Doctoral Theses

Effect of funding structure and liquidity on the financial performance of sugar manufacturing firms in Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Effect of funding structure and liquidity on the financial performance of sugar manufacturing firms in Kenya ODOYO, Samson Oando The sugar industry is critical, supporting over 100 million people globally by providing fuel and food. In Kenya, approximately 8 million individuals depend on the sugar firms for their livelihoods, whether directly or indirectly. This industry significantly contributes to the national economy, representing 15% of the agricultural Gross Domestic Product (GDP) as of 2022, while its contribution to GDP in 2023 was 0.5%. The substantial role of the sugar firms highlights their importance in promoting economic sustainability and generating employment within the agricultural sector. However, sugar manufacturing firms face challenges such as unstable finances, inefficient manufacturing methods, and competition from cheaper imported sugar. Despite government efforts to improve the firm's performance by providing additional funding, many firms continue to experience declines in profit, attributed to insufficient working capital and liquidity to sustain their operations. This has led to a situation where most firms are burdened with substantial debts amounting to Kshs 58 billion as of December 31, 2018. The primary objective of this research was to determine the effect of funding structure and liquidity on the financial performance of Kenya's sugar manufacturing firms. The specific objectives of this study were to determine the effect of funding structure on the financial performance of sugar manufacturing firms in Kenya, establish the effect of liquidity on the financial performance of sugar manufacturing firms in Kenya, and evaluate the moderating effect of liquidity on the relationship between funding structure and financial performance of sugar manufacturing firms in Kenya. This study was anchored on the trade-off theory. The interrelationship among variables, funding structure, liquidity, and financial performance is illustrated in a conceptual framework. A correlational research design was used, and nine sugar manufacturing firms were selected through a census sampling technique. A total of 324 secondary data points were collected from 2014 to 2022. The analysis of data was conducted using the ARDL model, which considers the short- and long-term impacts of liquidity and funding structure on financial performance. The results showed a significant positive relationship between the funding structure and Economic Value Added (coeff = 0.863, p = 0.000), meaning that the EVA is expected to increase by 86% for every 1% increase in the funding structure. a positive and significant relationship between liquidity and Economic value added (coeff=0.940, p=0.000), meaning that for every 1% increase in liquidity, the EVA is expected to increase by 94%. and that liquidity moderates the relationship between funding structure and Economic Value Added (coeff = 2.760, p = 0.001). This reveals that Companies that excel in liquidity management and maintain an appropriate funding structure are more likely to achieve higher Economic Value Added (EVA) over the long run. Given the positive long-term contribution of liquidity and EVA, it can be inferred that Kenyan sugar manufacturing firms should prioritize maintaining robust liquidity levels to strengthen their funding structure and ultimately create long-term value. The study concludes that funding structure and liquidity have significant relationships with economic value added and that liquidity moderates the relationship between funding structure and economic value added. The study recommends that firm managers and policymakers design more effective interventions and support mechanisms to maintain a proper balance between the components of funding structures and ensure a healthy level of liquidity within the sugar manufacturing firms. The findings are relevant for investors, firm managers, and policymakers as they can develop frameworks and guidelines that encourage better liquidity management practices within the industry. PhD Thesis

Contributions of participatory forest management practices to forest cover and livelihoods in Lembus forest ecosystem, Baringo County, Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Contributions of participatory forest management practices to forest cover and livelihoods in Lembus forest ecosystem, Baringo County, Kenya OKOTH, Samuel Ondeng’ Globally, forests and its resources have supported the expansion of many economies with a direct employment of about 2 billion people. Recent studies show a drastic fall in the global and local forest cover to 30% and 7% respectively, subsequently leading to review of forestry legislations to address declining forest cover. In Kenya, degradation of forests has been attributed to the exclusion of forests adjacent communities in its management with the authorities. This subsequently led to enactment of the Forest Act, 2005 which provided for participation of local communities through Plantation Establishement and Livelihood Improvement Scheme. However, the contributions of PELIS to forest cover and livelihoods improvement have not been established. Therefore, the objectives of this study were to: determine the contribution of PELIS (Number of seedlings planted) on Forest cover; determine the contribution of PELIS (Forest product yields) on Forest cover; determine the contribution of PELIS (Forests products income) on the livelihood; determine the cost and benefits of PELIS; and determine the contribution of policy and legislations on livelihood, forest cover and equity in Lembus Commnity Forest Association. Cross sectional descriptive research design was adopted. Purposive sampling was used to select the 8 Commnity Forest Associations, while systematic sampling was used to select 384 households. Primary sources of data involved administration of questionnaires, Key informant interviews, Focused Group Discussions. Secondary data were collected by review of pieces of legislations and policy documents. Data analyses was done by use of both descriptive and inferential statistics. The study established a very strong positive correlation between the number of seedlings planted and forest cover which was statistically significant (ρ = 0.934, p < .001). This indicated large effect size and hence very large contribution of PELIS to forest cover. The relationships between maize and beans yields and forest cover showed a strong positive association (ρ = 0.646, p < 0.001). This indicated a large effect size and hence large contribution of PELIS to forest cover. However, maize and beans incomes showed moderate positive relationship with both school transition and livelihood projects in 2019 (r = 0.464, p > 0.24), also for beans income in 2019 (r = 0.238, p > 0.05) and herbs income in 2019 (r = 0.265, p > 0.05). These results indicated medium effect size and hence medium contribution of PELIS to livelihood. The findings further indicated that the difference between the mean cost and benefits of PFM was statistically significant, (t (28) = 2.213, p<.05). Analysis of policy and legislative awareness showed a significant number of the forest community were unaware of existing laws and policies governing tree planting, livelihood and equity (p<.05). In conclusion, the study found out that participatory forest management practices had positive contribution to both forest cover and livelihood, however, the consumption of forests product was imbalanced among the stakeholders. The majority of community forest association members were unaware of laws and policies governing tree planting, livelihood and equity. Therefore, there was need to increase plantation and crop production to contribute positively to forest cover and livelihood projects. The findings therefore would enable the Government to formulate laws and regulations that govern the sustainable management of forests and its resources. PhD Thesis

Influence of institutional size on the relationship between equity financing and lending propensity of micro-finance banks in Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Influence of institutional size on the relationship between equity financing and lending propensity of micro-finance banks in Kenya OWUOR, Omondi Edwin Globally, bank lending remains a critical issue, sparking continuous debate in both policy and academic circles. The lending propensity of financial institutions, including microfinance institutions (MFIs), averages 133.8% of GDP globally while Sub-Saharan Africa lags at 45.5%. In Kenya, lending as a percentage of GDP has declined sharply from 35.22% in 2015 to 12.2% in 2023, despite policy interventions such as interest rate caps, risk-based lending and capital regulation. Given that over 75% of GDP is driven by credit availability, this trend presents a significant economic concern. Existing studies have explored factors influencing lending, with mixed empirical findings regarding the role of equity financing and institutional size. However, most research is based on data from developed economies, while studies in emerging markets, including Kenya, primarily focus on commercial banks rather than microfinance banks (MFBs). Furthermore, the limited research on Kenyan MFBs largely examines financial performance rather than lending propensity. Existing studies show limited focus on effect of equity financing on lending propensity of microfinance banks (MFBs) in Kenya. Evidence on the role of institutional size is equally scarce, and its moderating influence in this relationship remains untested. This study therefore examines the influence of institutional size on the relationship between equity financing and lending propensity of Micro Finance Banks in Kenya .Specifically, the study sought to assess the effect of equity financing on lending propensity of MFBs in Kenya; to evaluate the effect of institutional size on lending propensity of MFBs in Kenya and to examine the moderating effect of institutional size on the relationship between equity financing and lending propensity of MFBs in Kenya. The Bank Capital Channel Theory and Pecking Order Theory serve as foundation for this study. The research used a correlational research design. The population for this research is 14 registered MFBs in Kenya from 2015–2023 where 10 MFBs were sampled purposively and pooled for 9 years in order to generate 90 observations. Secondary data were collected from audited financial statements using data collection sheet. Diagnostic tests verified that data satisfied classical regression assumptions. The research further utilized Moderated Multiple Regression to test Hypotheses, analyzing direct effects of equity financing as well as institutional size on lending propensity, and moderating influence of institutional size on lending propensity. Findings for Objective One are that equity financing has a negative impact on lending propensity (β = -0.421, p = 0.0001), which signifies that a unit increase with respect to equity financing by MFBs lowers lending propensity by 0.421, and that MFBs with greater use of equity financing are more likely to use a more risk-averse lending strategy. Findings for Objective Two are that lending propensity is positively influenced by institutional size (β = 0.251, p = 0.0000), which signifies that every unit increase with respect to natural log of institutional size is linked with a 0.251 increase with respect to lending propensity, which signifies that size plays a crucial role in increasing the credit expansion capability. Objective Three findings reveal a significant moderating effect (β = 0.108, p = 0.0054), confirming that institutional size conditions the effect of equity financing, offsetting its adverse influence and strengthening the case for moderation in emerging markets. The study shows equity financing reduces lending propensity of Kenyan MFBs, while institutional size positively moderates this effect. Expense ratio, regulatory capital, and risk tolerance also shape outcomes. Recommendations include financing diversification, institutional scaling, technology-driven loan recovery, and strengthened oversight with targeted support for smaller MFBs. PhD Thesis

Effects of spillover, boundary management, and social norms on employees’ work-life balance in national referral hospitals in Kampala, Uganda

Thu, 01 Jan 2026 00:00:00 GMT

Effects of spillover, boundary management, and social norms on employees’ work-life balance in national referral hospitals in Kampala, Uganda ENID, Arinaitwe Healthcare workers (HCWs) in Uganda’s national referral hospitals struggle to achieve work-life balance (WLB) due to heavy workloads, workforce shortages, and limited supportive policies, leading to high stress levels and low job satisfaction. Globally HCWs face burnout from poor WLB, a challenge worsened in sub-Saharan Africa by staffing deficits. In Uganda, 46% of HCWs consider relocation due to burnout and poor conditions, while Kampala’s referral hospitals, handling high patient loads (e.g., 90-120 births monthly with nurse-to-patient ratios exceeding 1:100), provide a critical context for studying WLB dynamics. Existing research focuses narrowly on family-related spillover, overlooking broader dimensions (affect, behavior, values), while other studies focused on identifying factors contributing to positive spillover rather than establishing a causal link between spillover and employee work-life balance. Additionally, some studies on boundary management only looked at one dimension of boundary management (work-family segmentation) thereby overlooking other constructs like work-life integration and boundary control while other studies focused on how people manage boundaries between work and personal life without establishing the causal relationship between boundary management and work-life balance. Moreover, studies that focus on social norms focus on isolated aspects of social norms such as work values or gender roles without integrating critical dimensions of social norms such as social responsibility, agreeableness, and social desirability. Therefore, the purpose of the study was to examine how spillover effects, boundary management, and social norms collectively influence WLB among HCWs in Kampala’s referral hospitals, offering insights for policy and workplace interventions. Using a correlational design within a positivist framework, grounded in spillover, work-family border, and cultural-historical activity theories, the study surveyed a stratified random sample of 352 HCWs from a population of 2,914. Validated questionnaires (content validity: 0.900, 0.913; reliability: 0.717, 0.897) were analyzed with descriptive statistics and multiple regression, revealing a strong relationship between predictors and WLB (R = 0.883, R² = 0.780). Social norms (β = 0.641, p < 0.001) and boundary management (β = 0.528, p < 0.001) positively influenced WLB, while spillover had a negative impact (β = -0.255, p < 0.001). These findings, reflecting challenges like 57.4% of HCWs experiencing workload-driven stress and 43.3% intending to leave within six months, highlight the need for targeted interventions. Recommended strategies include flexible scheduling, boundary management training, regular WLB audits, and institutionalizing WLB metrics to address dissatisfaction and reduce turnover intentions. By providing research-backed solutions, this study informs human resource policies in Uganda’s healthcare sector and similar high-pressure settings globally, enhancing employee well-being and mitigating burnout. The study recommends hospitals to implement after-hours communication protocols, mandatory recovery periods, and emotional decompression programs. Boundary management should be prioritized through workflow redesign, and scheduling autonomy tools. Social norms require cultural transformation via leadership modeling. PhD Thesis

Optimizing pragmatic strategic management practices to augmentactive tuberculosis case finding within health facilities in Nairobi County, Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Optimizing pragmatic strategic management practices to augmentactive tuberculosis case finding within health facilities in Nairobi County, Kenya ANGALA, Patrick Strategic management is essential for achieving organizational objectives; however, its application in healthcare—particularly in tuberculosis (TB) control—remains limited. The strategic management practices are known to positively correlate organizations growth and they include strategy formulation, goal establishment, financial ratio examination, Total Quality Management, social capital cultivation, and enhancing entrepreneurial orientation. The Porter Diamond Theory of National Advantage, developed to explain the competitive advantage that nations or regions may possess based on specific domestic factors. Infectious diseases are caused by pathogens and include TB, malaria, HIV/AIDS, and influenza. TB continues to pose a major global health threat, responsible for approximately one million deaths annually. Despite Kenya’s significant investments in active TB case finding, 40% of cases remain undetected, with Nairobi County alone contributing over 14% of the country's annual TB notifications. This study addresses the research gap by assessing how optimizing pragmatic strategic management practices can improve active TB case finding within health facilities in Nairobi County. Specifically, the study sought to: (1) establish the implementation rate of strategic management practices; (2) model the strategic management practices coefficient matrix; (3) measure the capacity of health facility staff in implementing strategic management practices; and (4) determine the challenges and significance associated with optimizing strategic management practices in active TB case finding within healthcare facilities in Nairobi County. Guided by the Porter Diamond Theory and grounded in pragmatic philosophy, the study adopted a mixed-methods design. Data were collected from 220 of 239 TB treatment facilities (92.1%) and 406 clinic respondents (84.9%) between April and June 2024 through structured questionnaires and four focus group discussions conducted. The implementation period assessed was January 2020 to December 2023. The reliability coefficient of the instrument was 0.794, with goal establishment demonstrating strong sampling adequacy (KMO = 0.745). Findings indicate a low implementation rate of strategic management practices, yet these practices significantly predicted TB case finding outcomes (β = .574). Sensitization and availability of strategic plans were significantly associated with case finding success (χ² = 49.771, p < .001). Although infrastructure was generally rated highly, specific areas such as screening spaces were inadequate. Frequent capacity building showed a significant positive relationship with case finding (χ² = 11.223, p = 0.0003), while training duration showed no such association. Strategic practices correlated positively with firm strategy and structure (r = .356, p < .001), and logistic regression revealed that strategic management practices predictors were associated with a 25% to 84% likelihood increase in case detection. Key challenges included inadequate staffing, logistical barriers, financial impropriety and equipment maintenance issues. The study recommends optimizing strategic planning, enhancing community engagement, increasing innovation, and ensuring sustainability through resource mobilization. It also proposes adapting the Porter Diamond Theory with locally grounded frameworks that incorporate health systems thinking and governance tools. The study contributes significant empirical evidence on the role of strategic management practices in improving TB case detection and informs policy and practice in public health strategy design PhD Thesis

Contributions of socioeconomic, cultural and institutional factors on climate change adaptation strategies by smallholder farmers in Homa bay county, Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Contributions of socioeconomic, cultural and institutional factors on climate change adaptation strategies by smallholder farmers in Homa bay county, Kenya AWINDA, Danice Otieno Climate change poses significant challenges to smallholder farmers globally, particularly agricultural production in developing countries. This makes it necessary for agricultural systems to adapt to climate change effects. However, smallholder farmers have limited capacity or resources to adapt to climate change. Studies have provided insights into particular adaptation strategies and impacts, but remains unclear to what extent socioeconomic, cultural and institutional factors contribute to the choice of climate change adaptation strategies at household level. The main objective of this study was to assess the contributions of socioeconomic, cultural and institutional factors on choice of climate change adaptation strstegies by smallholder farmers in Homa Bay County. The specific objectives were to establish the contribution of socioeconomic factors (land size, gender, age, marital status, educational level) on choice of climate change adaptation strategies by smallholder farmers in Homa Bay County; determine the contribution of cultural factors (place attachment, cultural and religious beliefs) on choice of climate change adaptation strategies by smallholder farmers in Homa Bay County; find out the contribution of indigenous local knowledge (Farming experience, climate change experience) on choice of climate change adaptation strategies by smallholder farmers in Homa Bay County; and to examine the contribution of local institutions (group membership, types of institutions) on choice of climate change adaptation strategies by smallholder farmers in Homa Bay County. The study used cross sectional survey design and a sample size of 398 smallholder farming households out of a target population of 158,827 smallholder faming households in the study area. Quantitative data were collected using a structured household questionnaire administered to 398 household heads and qualitative data were collected using interview schedule administered to 24 key informants and focus group discussions administered to 12 groups. Quantitative data were analysed using frequencies percentages, cross-tabulation and Chi-square test of independence at 5% significance level. The Cramer’s V coefficient of effect size was used to measure the contributions of these factors on choice of climate change adaptation strategies. Qualitative data were analysed thematically based on study objectives. The results revealed that the socioeconomic factors with very strong statistically significant contribution to choice of climate change adaptation strategies included marital status (V= 0.257), household size (V=0.268), while size of farm (V=0.194) and source of farm labour (V=0.219) had strong contribution to choice of climate change adaptation strategies. Cultural factors with very strong contribution included level of attachment to place of residence (V= 0.372), family order in farm operations (V= 0.272) and religious beliefs (V= 0.412), to the choice of climate change adaptation strategies. Indigenous knowledge factors with very strong contribution included farming experience (V=0.250) and climate change experience (V=0.338), while duration of stay in the study area (V=0.232) had a strong contribution to choice of climate change adaptation strategies. The institutional factors with strong contribution included sponsorship by local institutions (V=0.195) and types of assistance received (V=0.181). The study concluded that the four factors (socioeconomic factors. cultural factors, indigenous local knowledge and local institutions) examined significantly contributed to choice of change adaptation strategies by smallholder farmers in the study area. However, culture was found to be central and had an influence on the effect of all the four factors in determining the choice of climate change adaptation strategies. The study recommended the need to strengthen cultural practices that enhance climate change adapyatio. Development of agricultural production should consider the socioeconomic, cultural and institutional factors contributing to climate change adaptation at household level for improved household food security in the study area. PhD Thesis

Moderating effect of financial sustainability on the Relationship between financial innovation and financial Growth of non-governmental organizations in lake Region economic bloc -kenya

Mon, 01 Jan 2024 00:00:00 GMT

Moderating effect of financial sustainability on the Relationship between financial innovation and financial Growth of non-governmental organizations in lake Region economic bloc -kenya ACHIENG, Eunice Achola Non-Governmental Organizations (NGOs) play a major role in supporting the well-being of underprivileged persons in less developed nations. Their funding stability and financial growth sustainability are foundamental to effective attainment of their goals. However, financial growth sustainability remains a key concern for even the most established NGOs world over. Whereas over the period 2010 to 2020, there has been a significant increase in NGOs being incorporated within the Lake Region Economic Bloc (LREB), literature reveals that 70% of the newly incorporated NGOs don’t survive when donor funding stops; attributing this to their inability to raise adequate internal funds. In terms of subject scope, the study is from the broad field of finance and sub field of financial management and area scope perspective study was carried out in Lake Region Economic Bloc. Empirical studies on the nexus between financial innovation, sustainability and NGOs’ growth revealed varied findings; but majority of which examine profit making organizations, making it unknown how financial innovations and sustainability influence financial growth of NGOs. The purpose of this study was to analyze moderating effect of financial sustainability on the relationship between financial innovation and financial growth of non-governmental organizations in Lake Region Economic Bloc-Kenya. Specifically, the study sought to; determine influence of financial innovation on financial growth of NGOs in LREB Kenya, to establish influence of financial sustainability on financial growth of NGOs in LREB Kenya and investigate the moderating effect of financial sustainability on the relationship between financial innovation and financial growth of NGOs in LREB Kenya. The study was guided by Resource based view, Diffusion, Porter’s generic and Schumpeter theories of innovation; which provide how new ideas spread to influence competitive advantage. Social Constructivist Research paradigm was adopted and executed through Crosssectional Research Design. The target population for this study was 517 respondents consisting of the CEOs and Finance managers. A sample of 220 respondents was selected based on modified Mugenda and Mugenda formula using simple random sampling method. Cross-sectional data involving both primary and secondary data were collected. Secondary data on financial growth was obtained from published NGOs’ reports while primary data on innovation was collected using structured five-point likert scale questionnaires. Data was analyzed using descriptive and inferential techniques involving; frequencies, percentages, independent samples t-test, one-way ANOVA, Pearson correlation and multiple regressions; to establish extent of innovation adoption and effect on financial growth of NGOs. Alpha coefficient of 0.841 indicated that data collection instrument was reliable, and validity test was done by involved experts judgement from Lecturers in research, NGOs experts. Results indicated that adoption of financial innovations significantly enhanced financial growth by 16.04% hence rejection of the H01 null hypotheses. Adoption of financial innovations was very high in LREB-Kenya given indices of 0.9. Further, product, process and structural innovations increased financial growth for NGOs in the LREB-Kenya by approximately 3.5%, 0.5% and 7.1% respectively hence a rejection of null hypotheses .A regression analysis coefficient of 2.796 having a p-value 0.015 for number of donors a sustainability aspect in the non-moderation effect model indicated a significant positive relationship between number of donors and percentage change in revenue such that a percentage increase in number of donors increased percentage change in revenue for NGOs in the LREB-Kenya by 2.8%, Null hypothesis rejected H02. A significant 2 R change of 0.033; 2 R changed from 73.7% to 77% after moderation implying that financial sustainability had a significant moderating effect of 3.3% and it enhanced influence of product, process and structural innovations on financial growth by 0.7%, 0.2% and 6.9% respectively, hence rejection of H03 Null Hypothesis. Results showed that financial innovation and sustainability significantly influenced financial growth of NGOs in LREB-Kenya by enhancing growth in revenues and financial sustainability significantly moderated the relationship between financial innovation and financial growth of NGOs in LREBKenya by enhancing influence of financial innovations on change in revenue. Findings of this study may be invaluable to management of NGOs in embracing financial innovation and sustainability adoption, scholars and policy makers. This is likely to enhance their revenue growth. More importantly, findings may also contribute to academia by providing valuable empirical data on innovation strategies influencing financial growth. PhD Thesis

Effects of genetic variations and altered gene expression patterns on severe malarial Anaemia pathogenesis in children from siaya county

Wed, 01 Jan 2025 00:00:00 GMT

Effects of genetic variations and altered gene expression patterns on severe malarial Anaemia pathogenesis in children from siaya county ONYANGO, Clinton Odhiambo Malaria remains a significant health burden in sub-Saharan Africa. In holoendemic Plasmodium Falciparum transmission regions, such as western Kenya, children aged <5 years are vulnerable due to naïve malarial immunity. Among these children, severe malarial anaemia (SMA, haemoglobin (Hb)<5.0 g/dL) is the most prevalent and life-threatening manifestation of severe malaria. Despite its high burden, the molecular mechanism driving SMA pathogenesis, particularly the host genetic and transcriptomic factors as well as parasite gene expression, remains poorly defined. This study determined the effect of human genetic variation, as well as the host and P. falciparum gene expression patterns on SMA pathogenesis in children (<5 years) from Siaya County. The specific objectives included: to determine the relationship between genetic polymorphisms in natural cytotoxicity-triggering receptor (NCR3) (rs2736191:C>G and rs11575837:C>T) and longitudinal malaria outcomes; to determine the influence of NK cell networks, and other immune signalling pathways on the pathogenesis of paediatric SMA, and to profile the transcriptome of blood-stage P. falciparum in children with SMA. The selected NCR3 SNPs reduced NCR3 transcription, thereby impairing NK cell recognition of iRBCs and cytokine signaling. In contrast, host and parasite transcriptomics provide insights into their expression profiles in SMA. Genomic DNA from dried bloodspots collected at enrollment from 1,515 children was genotyped for the NCR3 variants using TaqMan® assays, while total RNA from 66 children was used for RNA sequencing via Illumina® sequencing. Poisson regression revealed that the rs11575837 TT genotype increased the risk of malaria episodes [Incidence Rate Ratio (IRR)=1.540, P=0.009], while the CC haplotype was protective against SMA (IRR=0.823, P=0.009). Host transcriptomics of RNA from whole-blood collected at enrollment from 66 children revealed 6,862 differentially expressed genes (DEGs) in SMA vs. non-SMA, with increased NK cell expression (P=0.002) and dysregulated Inflammation_NK cell cytotoxicity network (Padj=3.628E-04) in SMA. Furthermore, the HSP60-HSP70-TLR2/4 signalling pathway (Padj=5.483E-09) was among the most dysregulated immune pathways, with altered glutamine metabolism in SMA. P. falciparum transcriptomics from 60 children revealed 566 DEGs in SMA vs. non-SMA. Weighted gene co-expression network analysis (WGCNA) and protein-protein interaction (PPI) of the DEGs identified parasite pathways potentially contributing to SMA. Additionally, the hub nodes in the WGCNA and PPI networks, which increased the risk of SMA, were identified. Overall, NCR3 variation influences malaria and SMA risk, while SMA is characterised by dysregulated NK-cell function, impaired HSP60-HSP70-TLR2/4 signalling, altered glutamine metabolism, and distinct parasite transcriptional profiles. These findings advance the understanding of SMA pathogenesis and identify hub nodes as potential therapeutic targets. PhD Thesis

Effect of financial information systems on the relationship between control activities, risk assessment, and revenue collection in lake region economic bloc counties in Kenya

Wed, 01 Jan 2025 00:00:00 GMT

Effect of financial information systems on the relationship between control activities, risk assessment, and revenue collection in lake region economic bloc counties in Kenya OKISE, Joshua Clinton Revenue collection is vital for financing public services and driving sustainable development. Advanced economies like the United States, China, and India have recorded notable gains, with the U.S. tax-to-GDP ratio rising from 25.8% in 2020 to 26.6% in 2021, China from 20.1% to 21.0%, and India posting a 34% revenue increase in 2021/2022.In contrast, Nigeria‘s ratio fell from 6.0% in 2019 to 5.5% in 2020, while Kenya‘s dropped from 15.8% to 15.2% between 2020 and 2021. The Lake Region Economic Bloc (LREB) performed worse, with its ratio stagnating at 4% (2019–2022) before declining to 3% in 2023–2024, resulting in only 65–72% revenue realization and a 30.8% funding gap, forcing reliance on costly borrowing. Existing studies affirm the importance of internal controls and financial systems but reveal gaps: focus on private sector contexts, limited exploration of FIS as a moderator, reliance on cross-sectional or perception-based data, and lack of robust diagnostic testing. This study examined the effect of Financial Information Systems (FIS) on the relationship between control activities, risk assessment and revenue collection in the Lake Region Economic Bloc (LREB) counties in Kenya. Objectives include assessing the effects of control activities and risk assessment, as well as the moderating role of FIS in strengthening these relationships. Grounded in Contingency, Agency, and Task-Technology Fit theories, the study adopted a correlational panel design using secondary data from all 14 LREB counties (2015–2024), applying panel regression to evaluate these relationships. The regression analysis reveals that both internal control activities (ICA) and financial information systems (FIS) are positively and highly significant predictors of revenue collection, with a % increase in ICA corresponding to a 5.8% increase in revenue collection (z = 7.71, p < 0.001) and a % increase in FIS associated with a 6.7% increase in revenue collection (z = 8.60, p < 0.001). Critically, a significant synergistic interaction exists between ICA and FIS (β = 0.016, z = 3.33, p = 0.001), indicating that their combined effect on revenue performance is greater than the sum of their individual impacts. While the Annual Risk Index Score itself showed a negative but marginally non-significant effect in the fixed-effects model (β = –0.013, t = –1.80, p = 0.096), FIS significantly moderates this relationship, with the interaction term (Risk × FIS) being positive and significant (β = 0.009, t = 2.18, p = 0.049), demonstrating that robust financial systems mitigate the adverse effects of risk. The model explains substantial variance in revenue collection, with an overall R² of 64.5% and a within-county R² of 71.7%. The study conclusively establishes that internal control activities (ICA) and financial information systems (FIS) are fundamental drivers of revenue collection efficiency in the Lake Region Economic Bloc counties, with a significant synergistic interaction underscoring the necessity of integrating these systems for superior outcomes. Furthermore, FIS serves a critical risk-mitigation role, counteracting the negative effects of annual risk on revenue performance, while persistent unobserved county-specific factors also substantially influence revenue capacity. Based on these findings, recommendations include prioritizing the concurrent strengthening of ICA and FIS to leverage their synergy, deploying FIS strategically for risk mitigation, adapting policies to county-specific contexts due to significant between-county variation (ρ = 0.620), and investigating specific county-level factors such as governance structures and institutional capacity to inform targeted policy design. Policy should focus on capacity-building for finance staff and extending digital revenue platforms to grass-roots micro-traders (―Mama Mboga‖) to promote equity and compliance. PhD Thesis

Determinants, mechanisms, and association of water insecurity with HIV treatment outcomes among adults on art In Kisumu county, Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Determinants, mechanisms, and association of water insecurity with HIV treatment outcomes among adults on art In Kisumu county, Kenya ODAK, Jacquelyne Jascinter Despite progress in HIV management, resource insecurities threaten the gains made with antiretroviral therapy (ART) among adults globally. Water insecurity, a common problem in high HIV burden regions, has not received much attention despite its important role in HIV treatment outcomes. Kisumu County has a high HIV prevalence (11.7%), a 17% viral suppression gap, and only 42% water access, however, the relationship of water insecurity with HIV outcomes among ART clients is not adequately understood. This study, in line with the Sustainable Development Goals (SDGs) 3 and 6, had the general objective of establishing the determinants, the mechanisms, and the association of water insecurity with HIV treatment outcomes among adults on ART in Kisumu County. The specific objectives were 1) to estimate the prevalence and characterize the drivers and dimensions of water insecurity; 2) to explore the lived experiences of water insecurity and elucidate pathways from water insecurity to HIV treatment outcomes, and 3) to determine the association of water insecurity with HIV treatment outcomes among adults on ART and assess whether sex modified this association. An integrated multiphase mixed-methods design was employed. In Phase I, a baseline cross-sectional study of 434 randomly selected adults addressed the first objective, with a nested water quality sub-study. In Phase II, water insecure participants were purposively selected to explore the lived experiences of water insecurity. In Phase III, a matched case–control study of 356 randomly selected adults was conducted to determine the association between water insecurity and HIV treatment outcomes and assess sex as an effect modifier. Quantitative data were analyzed using descriptive and inferential statistics (α = 0.05). Qualitative data were analyzed using inductive thematic analysis, followed by framework analysis to develop a novel conceptual model. Baseline household water insecurity prevalence was 64%. Determinants of water insecurity included socio-structural factors, communal, and individual factors. Female sex (OR = 4.88; 95% CI: 3.11–7.67; p < 0.001; AOR = 3.65; 95% CI: 2.02–6.58; p < 0.001), and microbial contamination (OR = 10.04, 95% CI: 5.94–16.95, p < 0.001; AOR = 3.96, 95% CI: 2.07–7.59, p < 0.001) were independent predictors of water insecurity. Water sources had widespread microbial (76.5%) and physicochemical (94%) contamination. The lived experiences revealed challenges with availability, access and quality, resulting in HIV treatment interruptions. Physical health, psychosocial, resource insecurity, and water-dependent dosing mechanistic pathways linked water insecurity to HIV treatment outcomes. In the case–control study, water insecurity was strongly associated with poor HIV treatment outcomes (OR = 3.18, 95% CI: 1.95–5.17; p <0.001; AOR = 3.66, 95% CI: 2.13–6.29, p < 0.001), with no evidence that sex modified the association. Increasing severity of water insecurity was associated with higher odds of poor HIV treatment outcomes, with each 5-point increase in the water insecurity score doubling those odds (OR = 2.05, 95% CI 1.72–2.44; p < 0.001). Water insecurity was highly prevalent among adults on ART and increased the risk of poor HIV treatment outcomes. Multi-sectoral collaboration for strengthening water infrastructure, governance, and adaptive capacities may reduce water insecurity and downstream health impacts. Integrated patient-provider strategies can help sustain HIV care engagement despite structural barriers to treatment continuity. Institutionalization of water insecurity interventions within HIV care may mitigate its impact on HIV treatment outcomes in Kisumu County, while contributing to the global SDGs efforts of eradicating HIV. PhD Thesis