Browsing by Author "Opon, Shadrack Ochieng"

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Contribution of health workers and patient characteristics on adherence to antenatal clinic appointments in public hospitals: a case of Homabay and Kisumu County referral hospitals, Kenya
(PAMJ - One Health, 2020-11) Opon, Shadrack Ochieng; Tenambergen, Wanja Mwaura; Njoroge, Kezia Muthoni
Introduction: missed appointments account for about 56% of wasted health resources in the world. There is about 42% missed appointment rate in African medical setting. Antenatal clinics in Kenya experience about 44% missed appointment rate accounting for about 22% of wasted health resources. About 1.7 million children born between 2013 and 2017 did not receive all prescribed vaccines. About 42% and 35% of antennal appointments in Homabay and Kisumu Counties were missed in 2019. The study assessed contribution of health workers and patient characteristics on adherence to antenatal clinic appointments in public hospitals. Methods: a crosssectional research design was employed in Homabay and Kisumu County hospitals. The study included 2 hospital managers per hospital, 70 and 63 antenatal clients in Homabay and Kisumu County hospitals respectively. Patients were stratified and proportionately sampled, while hospital managers were purposively sampled. Sample size was determined using Yamane Formula. Key informant interview and selfadministered structured questionnaire were used to collect data, and analysis done using SPSS tool. Results: findings showed, in Homabay and Kisumu County hospitals respectively, that: 50 (71.4%) and 20 (40%) missed appointments due to inadequate staff responsiveness towards their needs; 50 (71.4%) and 28 (56%) due to staff attitude. Single and separated antenatal clients miss more appointments compared to married and cohabiting clients. Conclusion: there is low adherence to appointments in antenatal clinics in Homabay and Kisumu County hospitals because of poor staff attitude, inadequate staff responsiveness; and lack of sufficient education on the importance of antenatal care among mothers
The effect of patient reminders in reducing missed appointment in medical settings:a systematic review
(PAMJ - One Health, 2020-06) Opon, Shadrack Ochieng; Tenambergen, Wanja Mwaura; Njoroge, Kezia Muthoni
Missed appointments are a problem to healthcare professionals worldwide. There is up to nearly 42% missed appointment rate in medical setting globally. Reducing missed appointment rates improves the efficiency of health services and health outcomes of patients. Missed appointment rates can be reduced by reminding patients about their medical appointments in advance. A simple way of doing this is via electronic notification to the patients´ phones. The aim of this paper is to review the effect of patient reminders in reducing missed appointment rates. The methodology was conducted based on the PRISMA guidelines for systematic reviews. Literature search was conducted extensively using Google Scholar and PubMed databases based on terms such as cell phone reminders, electronic notification reminders, missed appointment rates, clinic attendance and SMS reminders. Geographical and publication biases were assessed. The result of the review showed that 95% studies reviewed reported a positive effect of patient reminders on appointment rates, with an average of 41% reduction in missed appointment rates and 34% increase in clinic attendance rates in all the studies. The review revealed that patient reminders reduce missed appointment rates and improve clinic attendance rates. Multiple reminders produce better outcomes. Reducing missed appointment rates also improve the efficiency of health care facilities.
Effect of systems approach intervention on adherence to antenatal and postnatal appointments: a systematic review
(Pan African Medical Journal-One Health, 2020-06) Opon, Shadrack Ochieng; Tenambergen, Wanja Mwaura; Njoroge., Kezia Muthoni
Maternal and child health is one of the most significant aspects of service delivery pillar. With every country focusing on the achievement of sustainable development goal number three (SDG 3), provision and utilization of maternal and child health services continue to attract global attention. Many countries make significant investments to provide these services at no cost to expectant mothers. However, maternal and child health services have not obtained optimal utilization for various reasons. Improving adherence to antenatal care (ANC) is an integral strategy to reduce under-five mortality and to improve maternal and child health. In sub-Saharan Africa, women often initiate antenatal care visit in their first trimester, but do not follow through to the recommended four ANC visits. Failure to attend ANC visits increases fetal, maternal, and neonatal mortality. Therefore, there is need for comprehensive systems to attain SDG 3 by 2030. A systematic approach intervention that cuts across health system has been proven to increase adherence. Interventions such as patient reminders and public relation initiatives such as information sharing, effective communication and education among health workers could prove effective in this course. The aim of this review is to examine the impact of systematic approach intervention on adherence to ANC appointments. The methodology included PRISMA guidelines for systematic reviews. Google Scholar and PubMed databases were searched using the terms such as systems approach intervention, adherence to appointments, missed appointments, ANC visit attendance, Postnatal Care (PNC) visit attendance, ANC adherence, and PNC adherence. Biases were assessed based on geographical area and publication dates. The result of the review showed that all the studies included reported a positive effect of systems approach intervention in increasing appointment adherence, with an average of 42% appointment adherence and 35% reduction in missed appointments in antenatal and postnatal clinics across all the studies. Conclusively, systems approach intervention increases adherence to appointments in antenatal and postnatal clinics. Multiple interventions also produce better outcomes.
Health systems factors influencing utilization of essential health package in public hospitals.
(KeMU, 2016-07) Opon, Shadrack Ochieng
Availability of health care services does not guarantee that patients will optimally use them. In Homabay County, lack of access to health services is among the top reasons for low service utilization. This study focused on service delivery pillar and in particular the utilization of essential health packages (EHP), which include infectious diseases, maternal and newborn health, nutritional deficiencies and common injuries. According to Kenya Demographic Health Survey 2014, the health care utilization rate is 77% for those who are sick in Kenya. Among those who are ill and do not seek care, 44% and 18% were hindered by cost and distance respectively. The Health Sector Statistics Report also suggests that the overall child mortality rate is 121 per 1,000 live births. In Homabay County, child mortality rate is 91 per 1,000 live births, and maternal mortality rate is 583 per 100,000, compared to the national average of 488 per 100,000. The study assessed health systems factors influencing the utilization of EHP in public hospitals in Homabay County. Specifically, the study assessed how human resources for health, availability of drug, the role of health infrastructure, and organizational practices influence the utilization of EHP. The study adopted cross-sectional research design. Two hospitals were conveniently sampled (Homa-bay County Hospital and Mbita Sub-County Hospital) due to their large volume of patients. Yamane's formula was used determine the respondents' sample size. The study used stratified and simple random sampling methods to sample 138 health workers (Pharmacists 5, Clinicians 13, Health Management Information System Officers 8, Nurses 104, and Hospital Managers 8), and simple random sampling to sample 186 patients. Structured questionnaire and key interview guide (with 8 hospital heads) were used to collect data. Findings revealed that, all the health workers 138 (100%) said that Homabay County has shortage of health workers, the hospitals have inadequate drugs and patients are referred elsewhere due to lack of medical equipment. Majority 115 (83.3%) health workers say hospitals lack operational ambulances. Majority 153 (82.3%) and 135 (72.6%) of patients are hindered by cost and distance respectively to access health care. Among organizational factors, majority 159 (85.5%) patients do not always find all services they wanted and had ever failed to seek care because of the long waiting time. The regression model revealed at least 0.06 coefficients, indicating that a positive change in the independent variables (human resources for health, availability of drugs and supplies, health infrastructure, and organizational practices) results in a positive change in the dependent variable, utilization of EHP. Positive Pearson's correlation of 0.11 showed a close relationship between the variables. Conclusively, Homabay County lacks adequate health workers, drugs and hospital infrastructure, in addition to poor organizational practices leading to low utilization of EHP. The study recommends that the county employs more health workers, improves the procurement system, invests on health infrastructure including medical equipment, emergency ambulances, and buildings and should review costs of services to improve utilization of EHP in Homabay County.
Influence of organizational and access factors on adherence to appointments in antenatal clinics in Homa Bay and Kisumu County Referral Hospitals, Kenya
(PAMJ - One Health., 2021-08) Opon, Shadrack Ochieng; Tenambergen, Wanja Mwaura; Njoroge, Kezia Muthoni
Introduction: the world wastes about 40% of health resources, and African medical setting has about 42% missed appointment rate. Kenya has 44% missed appointment rate in antenatal clinics, wasting about 22% of health resources. Five hundred and two thousand eight hundred and sixty (502,860) children were not immunized in 2017. Homabay and Kisumu Counties with 91/1000 and 149/1000 under-five mortality rates, recorded 42% and 35% missed appointment rates in antenatal clinics respectively in 2019. This study assessed influence of organizational and access factors on adherence to appointments in antenatal clinics. Methods: the study adopted cross-sectional research design across two hospitals, purposively sampled (Homabay and Kisumu County Hospitals) because of high under-five mortality and high HIV prevalence rates. Stratified and proportionate sampling were used to sample patients, and purposive sampling for hospital managers. Yamane Formula was used to determine sample size. The study comprised 133 antenatal patients (Homabay County Hospital 70, Kisumu County Hospital 63) and two hospital managers per hospital. Self- administered structured questionnaire and key informant interview were used to collect data. Results: study revealed in Homabay and Kisumu County hospitals respectively, as follows: 55 (78.6%) and 35 (70%) antenatal clients missed their appointments because of waiting time; 55 (78.6%) and 30 (60%) due to facility operating hours; and 55 (78.6%) and 25 (50%) due to opportunity cost of seeking services; and 55 (78.6%) and 20 (40%) due to facility proximity. Conclusion: there is high missed appointment rates in antenatal clinics in Homabay and Kisumu County hospitals because of poor organization of antenatal services, opportunity cost and facility location.