The purpose of this study was to investigate influence of immediate preschool enrolment on curriculum implementation in public preschools in Mirangine district, Nyandarua County. Three research questions were formulated to guide the study. These included investigation on parent’s role in preschool curriculum in Mirangine district Nyandarua County. The research also examined the preschool teacher’s role in the curriculum implementation. Further the research investigated the role of infrastructure in the curriculum implementation. The study methodology was survey design with a sample of twenty parents and twenty teachers respondents derived from a population of 1543 parents and 73 teachers, through cluster and simple random sampling technique. This gave every preschool teacher and parent equal opportunity of being selected. The study instruments were written questionnaires for teacher respondents, interview schedule for parent respondents and observational schedule for the infrastructure. The instruments were pilot tested to five parents and five teachers which were not used in the final study. The study established that many parents felt that financial support was the most important contribution in their children’s curriculum implementation. It was also established that “High cost” preschool parents motivated their children curriculum implementation more than “low cost “school parents. The curriculum further established that the major role of the preschool teacher was to enable the child socialize with peer. Sharing of teaching/learning resources enabled children to effectively socialize with his/her environment. The nature, quality and quantity of the preschool dictated among others teaching approach/methodology. Group activities were seen to be quite popular when classrooms had adequate space. Based on the findings it is recommended that the number of toilets in preschools be increased because young children are more frequent in toileting than older children and thus need of minimizing queuing period. The research further saw need of accompanying children to and from school. The study recommends a research be done on academic performance of pupils (in primary) who have undergone preschool education and those who have not. Further study should be done on influence of period (number of years) of preschooling on primary education.

This study‘s main objective was to a comparatively analyze how two leading newspapers in Kenya prime banking news. The specific questions that this study sought to answer were: to establish the key banking issues themes and how they are disseminated to the public through print media; who the key voices and agenda-setters are and how were they primed over time; how are banking issues presented and the geographic diffusion pattern of the media coverage of the banking news. The study reviewed the Priming Theory and the Agenda setting theory. The research design involved content analysis of the literature with a bias towards the following themes: number of articles; size in cm2 , type of the story, placement, prominence and the main subject that stories are published mostly. Data collection involved conducting interviews with the media professionals, banking sector employees and desk review of newspapers. One major limitation is the fact that the research was based on information provided to a certain portion of the overall Kenyan demographic, and thus the recommendations could be most valid and useful for a similar portion of the Kenyan demographic. Notably, the study evidence suggests the media were more amicable to the vested interests of the political class than the banking sector news. This was confirmed by the fact that during the entire 6month study period, no banking related news item appeared in ‗A‘ section of the two newspapers. Interestingly, majority of the articles containing the words ―banking news and/or ―financial news appeared in the D section of newspapers. This should be a matter of concern, not just for banks but also editors and media owners. Very often, print media articles mentioned peer or rival banks in the same sentence hence the need for banking institutions to work together. More so, the findings divulge that the media attention relating to banking news is increasing over time and recommends that bank should establish personal relationships with a small cadre of print media professionals. In terms of geographically focus, banks should invest in national campaigns and or news. In a nutshell, the print media is a powerful tool that has been and can continue to be used to effect business change. Banking industry news is important and salient business issue of the present time. While banking institutions already actively attempt to use the print media in order to sensitize people about the industry and market their products, there are ways in which they can improve their media communications strategies through priming.

Trypanosoma brucei causes both Human African Trypanosomiasis and Animal African Trypanosomiasis. These diseases are transmitted by tsetse flies through saliva infected with T. brucei as the vector feeds on a blood meal. One strategy of controlling disease transmission is disrupting the life cycle of T. brucei in the tsetse fly. Ongoing studies on Sodalis glossinidius have provided the proof-of-concept that tsetse endosymbionts may be used to interfere with pathogen transmission through the vector. This strategy, however, relies on the knowledge of trypanosome biology, especially the developmental events that take place in the tsetse fly vector to allow for its survival. This study aimed at constructing a gene co-expression network to predict key genes in T. brucei development in the tsetse fly, the functional roles which these genes are associated with, and also predict 3' untranslated region motifs for gene clustering together in the network. RNA-seq counts data generated from the developing T. brucei parasite in the tsetse fly was used in this study. The expression levels of T. brucei genes were obtained by running the RNA-seq data through the RNA-seq pipeline. Using the T. brucei gene expression data, the weighted gene co-expression network analysis approach was used to construct and analyze the network. Twelve (12) out of 27 functionally enriched gene modules (clusters) of the co-expression network were obtained from the network analysis. The enriched functional roles for the clusters were associated with cell cycle, cell signaling, mitochondrion, protein biosynthesis, and cell surface and highlight important functional processes during the parasite’s development on tsetse fly. The hub (key) genes for the 12 modules encoded proteins such as RBP6, Inner arm dynein 5-1 protein, and BARP protein, that have previously been proven crucial in T. brucei development in the tsetse fly. The hub genes may be involved in key processes that enable the parasite develop and complete its life cycle in tsetse fly. Other hub genes encoded proteins whose functional roles are still unknown and could serve as candidate genes for further studies. The 3’ untranslated region motif prediction for genes clustered together identified 10 significantly enriched motifs that could provide insights into gene regulation during parasite’s development in tsetse. The results of this study provide a resource for network-based data mining to identify candidate genes for functional studies. The knowledge obtained from co-expression analysis will provide novel insights on the role of genes in development and T. brucei molecular processes that may be targeted by trypanocidal products.

Catha edulis (Khat) is a natural psycho-stimulant herb containing the alkaloid cathinone known for causing excitement, loss of appetite and euphoria among others, after chewing its young buds and tender leaves. Although khat is reported to cause various health problems, most of them have never been systematically investigated, especially on contamination with parasite stages and eventual transmission to humans. Food contamination may occur at any stage including preparation, production, processing and distribution. This risk therefore, depends largely on the health status of the handler, personal hygiene, knowledge and systematic application of food hygiene. This study explored the possibility of transmission of intestinal parasites through use of the herb. This survey was conducted between the months of December 2018 and May 2019 in Eastleigh, Kawangware, Kibra, Mathare and Dandora suburbs in Nairobi County. This involved 155 (105 males & 50 females) selected khat vendors using a structured questionnaire to collect demographic data. Khat leaves were collected in aerated bags, then processed and evaluated for presence of contaminant parasites that infect humans using concentration and direct methods, in the laboratory at Jomo Kenyatta University of Agriculture and technology. Data on environmental risk factors/conditions was gathered from the vendors through a structured questionnaire and physical observation of the surrounding. The minimum and maximum ages of respondents were 22 and 43 years respectively. Data obtained were analyzed using SPSS version 23.0 and significance pegged at <0.05. Parasites were isolated in 24 (15.4%) of the study sites: Giardia lamblia cysts were isolated in 10 sites (6.5%) and E. histolytica in 9 sites (5.8%) and were the main parasites across the suburbs. 54.8% (n=85) of the vendors stored the leaves on the ground uncovered. Garbage wastes were found in 70.3% (n=109) of the study sites. Presence of parasites was statistically associated with the area/ site, p=0.011 and the type of wastes (p=0.043). The present study revealed main contaminants of C. edulis leaves were cysts of G. lamblia (6.5%) and E. histolytica (5.8%); ova of A. lumbricoides (1.9%) and larvae of Strongyloides stercilaris (1.3%). Poor storage of leaves, personal hygiene and polluted environmental conditions significantly contributed to and represented potential routes for the transmission of parasitic infections. Public health education may be key to reducing parasites infections got through contaminations. Similarly, setting up of standard shops with required level of hygiene by the County Government for vending C. edulis leaves is essential.

In 2016, Kenya adopted the universal testing and treatment of people living with HIV in line with WHO recommendations and as a fast track to achieving the UNAIDS 2030 target of 95:95:95. This “Test and start” program has been implemented for six years with little literature on its implementation challenges at the individual level and clinical outcomes, especially comparing to the previous period before “Test and start”. This study compared the survivorship and viral load suppression among PLHIV who started ART in the period before “Test and start” and after “Test and start “and also determined the factors associated with survivorship among PLHIV. A retrospective cohort study design was used to study PLHIV aged more than 15 years and started on ART in the periods of April to August 2016, and April to August 2017, then followed up for 24 months. Primary outcomes were death or loss to follow up. Kaplan–Meier survival methods were used to describe time to primary outcome. Cox proportional regression analysis was used to determine features associated with poor clinical outcomes. In this study, 786 patients (470 pre “Test and start” ”, and 316 in the “Test and start” cohorts) were enrolled. At 24 months after recruitment, retention rates for the pre and after “Test and start” groups were similar at 68% and 64% respectively (absolute difference: -4.0%, 95%CI -11-3.1, P=0.27). In multivariable regression model, the “Test and start” group showed no significant effect on risk of poor outcomes (aHR=1.17, 95% CI=0.89-1.54). Of the 240 with poor outcomes, 102 out of 316 (32%) and 138 out of 470 (29%) occurred among the “Test and start” group and pre “Test and start” patients respectively. Increasing age (aHR=0.98, 95% CI =0.97−0.99), formal employment (aHR=0.42, 95%CI=0.23- 0.76) and not being employed (aHR=0.53, 95% CI=0.34-0.81) were associated with lower risk of poor outcomes. The risk of poor outcomes was higher among males compared to female patients (aHR=1.37, 95%CI=1.03−1.82), and among divorced/separated patients compared to the married (aHR= 1.44, 95%CI= 1.04−1.99). Among 274 patients with a viral load reading at month 6 after starting ART, 15 (9.9%) were unsuppressed (VL≥1000 copies /ml) in the pre “Test and start” group while 12 (9.8%) were unsuppressed in the after “Test and start” group. The proportion of viral load suppression was not significantly different (P=0.95) in the two cohorts with similar findings found at 12 and 24 months. The viral load suppression rates, retention and attrition patterns for the “Test and start” cohort was comparable to those started on ART before “Test and start”. Patients who are males, young, divorced/separated, with poor socio-economic status had higher risks for poor clinical outcomes. Therefore, the “Test and start” program is as effective as the previous policy in clinical outcomes and should be continued as the early ART treatment averts severe morbidity and mortality as outlined in previous studies.

In many countries, blood group O is considered a universal donor; nevertheless, there have been reported cases of transfusion reactions due to transfusion of group O whole blood and its components in non O recipients. These adverse outcomes are attributed to high titres of naturally occurring immunoglobulin M (IgM) and immune immunoglobulin G (IgG) blood group antibodies in this donor blood. Antibody levels vary in diverse populations and are not known at the Kenyatta National Hospital (KNH) setting. This study aimed at determining the prevalence, and titre levels of IgM and IgG anti-A and anti-B antibodies amongst group O donors at Kenyatta National Hospital Blood Transfusion Unit. A cross-sectional study was adopted and carried out at KNH between February and April 2018. A sum of 233 group O donors took part in the study. A multi-stage convenience sampling method was used. A questionnaire was used to obtain demographics and specific known variables related to high antibody titre. Donor blood was collected and processed to obtain plasma which was afterwards titrated by the use of an immunohematology analyzer (Immucor Neo®) to detect IgM and IgG anti-A and anti-B antibody titres. Descriptive statistics was established on demographic variables. In assessing the relationship between high antibody titre and variables, Chi-square and Fisher exact tests were used. The blood donor population ages ranged from 18-58 years and the mean age was 29.3(SD ±8.7) years. The majority of them were male 183/233 (78.5%) with the most common age group was of 18-28 years consisting 122/233(52.4%). The prevalence of high titre among the group O donors was at76 % irrespective of antibody class (IgG and IgM) and specificity (anti-A and anti-B) using an antibody dilution cut off of ≥ 1:64. The prevalence of group O donors with titre ≥ 1:64 was 36% for IgM anti-A, 26.6% for IgM anti-B, 48.1% for IgG anti-A and32.2% for IgG anti-B. Age, gender, past transfusion history, and pregnancy were not related to high antibody titre. Nevertheless, and contrary to expectations, a higher antibody titre was detected among those who had not consumed yoghurt (P=0.03). This study sheds light on the significance of pre-transfusion ABO antibody titration at KNH. It is highly recommended that the use of group O donor blood be restricted to group O recipients. It should only be transfused to others groups in emergency times when a low antibody titre can be established.

Tuberculosis is caused by the bacterium Mycobacterium tuberculosis, which is an air born disease transmitted from person to person by aerosolized droplet nuclei. It typically affects the lungs (pulmonary tuberculosis) but can affect other sites as well. The failure to eliminate or completely reduce TB as a public health problem has been largely associated with little attention the disease attracts from the government, poor management of TB control programmes, high rates of poverty and population growth especially in urban areas due to migration and HIV/AIDS pandemic. Considerable progress has been made since introduction of DOTS strategy. The primary objective of this study was to determine the factors associated with TB outcomes among TB patients in Mombasa County. The study was conducted in Mombasa County which is one of the 47 counties in Kenya with an urban population of 1,063,854. The study was conducted in all health care units in the county. The study used a cross-sectional research design. The study population was the total number of notified patients with tuberculosis in one quarter in the study area (Mombasa’s health care units) and this was found to be 1207 in the year 2017. It was from this population that a systematic random sample size of 265 patients were interviewed. Data was collected within a period of three months with the help of three research assistants using semistructured questionnaire and focused group discussion guide Quantitative data were analyzed using SPSS version 20 Descriptive statistics frequency (%), mean, and standard deviation were used to express quantitative data. In bivariate analyses, odds ratios (OR) and 95% confidence intervals (CI) for the association between TB treatment outcome and health related factors, institutional factors and patient related factors was done using logistic regression. The results revealed that patients who are educated about health are more likely to cure of TB than patients who are not (OR 1.716, 95% CI, 0.35 to 2.48). More so, patients who receive psychosocial support are more likely to get cured than those who don’t receive psychosocial support (OR 4.08, 95% CI, 2.00 to 8.32). The results also revealed that patients who visits hospitals where health-workers are trained in less than 6 months are more likely to get cured compared to those who visits hospitals where health workers last training was more than a year (OR - 3.116, 95% CI, 0.703 to 3.93). The results further reveal that monthly supervision is more likely to result to cure as compared to no supervision at all (OR 2.433, 95% CI, 0.72 to 4.142). Similarly, once in a while supervision is more likely result to cure as compared to no supervision at all (OR 1.432, 95% CI, 0.31 to 3.12). The results of the study give evidence to, therefore, conclude patient related factors, health care workers related factors, and institutional factors are critical to TB treatment outcome in that order. The study gives an impetus to propose categorical efforts in addressing patient related factors such as enhancing further awareness on treatment adherence and imposition of penalties to habitual treatment defaulters. Institutional frameworks also need to be put in place to address distance to health centre issues, convenience of clinic time and drug stock out as a sure way of minimizing the sources of variation on TB treatment outcome.

Skilled care through antenatal, delivery and postpartum period, is essential for the mother-newborn health. Migori County in the Nyanza region had 53.4% births aided by a skilled health professional compared to an average nationally of 61.8%, while the region averaged 65% in the 2014 Demographic and Health Survey. To address the comparatively lower uptake of skilled care, a maternal-infant community-level health interventional project was instituted. This study assessed the effectiveness and determinants of the integrated maternal- infant health intervention on uptake of skilled professional services through birth and postnatal among reproductive age women in Migori County. A quasi-experimental, posttest only nonequivalent groups design was applied in this study. A sample of 590 reproductive age women, who gave birth after January 2014 in Rongo and Migori sub-county, were included in the study. Data were collected using interviewer administered questionnaire and key informant guides. Utilization of postpartum and delivery services in a health facility were the two main outcome measures of the study. Descriptive statistics reporting proportions, Chi square and Fisher’s exact test at bivariate and odds ratio at multivariate analysis level were computed. The findings show a twenty seven percent (27.2%) increase in utilization of facility delivery for the intervention group, compared to 16.6% increase for the control (χ2= 9.0, P= 0.003). Participants who received the intervention had increased odds - AOR= 1.56, p=0.048, of having a health facility delivery and higher odds - AOR= 3.31, p=0.016, to using postpartum care services. Being in married union decreased the odds - AOR= 0.33, p=0.006, of seeking health facility delivery. Choice of health facility delivery was positively influenced by a mother having had attended at least four antenatal visits and having a birth companion (p=0,000), with ones mother as a birth companion (AOR 4.97, p=0.000). There were a higher proportion of complications necessitating attention by a health professional reported at 13.3% in the control group, compared to intervention at 2.9%. Having been sensitized on maternal-infant health by traditional birth assistant, cut down probability of uptake of delivery at health facility by 18.2 times (AOR= 0.055, p=0.017). At multivariate analysis, participants who had community health Volunteer referral for post natal care to a health facility, had greater odds - AOR= 2.72, p=0.039, of taking up the services, the odds declined for those taking between 30 to 60 minutes to health facility (AOR 0.166, p=0.002). From the key informants, lack of male partner support and ‘feeling experienced’ were cited as barriers to seeking skilled care at health facility. In conclusion, the intervention improved uptake of facility delivery and postpartum care. Availing health education and having ones mother as birth companion are two critical aspects that can improve uptake of skilled birth attendance and postpartum care. Study recommends appliance, and scaling up similar ‘community-level’ approaches in raising utilization of health facility care in the other Migori County, sub-Counties and in other places in Kenya where reduced uptake of SBA prevails. Further, more emphasis is needed on health education for the pivotal role played in influencing uptake of postnatal care.