http://localhost/xmlui/handle/123456789/1154 2026-05-16T22:10:56Z http://localhost/xmlui/handle/123456789/6977 Comparative Study of Multi Prime and Single Prime Contracting Performance in Large Road Construction Project in Kenya Orango, Elijah Onyango This study explored the performance difference between Single-prime and Multi prime contracting methods in terms of cost, quality, timeliness, and overall xi performance as they are used in road construction in Nairobi City County. The study employed a comparative primary cross-sectional study with primary data collection using a semi-structured Likert-scaled questionnaire to collect data from professionals who have been involved in both contracting methods in roads construction in the County over the past 10 years. The study employed purposive and snowball sampling to select the professionals who were in active road construction projects in the county and professionals who had been involved in roads construction in Nairobi City County in the past ten years. The Study tool was tested for reliability and found to meet internal consistency requirements. The analysis of construction costs revealed a statistically significant difference between single prime and multi-prime (p = 0.006), suggesting that single prime projects costed slightly higher. The analysis also indicated no statistically significant difference in project timelines between the two contracting methods (U = 704.000, z = -1.208, p = 0.227). However, the higher mean rank for Multi-prime (45.79) compared to Single-prime (39.37) suggests longer time in Multi prime projects. A statistically significant difference was observed in the quality of project output between Single-prime and Multi-prime contracting methods (p = 0.002). The significantly higher mean rank for Single-prime (38.91) compared to Multi prime (46.46) (p=0002) indicates that Multi-prime contracting is associated with higher quality project outputs. The difference in overall contract performance between the two methods was statistically significant (p = 0.019). Notably, despite the seemingly lower quality output, Multi-prime contracting showed a slightly higher mean rank (45.87) compared to Single-prime (39.32) in overall performance. The result suggests that single-prime contracting may actually be associated with marginally higher costs, lower quality, but shorter completion time, possibly due to the prime contractor's markup on subcontractor work. This study concludes that Multi-primes preforms better than Single-prime contracting methods in terms of cost and overall performance in large and complex road construction projects in Nairobi City County-Kenya Nairobi City County where a lot more technical expertise may be required. MS in Construction Engineering and Management 2026-05-15T00:00:00Z http://localhost/xmlui/handle/123456789/6975 The Prevalence and Associated Factors of Atopic Dermatitis in Children aged between Six Months and Twelve Years Attending the Pediatrics Dermatology Clinic at Kenyatta National Hospital, Kenya Hassan, Zahara Haji Background: Atopic dermatitis (AD), is chronic inflammatory skin disease characterized by acute flare-ups of intense pruritus and dry scaly lesions. The onset of AD is usually between 2 and 6 months of age, although it can begin at any age. AD affects up to 20% of children and 3% of adults; latest global data shows increases in its prevalence. In Africa, the prevalence of AD ranges from 4.7% to 23%. In Kenya, the prevalence and the associated factors among pediatrics is poorly defined as there is paucity of evidence around it. As such, the clinicians attending to these clients often rely on the theoretical and literature evidence sourced from other parts of the world. The study main objective is to determine the prevalence and associated factors of atopic dermatitis among pediatric patients aged between six months and twelve years seen at the dermatology clinic at Kenyatta National Hospital, Kenya.This was a cross sectional study conducted at the Dermatology Pediatrics Clinic in the period between August and November 2024. The sample for the study was recruited consecutively until the sample size of 148children was achieved. A structured questionnaire was used to collect data. The data collected include demographic, family and personal history of associated atopic conditions, atopic dermatitis diagnosis and severity of atopic dermatitis using POEM score. Ethical Approval was acquired from KNH-UON ERC. Data was analyzed using SPSS v.25 and the prevalence of atopic dermatitis was calculated as a proportion of the total sample size and expressed as percentage. Binary logistic regression was performed to investigate factors associated with AD. Significance was assessed at< 0.05. The results showed that majority of the patients, N=90(60.8%) were female, N=59 (39.9%) were aged more than 10 years, most patients had 1-5 siblings N= 62(41.9%) and N=112(75.7% had their mothers unemployed. The prevalence of atopic dermatitis was N=38(25.7%) with a CI of between 18.9% to 33.5%. After adjusting for cofounders, the adjusted odds ratio showed that factors associated with Atopic Dermatitis included age of 5 years and below (aOR = 12.11, 95% CI: 3.11, 56.37, p < 0.001), males (aOR = 2.83, 95% CI: 1.32, 6.03, p = 0.015), family history of allergic asthma (aOR = 8.33, 95% CI: 3.67 33.11, p < 0.001), family history of allergic rhinitis (aOR = 18.13, 95% CI: 7.67–70.11, p < 0.001), family history of allergic conjunctivitis (aOR = 6.11, 95% CI: 2.64–20.78, p = 0.007), family history of atopic dermatitis (aOR = 7.11, 95% CI: 1.36–23.63, p = 0.019), allergic asthma(aOR 11.18 95% CI3.14,25.11 P=<0.001), allergic rhinitis (aOR 12.88,95%CI 2.65,51.02 P=<0.001) and allergic conjunctivitis (aOR 15.53,95% CI 1.71,52.75 P=<0.001) . The severity of eczema among patients N=38 was assessed using the POEM score. The findings showed that 44.7% had minimal eczema, 34.2% had mild eczema, 13.1% had moderate eczema, and 7.4% had severe eczema. The study concluded that one in four children attending dermatology clinic were found to have atopic dermatitis. Younger children, males, and those with unemployed mothers had higher odds of developing AD. A family history of allergies and personal factors like allergic asthma, rhinitis, and conjunctivitis also increased the risk of AD. Thus, healthcare providers prioritize early screening for AD in children, especially those with a family history of allergies. Keywords: Atopic dermatitis, Eczema, pruritus, prevalence, associated factors Master of Medicine in Dermatology 2026-05-14T00:00:00Z http://localhost/xmlui/handle/123456789/6972 Effectiveness of Reminders and Social Support Framework on Birth and Health Outcomes among HIV Exposed Infants in Nyahururu County Referral Hospital, Kenya Lodeke, Silas The reminder systems and social support mechanisms not only reduce antiretroviral therapy (ART) default rates but also ensure continuity of care, which is essential for improving both maternal and infant health outcomes. The role of short message service (SMS) reminders has significantly enhanced antenatal care (ANC) attendance, adherence to antiretroviral drugs (ARVs), viral suppression, and prevention of mother to-child transmission (PMTCT) of HIV. In Kenya, mother-to-child transmission remains a concern, with Laikipia County showing a higher infection rate among infants. These trends highlight the urgent need for targeted interventions in Laikipia County to improve infant health outcomes. The objective of the study was to assess the effectiveness of reminders and the social support framework on birth and health outcomes among HIV exposed infants (HEIs) at Nyahururu County Referral Hospital in Laikipia County. A quasi-experimental design was used in this study. In addition, 220 HIV positive pregnant mothers attending the comprehensive care Centre were recruited. Systematic random sampling was used to select the respondents. Both primary and secondary data were collected using structured questionnaires. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) software, version 28. Descriptive statistics, including frequencies and percentages, were used to summarize and organize the data. Correlation, regression and Chi- square statistic was used to test for association/relationship between variables and level of significance. All statistical tests of significance were conducted at a coefficient level of alpha less than 0.05 with the help of SPSS 2.5 for windows. Results showed that 63.1% of mothers in the reminder group adhered to three to four ANC visits, compared to 57.7% in the routine group. In addition, the study found that most mothers in both groups had spontaneous vaginal deliveries (96.4% in the reminders group), with fewer requiring medical interventions. Moreover, the findings showed that 77.7% of mothers in the reminder group practiced exclusive breastfeeding for six months, compared to 65.0% in the routine follow-up group, indicating. Moreover, the study found a significantly higher proportion of infants in the reminder group tested HIV negative (98.2%) compared to 95.0% in the routine group. Survivorship was also higher, with 95.5% of infants in the reminder group surviving past one year, compared to 86.0% in the routine follow-up group. The correlation coefficient of 0.78 signified a strong positive relationship between the use of on reminders and improved health outcomes for HIV exposed infants, including higher survival rates (p-value=0.000). The Chi Square value of 20.8 reflected a significant association between the use of reminders and improved health outcomes for infants, underscoring the substantial impact of on reminders on enhancing infant health and survival rates (p-value=0.000). The study concludes that the use of reminders significantly enhances and infant health outcomes. The study recommends integrating structured reminder systems and social support into maternal and child health programs to improve adherence to ANC and ART, enhance birth outcomes, promote exclusive breastfeeding, and boost infant health and survival among HIV exposed populations. PhD in Public Health 2026-05-15T00:00:00Z http://localhost/xmlui/handle/123456789/6971 Clinical Etiology and Histopathologic Correlation of Exfoliative Erythroderma at the Kenyatta National Hospital Wainaina, Karen Waithera Exfoliative erythroderma is a dermatologic emergency characterized by diffuse skin redness and scaling involving at least 70% of the body surface area. It is a clinical presentation that usually indicates an underlying primary process. Once a clinical diagnosis of EE was made, prompt supportive measures were instituted while efforts were undertaken to identify the underlying cause of the presentation. These causes were determined clinically and/or through histopathological evaluation following a skin biopsy. Identifying the underlying cause was important for reducing recurrences, complications associated with skin failure, and mortality risk. The correlation between clinical and histopathological diagnoses had not been determined for the Kenyan population. The purpose of the study was to assess the frequency of causes of EE and their histopathologic correlation at Kenyatta National Hospital. This was an ambispective study that included both prospective and retrospective components conducted in the wards and clinics of Kenyatta National Hospital. All adult patients with EE who met the study criteria were included. This study assessed 94 cases of EE at KNH to determine the frequency of skin biopsies and clinicopathologic correlation. Descriptive analysis was used to summarize clinical and pathological findings. Correlation analysis was conducted using Kappa statistics, and sensitivity analysis was also performed to determine the accuracy of clinical findings. A p-value of <0.05 was considered statistically significant at a 95% confidence interval. Data analysis was performed using SPSS version 27. While clinical assessments frequently identified psoriasis and malignancies, the leading histopathologic causes were malignancies (kappa=0.73) and immunobullous diseases (kappa=0.89). To prevent clinical misdiagnosis of the underlying cause of EE, a biopsy-first protocol was recommended for all new EE presentations to ensure diagnostic accuracy and guide next management steps. Master of Medicine in Dermatology 2026-05-15T00:00:00Z