Kisumu, troisième ville du Kenya sur les rives du Lac Victoria, est aujourd’hui le lieu de la définition de politiques urbaines, menées aussi bien par des acteurs locaux qu’internationaux, qui visent à faire de la ville une charnière logistique de la construction est-africaine. Ces politiques urbaines exemplifient la prolifération à l’échelle mondiale des agendas urbains centrés sur la compétitivité et de l’attractivité dans les villes, même les plus ordinaires. Kisumu n’est pourtant pas le réceptacle passif de modèles urbains qui s’imposent sur une périphérie du monde. Nous proposons d’explorer les paramètres géographiques, historiques et politiques qui tracent la particularité de la trajectoire de la ville dans la mondialisation. Kisumu doit être appréhendée au-delà de sa dimension locale : les relations scalaires à partir desquelles se formulent le projet urbain contemporain permettent de mettre en lumière l’adoption à Kisumu d’un agenda compétitif. A travers une « monographie multiscalaire », nous dégageons trois axes de contextualisation des relations scalaires par lesquelles se comprennent les évolutions contemporaines de la politique urbaine et ses conséquences spatiales. Premièrement, la longue durée de l’insertion coloniale de la ville dans le monde structure la formulation du projet urbain contemporain et en investi ses lieux clefs (centre-ville et aéroport). Deuxièmement, la construction et la formation de l’État colonial et postcolonial sont des médiations centrales dans la manière dont s’énoncent les enjeux politiques d’un projet urbain compétitif. Finalement, les différentes échelles d’appartenance à l’ethnicité Luo qui prennent Kisumu comme lieu d’ancrage façonnent la manière dont le projet est localement adopté et contesté. / Kisumu, third largest Kenyan city on the shores of Lake Victoria, is today the place where are defined urban policies both by local and international actors that aim to make the city a logistic hub in the East African construction. At the world scale, these policies illustrate the proliferation of competitiveness oriented urban agendas, even in most ordinaries cities. However, Kisumu is not the passive container of circulating urban models imposed on a world periphery. We propose here to explore the geographical, historical and political parameters that explain the particular urban trajectory of Kisumu in the globalisation process. We see Kisumu beyond its local dimension: scalar relations from which the contemporary urban project is built highlight the local translation of a competitiveness-oriented agenda. Through a “multiscalar monography”, we bring three major directions out that help us to contextualize the scalar relations from which we can understand the contemporary evolutions of urban policies and their spatial consequences. First, the longue durée of the colonial embeddedness of the city in the world still helps the formulation of the contemporary urban agenda. Secondly, the construction and the formation of the colonial and postcolonial state are mediates the way the politics of the newly defined agenda is enunciated. Finally, the different scales of belonging to the Luo ethnicity the city is the anchorage shapes the way the project is locally both adopted and contested.

The purpose of this study was to explore the practices, perceptions and needs of nurses in relation to their participation in continuing professional development. A quantitative descriptive study was conducted guided by Knowles’ Adult Learning Theory as the conceptual framework. Data collection was done using a structured self-administered questionnaire with a sample of 178 nurses. The findings revealed that the respondents perceived continuing professional development as important. However the study found minimal involvement of nurses during the initial stages of designing continuing professional development programmes and this may lead to incorrect identification of learning needs. Personal, organisational and professional factors were identified as barriers to nurses’ participation in continuing professional development. Preparation of nurses in advance and the use of teaching strategies that recognise past experience and adults as resources were found to increase nurses’ participation in continuing professional development programmes / Health Studies / M.A. (Health Studies)

The purpose of this study was to explore the practices, perceptions and needs of nurses in relation to their participation in continuing professional development. A quantitative descriptive study was conducted guided by Knowles’ Adult Learning Theory as the conceptual framework. Data collection was done using a structured self-administered questionnaire with a sample of 178 nurses. The findings revealed that the respondents perceived continuing professional development as important. However the study found minimal involvement of nurses during the initial stages of designing continuing professional development programmes and this may lead to incorrect identification of learning needs. Personal, organisational and professional factors were identified as barriers to nurses’ participation in continuing professional development. Preparation of nurses in advance and the use of teaching strategies that recognise past experience and adults as resources were found to increase nurses’ participation in continuing professional development programmes / Health Studies / M.A. (Health Studies)

Thesis (doctoral)--Köln, University, 2001.

Univ., Diss--Köln, 2001.

Magister Public Health - MPH / Background: STIs are of major public health concern in developing countries, not least because they facilitate transmission of HIV, but also because they are important causes of mortality and morbidity among African populations, resulting in, among other things, adverse birth outcomes, neonatal and infant infections, ectopic pregnancy, anogenital cancer,infertility, pelvic inflammatory disease, and death. Thus, effective treatment needs to be prompt and accurate to control the spread, and morbidity and mortality of STIs. Even though syndromic approach to the management of STIs is effective, most evaluations have focused on syndromic STI management within STI clinics as opposed to research studies. Partner notification is an integral component of the syndromic approach and is aimed at preventing onward transmission of infection as well as re-infection. It includes informing sexual partners of infected people of their exposure, administering presumptive treatment, and providing advice about the prevention of future infection.Methods: This is a cross sectional descriptive study based on a retrospective review of STI data of study participants in KICoS aged 18 to 34 years. A non probability convenience sampling method was used to recruit study participants. A total of 1,277 participants were prescreened into KICoS of whom 847 were enrolled into this study. Data was collected using CAPI and ACASI questionnaires as well as Teleforms which was analysed in SAS for windows 9.1. Results: Syndromic prevalence of STIs was 5.7% while the aetiological prevalence was 32.8%.Risk factors to STI acquisition included, being female, having multiple sexual partners,having lower than tertiary education, using recreational drugs and being HIV. Agreement between the interviewing methods as well between the syndromic and laboratory diagnosis ranged from fair to substantial. This was also true for the agreement between laboratory and CAPI as well as between the laboratory and ACASI. Sensitivity was generally low while specificity was high. Uptake of contact tracing cards was high though with very low uptake of contact treatment with only 2.1% and 0.4% partners of the syndromically and aetiologically diagnosed participants coming for treatment.Conclusions: STI is a problem in this community and thus there should be more emphasis on risk reduction messages in patient education to mitigate the spread of STIs. The performance of syndromic management was very poor against the aetiological diagnosis thus there needs to further review the use of syndromic diagnosis of STIs in research settings. Partner tracing needs to be intensified since there was very poor partner treatment even with high uptake of contact cards.Acknowledgements: This study would have not been what it was without the immense support I received from many individuals all of whom cannot be mentioned here. I would however want to thank the Dr Wairimu Chege (Principal Investigator, KICoS) for her inspiration and encouragement. I would also like to thank my supervisor, Ernie Kunneke for going through this study with me repeated times including on a ride to the airport. On the same note I would also like to thank my lecturers and student administrators at the SOPH. My gratitude also goes to my colleagues Richard Ndivo, Sherri Pals and Eleanor McLellan-Lemal for all the support they accorded me throughout this research.I would also want to give my heartfelt gratitude to my family. My daughter Akinyi who used to type with me at night, her mother Auma for understanding my late nights up and finally to my Parents Mr and Mrs Gideon and Monica Otieno for understanding the importance of education and taking me to school through all the difficulties. Last but not least I would like to express my gratitude to the almighty God for having seen me through this process.

Philosophiae Doctor - PhD / This thesis presents research on the use of modified respondent driven sampling (mRDS) methodology to enhance identification and recruitment of key populations (KP) into an HIV prevention trial in Kisumu, western Kenya through a three phase mixed method study. The study was carried out in Kisumu, western Kenya within the Kenya Medical Research Institute (KEMRI) and the US Centers for Disease Control and Prevention (CDC) Research and Public Health Collaboration platform. The three phases included: 1. PHASE I: Identification and determination of categories of KPs and techniques of locating and motivating them to participate in HIV prevention trials.2. PHASE II: Design and Implementation of a mRDS methodology in recruiting Ks into HIV prevention trials.3. PHASE III: Evaluation of the mRDS in recruitment of KPs into an HIV incidence cohort study. Methods Phase I of the study included the conduct of in depth interviews which were used to identify different categories of persons considered to be KPs within Kisumu, identify strategies of locating the KPs and determine motivators and inhibitors of KPs participation in HIV prevention trials. Phase II on the other hand included the administration of a survey that had been refined in Phase I. The survey was used to design a mRDS methodology which was then implemented to recruit KPs into the survey. Phase III evaluated the success of the mRDS in recruiting KPs into an HIV prevention study by assessing the risk profiles for participants screened and enrolled into the Phase III study. Ethical approval for the study was sought from the ethics committee of the Kenya Medical Research Institute, the US CDC and the University of the Western Cape.The study recruited 53 individuals into phase I and was able to 8 identify different categories of people considered to be KPs and the 4 salient strategies that could be used to recruit them into HIV prevention studies. The phase also identified 8 potential motivators and 9 potential inhibitors to participation in HIV prevention research. These categories and salient strategies were used in phase II to develop and pilot a mRDS methodology in recruiting 203 individuals into a survey. The survey was used as a validation tool for the risk levels of persons recruited by the mRDS using the variables of inconsistent condom use and having multiple partners. The validated mRDS was then applied in the recruitment of 1,292 participants in phase III of thestudy. These study participants had characteristics similar to those seen in similar studies and elucidated from phases I and II of the study. HIV seropositivity was used as the variable for validating risk levels of participants in this study and this was found to be higher that that seen in general population and comparable to that seen in other KPs groups in the region. Results: Overall the study was able to identify different categories of people considered to be at high riskof HIV acquisition. The groups identified included people who frequent bars (e.g. bar workers, drunkards, sex workers, businessmen), people who work in transportation (e.g. truck drivers, matatu drivers, motorcycle drivers, taxi drivers, bicycle taxi drivers), fishermen/fishmongers, MSM and hair salon workers. The study also identified using personal contact, link persons, peer mobilisers and leaders as strategies of identifying and locating KPs. The study used the mRDS successfully in recruiting participants with evaluation of inconsistent condom use and multiple sexual partnerships showing the participants to be of high risk behaviour. Of all the females in the study, only 3.3% were pregnant. The prevalence of Chlamydia was 2.9%, gonorrhoea was 5.0%, syphilis was 0.4% and HSV-2 was 46.0%. Those who tested positive for HIV were 26.2% with 42.3% of the HIV positive participants having CD4 counts of between 250 – 500 cells/ml. Recommendations and Conclusion:The mRDS was successful in recruiting KPs in an HIV prevention trial. Majority of the participants reported inconsistent condom use and having multiple sex partners. In addition to MSM, SW and transport industry workers, fisherfolk, discordant couples, widowers, street youth, car washers and police also form part of KPs groups. The HIV prevalence was higher amongst these groups compared to general population with discordant couples having the highest HIV prevalence. The study recommends that mRDS should be used to identify and recruit KPs as it not only allows for faster recruitment of KPs, it also reduces the expense and complexity associated with coupon management in the standard RDS.

No description available.

No description available.

<p>In the Kisumu District, Kenya, unreliable rainfall pattern has been identified as one of the main causes for poverty in rural areas. The negative effects of such unreliable patterns could be mitigated through improved water resource management and planning. However, estimates of current (and future) water availability will likely differ depending on whether managers draw upon data gathered at a local-scale or regional-scale. This is particularly important in developing regions where, due to lack of data availability, managers are often limited in their choice of data resolution. This study investigates the potential effect of spatial resolution of data on water management and planning by comparing hydro-climatic trends in local-scale data with trends in regional-scale data. The influence of adopting local-scale versus regional-scale data is further demonstrated by estimate the storage requirements of proposed irrigation ponds for farmers in the Orongo village of the Kisumu District located in Kenya, Africa. Results indicate a low correlation between local and regional hydro-climatic trends. Data spatial scale directly influences water resources management leading to a 300% difference in estimated storage requirement for the average farmer.</p>