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

The project aimed at developing a Records Retention and Disposition Schedule for the registry of Masindi Municipal Council. This was achieved by examining the current records retention and disposal practices, identifying the necessary requirements for developing a records retention and disposal schedule and, designing and implementation of a records retention schedule for Masindi Municipal Council. The qualitative approach was used together with a case study project design in which interviewing was the only data collection method that was used in this project. This led to the use of an interview guide as data collection instrument. The sample size was nine (9) participants which was obtained through the application of the data saturation principle. Findings revealed that MMC is faced with several consequences such as loss of valuable documents, cost ineffectiveness, congestion of records in office, denied access to information, informal decisions, audit queries and penalties, time consuming, inaccurate data and delays in the retrieval which were all attributed to an uncontrolled records retention and disposition. All these resulted from the appraisal of records based on registry official’s personal whim. Findings also identified the requirements (functional and nonfunctional) necessary for designing and creating a RRDS for MMC. Major conclusions were; the need for written policies to regulate records retention and disposition, streamlining of lists identifying all forms of records and providing professional training and workshop to records managers in MMC registry. Major recommendations included regularly revisiting and updating the developed RRDS by MMC records managers together with a team of experts, ensure that all the available records regardless of their format, are covered in the developed RRDS with proper retention periods well aligned against each of them in particular, conducting continuous professional training for all records officers and the continued management of records destruction certificate as well as their inclusion on the list of records for scheduling.