School of Medicine and Health Sciences

Permanent URI for this collectionhttp://41.89.31.6:4000/handle/123456789/315

Welcome to School of Medicine and Health Sciences collection.This collection contains Journal articles published by faculty affiliated to the school.

Browse

Now showing 1 - 20 of 189

Seasonality of Cryptosporidium oocyst detection in surface waters of Meru, Kenya as determined by two isolation methods followed by PCR
(Journal of Water and Health |, 2008-10) Muchiri, John M.; Ascolillo, Luke; Mutuma, Mugambi; Mutwir, Titus; Ward, Honorine D.; Naumova, Elena N.; Egorov, Andrey I.; Cohen, Seth; Else, James G.; Griffiths, Jeffrey K.
Meru, Kenya has watersheds which are shared by wildlife, humans and domesticated animals. These surface waters can be contaminated by the waterborne pathogen Cryptosporidium. To quantify the seasonality and prevalence of Cryptosporidium in Meru regional surface waters, we used a calcium carbonate flocculation (CCF) and sucrose floatation method, and a filtration and immunomagnetic bead separation method, each of which used PCR for Cryptosporidium detection and genotyping. Monthly water samples were collected from January through June in 2003 and 2004, bracketing two April-May rainy seasons. We detected significant seasonality with 8 of 9 positive samples from May and June (p<0.0014), which followed peak rainy season precipitation and includes some of the subsequent dry season. Six of 9 positive samples revealed C. parvum, and 3 contained C. andersoni. None contained C. hominis. Our results indicate that Meru surface waters are Cryptosporidium-contaminated at the end of rainy seasons, consistent with the timing of human infections reported by others from East Africa and contrasting with the onset of rainy season peak incidence reported from West Africa.
Preparedness of County Referral Health Facilities in Implementing Adolescent Friendly Health Services: A Case of Mama Lucy Kibaki County Refferal Hospital, Kenya
(Global Journal of Health Science;, 2015) Owuondo, Pacific Akinyi; Mwaura-Tenembergen, Wanja; Adoyo, Maureen; Kiilu, Elizabeth M.
Background: Health service delivery is a key pillar of health system management. However, there is limited peer reviewed literature on health services to adolescents necessitating assessment of whether the existing health facilities were prepared to implement the adolescent friendly health services. Staff capacity, health resources and health system factors were assessed in regards to health service delivery to adolescent cohort study. Methods: Cross-sectional research design was adopted, census, stratified random sampling and simple random sampling were used to establish study participants. Data was collected using structured questionnaires and focused group discussions for adolescents. Analysis was done using Statistical package for the social science Version 17.0 programme for data analysis and results were presented in tables and graphs. Results: The study established that there is limited adolescent friendly health services implementation in the facility. Even though 107 (73.3%) of the healthcare providers referred to the adolescent health services offered at the facility as friendly. Health workers capacity was limited in regards to adolescent friendly health service delivery. On the other hand 212 (100%) adolescents recommended specific health resources to be incorporated within the health system to improve the services rendered to them. Conclusion: The link between health care resources and adolescent health is not well understood by health workers and managers leading to inadequacy of services specific to adolescents. Laborious awareness drives to sensitize county referral health facilities to make a significant investment in the health system that supports adolescent friendly health service implementation. Similar studies need to be done in other county referral health facilities to generate more supportive evidence.
INVENTORY MANAGEMENT PRACTICES FOR ESSENTIAL DRUGS AT PUBLIC AND MISSION HOSPITALS IN MERU COUNTY, KENYA
(International Journal of Current Business and Social Sciences, 2015) Meeme, Shadrack M.; Okero, Dominic C.; . Muiruri, Lilian K.
BACKGROUND: Essential drugs are important for quality service delivery in the healthcare system. Proper inventory management of essential drugs in the health facilities is critical in ensuring availability of essential drugs (ED). Despite the importance of the required essential drugs at various user points, about one third of the world’s population does not have access to ED. This is a serious problem considering that drugs take up a significant portion of the healthcare budget and availability of ED is critical in quality healthcare provision which is a priority of the Health Systems. OBJECTIVES: To examine the current stock control practices for essential drugs at public and mission hospitals in Meru County, determine the current storage practices for essential drugs at public and mission hospitals in Meru County and establish the current practices for managing returns of essential drugs at public and mission hospitals in Meru County. METHODS: Cross-sectional descriptive study design was employed in the study and it involved 205 clinical and inventory management staff dealing with essential drugs inventory management and use in four hospitals in Meru County, Kenya. RESULTS: Method by which essential drugs are approved and issued were mostly FEFO (First Expiry First Out) 36(90.0%) and FIFO (First In First Out) 2(5.0%) and was significant on the inventory management practices (χ2 Wald test P-value =0.011). Good inventory control practices were identified mainly in FEFO (First Expiry First Out) approval and issuance methods. Stages of inspection were significant on the inventory management practice (χ2 Wald test P-value =0.000). There was significant correlation between the inventory management practices and inspection stage of essential drugs (χ2 Wald test P-value =0.037) with best practices identified when inspection was done before storage. This implies that inspection before storage increased odds of good inventory management practices. From the study it established that the main suppliers of essential drugs were MEDS 35.5%, KEMSA 29.0%, Pre-qualified supplier 19.4% and Private distributors 16.1% (p-value= 0.734). The study established that ordering of drugs mainly depended on past consumption 61.1 % other than request by users 22.2 %, majority of clinical staff 56.6 % complained of receiving drugs of questionable quality from the hospital drugs store indicating a problem in inspection of ED before storage. CONCLUSIONS: The study concluded that mission hospitals performed better than public hospitals in all aspects of inventory management. This is significant and considering that health care workers use essential drugs to deliver quality services to the clients. Patient visiting mission hospitals were likely to get all prescribed medicine which was a measure of quality on patient perspective than patient seeking health care from public health facilities: RECOMMENDATION: The study recommends public health facilities to benchmark with mission hospitals to improve inventory management practices thus ensuring availability of ED .
Human resource capacity for information management in selected public healthcare facilities in Meru County, Kenya
(Pan African Medical Research, 2015-04) Kiilu, Elizabeth Mueke; Okero, Dominic Charles; Muiruri, Lillian; Owuondo, Pacific Akinyi
Introduction: Reliable health information is essential for decision making in the healthcare system. Information management in Kenya was considered the weakest area under the Health Information System pillar mainly due to inadequate health workers capacity. The study therefore aimed at assessing health workers skills and current training needs for information management in the selected healthcare facilities. Methods: Cross-section research design was adopted and both purposive sampling technique and censuses were used to establish the study participants. Analysis was done using SPSS version 20 and results were presented in tables, charts and graphs. Results: It was established that capacity building was usually undertaken through on-job trainings i.e. 85.1% (103) health workers had on-job training on filling of data collection tools and only 10% (13) had received formal classroom training on the same. Further, only 9.1% (11) health workers had received information management training while 90.9% (110) had not received such training. Health workers demonstrated below average skills on information management i.e. only 17.4% (21) could check for data accuracy, only 16.5% (20) could compute trends from bar charts and only 16.5% (20) could transform the data they collected into meaningful information for use. Conclusion: The researcher recommended that healthcare facilities management teams develop a competency based framework for defining the desired skill mix for information management and have a yearly Training Needs Assessment for assessing training needs for information management among the health workers.
Effectiveness of Ng’adakarin Bamocha model in improving access to ante-natal and delivery services among nomadic pastoralist communities of Turkana West and Turkana North Sub-Counties of Kenya
(Pan African Medical Journal., 2015-04) Jillo, Jillo Ali; Ofware, Peter Obonyo; Njuguna, Susan; Mwaura-Tenambergen, Wanja
Introduction: Access to maternal and child health care services among the nomadic pastoralists community in Kenya and African continent in general is unacceptably low. In Turkana, only 18.1% of the women had seen a nurse or a midwife for antenatal care during pregnancy while only 1.3% of pregnant women reported delivery at health facilities in 2005. Ng’adakarin BAMOCHA model, based on migratory routes of the Turkana pastoralists and container clinics was adopted in 2007 to improve access to maternal and child health services by the nomads. Methods: A crosssectional study design was used to establish the effectiveness of Ng’adakarin BAMOCHA model on accessibility and uptake of ante-natal care and delivery services. A total of 360 households and 400 households were interviewed for pre-intervention and post-intervention respectively. The study compared the pre-intervention and post-intervention findings. Structured questionnaires and focus group discussion were used for data collection. Results: There was no improvement in the fourth ante-natal care visits between pre-intervention and post-intervention groups at 119(51.5%) and 111(41.9%) respectively (p<0.05). Knowledge of the community on the importance of ANC visits improved from 60%-72% with significance level of p<0.05. There was a significant increase 6%-17% of deliveries under a skilled health worker (p<0.05). TBA assisted deliveries increased from 7.5%- 20.2% with a p<0.05.There was significant reduction in home deliveries from 89.5%-79.5% with a p<0.05. Conclusion: The Ng’adakarin Bamocha model had a positive effect on the improving maternal health care among the nomadic pastoralist community in Turkana.
Adoption of Computerised Health Information System Focusing on Kenya’s Health Facilities
(Journal of Biology, Agriculture and Healthcare, 2016) Githiom, Samuel; Muiruri, Lillian; Osuga, Ben
Although the benefits of information technology are clear adapting new information systems to health care has proven difficult globally and rates of use have been limited. With the challenge of inadequate health workers and low quality of service delivery, Information Communication Technology is essential to ensure availability of Information to multiple users and multiple settings. It is also important for Integration of variable types of data media, data legibility, reduced medical errors, complete and quality data. It also enable structured data entry, accurate calculation of processes, provision of tools for decision support and data based analysis. Although Kenya as a developing country has invested in Information Communication Technology with the aim of improving patient care, all indications have shown slow adoption of technology in healthcare industry. Therefore it is important to focus on means of hastening adoption of HIS in order to enhance service delivery in the health sector and hence effective service delivery for Kenyan people
The Design Criteria in Implementation of a Health Management Information System: a Case of Kenyatta National Hospital
(2016) Omambia, Salim Matagi; Odhiambo-Otieno, G.W; Mwaura, Wanja
Embracing modern technology is one among very many ways of improving efficiency and reducing costs within healthcare organizations. While the integration of information and health services potential benefits cannot be disputed, there are many challenges which affect its adoption, in fact, majority of organizations have abandoned their newly acquired systems only to go back to their old manual systems.The objective of this study was to determine the design phase of the implemented Health Management Information System at Kenyatta National Hospital. This study was a cross-sectional descriptive study, the targeted population of the study were 35 healthcare workers who were involved in the designing of the Health Management Information System at Kenyatta National Hospital, and the sample technique used was snowball sampling The study utilized an in-depth interview schedule for 33 respondents in the design phase who were selected using snow-ball, the data collected from the field was analyzed through the use of univariete and bivariete statistics. Data presentation was in form of descriptive statistics such as frequency distribution, percentages, pie charts, bar graphs and tables. The data from the design phase were summarized in three main evaluation areas targeting the perception of the HMIS, purposes and processesFrom the findings, in the design stage although the respondents did not show systematic ordering there was evidence to the effect that the steps were followed during the design phase. From the findings majority of the key informants were able to define HMIS and distinguish the key features of the HMIS. Out of the 33 participants, 13 (33.4%) reported that they knew the persons who originated the idea of the electronic HMIS in KNH, a similar number were involved in the conceptualization of the system, while 4 (12.2%) indicated that they were involved in designing the HMIS and 18 (54.6%) were involved in implementation. Despite the general lack of knowledge on HMIS policy the informants demonstrated adequate understanding of the objectives of the electronic HMIS in KNH. Based on the responses obtained during interviews there were multiple problems related to the manual system that existed in KNH during the pre-implementation stage and these issues served as the basis for objective setting for the current HMIS in the hospital. Most key informants felt that the hypothesized benefits of the current HMIS were being realized including improved efficiency while four key informants felt that the benefits had been partially realized. An evaluation of the manual HMIS was done during which deficiencies of the HMIS were identified through consultations involving HMIS users and stakeholder. A HMIS needs assessment was conducted and formed the basis of the electronic system requirements with specific proposals for improvement of the deficiencies identified in the manual HMIS. An evaluation of the manual HMIS was done during which deficiencies of the HMIS were identified through consultations involving HMIS users and stakeholder. During the interviews the participants were able to highlight various aspects of the IS development cycle and there was evidence to the effect that the steps were followed during the design phase plus an evaluation of the manual system was done during which deficiencies of the system were identified through consultations involving HMIS users and stakeholders.Based on the results and discussions, among the main problems that key informants described during the design phase was major inefficiencies characterized by evident mismatching of resources input and output which spanned several areas including time, human resources and finances however, participants were able to highlight various aspects of the IS development cycle and there was evidence to the effect that the steps were followed during the design phase, planning plus an evaluation of the manual system was done during which deficiencies of the system were identified through consultations involving HMIS users and stakeholders. As a recommendation we can say that NH and the MOH needs to come up with an established standardized policy for implementing interventions
Assessing How the Packaging of Immunization Services Influence Uptake of the Immunization Services in Selected Health Facilities of Kajiado North Sub-County Kenya
(International Journal of Scientific Research in Science, Engineering and Technology IJSRSET, 2016) Kipngetich, Toweett John; Tenambergen, Wanja Mwaura; Adoyo, Maureen Atieno
Background: Immunization as a preventive measure to diseases is vital to organizational performance. Among the six pillars of the health system, this research focused on service delivery. A desk review indicated that there was low immunization coverage in the County. The objectives of the study was to determine how the cultural values, packaging of immunization and health promotion supports the uptake of immunization services Methods: A cross-sectional study utilizing a guided questionnaire, targeting 280 mothers and an interview guide targeting 9 health workers were used. Data analysis was done using SPSS version 21 using descriptive statistics. Qualitative analysis was done by thematic content analysis and framework analysis. Results: Majority of the respondents (mothers) were young with a mean age of 26 years. 233 (83%) agreed that immunization program is well explained to them when they visit health facilities. More than half 183(65.4%) of mothers got the information about immunization through continuous health education routinely offered in health facilities, whereas a significantly low 39 (13.9%) mothers got the immunization information through community health promotion. The correlation of health education with awareness indicated a (P-value = 0.406**) A p-value of 0.209** indicates that frequent visits to the health facilities did not influence the awareness of mothers on the immunization services offered in health facilities. Conclusion: The researcher concluded that there is a relationship between immunization uptake and immunization health promotion activities and recommended that the County Government of Kajiado should introduce outreach services and intensify health promotion activities
Health Insurance Plan and Utilization of Health Services: The Case of Tanykina Community Health Plan; Nandi County, Kenya
(International Journal of Scientific and Research Publications, 2016-03) Terer, Erick; Mwaura-Tenambergen, Wanja; Osuga, Ben
Community Based Health Insurance mechanism of Health financing targets the informal sector and the Rural who cannot access the national social health insurance. Tanykina Community Health Plan was established to help dairy farmers in Nandi North Sub county of Nandi to access quality health services using monthly milk deductions as the premiums. Despite this financial access, there is still low health care utilization by these residences. This study aimed to evaluate the effect of the perceptions of residents and clients on the utilization of health services. A cross-sectional study was conducted on patients attending the contracted health facilities. Of the 336 respondents (84% response rate) 169(50.2%) were enrolled members of TCHP, with most of them being female (95,55%) and over 50 % having at least college level of education. The level of education was highly correlated with increased healthcare utilization (p=0.069) though this was not statistically significant. Increased level of satisfaction correlated positively with increased used of outpatient services and this was statistically significant (p=0.05). The perceived availability of information was however no statistically significantly associated with increased utilization of health services in either outpatient department (p=0.112) or inpatient department (p=0.939). The perception of increased accessed to information increased with additional age of the clients. The belief that the services offered through TCHP target the poor in the society was highly associated with increased education level of the clients (p<0.05) and the duration of membership of the clients (p<0.05). There was also a 15% increase in the outpatient services use and 19% increased likelihood to increased inpatient use with the perception that the services target the poor in the society. Almost all the respondents n=325(97%) perceived that the services of TCHP are highly acceptable. The increased level of perceived acceptance was highly associated with increased utilization of inpatient services (p=0.04). Being male increased the level of perceived acceptance by 10 % compared to the female counterparts. With regard to in-patient health services an additional increase in the level of education of the insured members and the duration of membership significantly increases the utilization of these services by 0.19 and 0.89 respectively. However, the duration of membership was statistically significant (p=0.008) in influencing the level of in-patient utilization. We recommend managers of community based health insurance to continuously evaluate the perceptions that the members have in order to improve utilization of health services.
Influence of Maternal Health Education Delivered Through Community Health Referral Project on Antenatal Care Attendance: A Focus on Mirihini and Midoina Communities of Kilifi County, Kenya
(International Journal of Scientific and Research Publications, 2016-05) Shibonje, Janet Mukoshi; Mwaura-Tenambergen, Wanja; Njuguna, Susan
Timely delivery of effective, safe, quality and personal services is a key pillar of health system strengthening. A Maternal, Newborn and Child Health (MNeCH) Project was initiated by the Ministry of Health and World Vision Kenya in Bamba Division, Kilifi County. The project’s goal was to strengthen health systems at the facility and community levels, including Antenatal Care (ANC). One of the strategies used by the project to achieve its goal was to strengthen community health referral system. The objectives of the study were 1) to determine whether providing maternal health education to pregnant women had any influence on ANC attendance in the intervention and control communities and 2) to determine whether issuing referral advice forms to patients has any influence on ANC attendance in the intervention and control communities. This study adopted the static group control design to assess the influence of community health referral practices on ANC attendance in Mirihini, the intervention community in Bamba and Midoina the control community. Primary data were sourced from 246 mothers of children aged below 2 years, parents of children aged 2 to 4 years, as well as Community Health Volunteers (CHVs). Quantitative analysis yielded descriptive statistics and cross-tabulations with Chi-square (χ2 ) tests. Qualitative data were transcribed, described and analyzed systematically to reveal themes and patterns. Maternal health education: In Mirihini, there was no significant association between providing maternal health education on the ideal number of ANC visits and women’s achievement of optimal ANC attendance (χ2 = 1.423, df=1 & a ρ-value = 0.233). In Midoina, a significant relationship between the two aspects was obtained (χ2 = 3.109, df = 1 & ρ-value = 0.078. Referral documentation: In Mirihini, issuing referral documents to pregnant women was significantly associated with women’s achievement of optimal ANC attendance (χ2 = 8.308, df =1 & ρ-value = 0.004). In Midoina, there was no significant association between two aspects (χ2 = 0.823, df = 1 & ρ-value = 0.185). The study recommends the need for: CHVs to deliver more information to support care-seeking behavior change; project officers to strengthen supervisory support to CHVs by engaging with MoH to provide reporting materials and ensure consistency of monthly review meetings.
Utilization of Service Charters in Public Hospitals in Kenya: A Case of Thika Level 5 Hospital, Kiambu County
(International Journal of Scientific and Research Publication, 2016-06) Masese, Charles Onyambu; Tenambergen, Wanja Mwaura; Muiruri, Lillian
Service delivery in government health facilities in Kenya still faces multiple challenges. These challenges can still be identified ten years down the line since the introduction of Service Charter. The objective of the study was to assess how the service charter utilization would influence health service delivery in Thika Level 5 Hospital (TL5H) in Kiambu County. Cross sectional study design was employed. Quantitative data was collected using questionnaires. A sample size of 156 technical employees of TL5H and patients participated in this study. Collected data was edited, coded, and entered into the computer using the Statistical Package for Social Scientists (SPSS v 23). The respondents strongly agreed that the hospital charter content is not viewed annually creating unfriendly services (mean 1.73, SD 0.97), (mean 1.74, SD 0.997) indicated the respondents strongly agreed that the service charter is not clearly understood by the majority of patients informing them of their rights when seeking services. The respondents disagreed that the hospital management is always active in monitoring performance and playing the oversight duty according to the SC (mean 2.19, SD 1.20) on whether failure to utilize the service charter may lead to deterioration of quality and equity of healthcare, the respondents agreed (mean 2.05, SD 1.54). Most of the respondents strongly agreed there is availability of support for the service charter (Mean 1.72, SD 0.93), while the respondents also indicated that the waiting time has not improved despite the availability of service charter (Mean 2.98, SD 1.09). The study also established that there was uncertainty in the amount of waiting time in TL5H (Mean 1.775, SD 0.91). The channels used for communication were not clear (Mean 1.993, SD 1.12) while the communication at TL5H does not ensure clarity on issues (Mean 1.9, SD 1.07) while the respondent agreed on communication at TL5H was not always done to get commitment from staff (Mean 1.923, SD 1.047) and there was inadequate open communication of most issues at TL5H (Mean 1.846, SD 1.075). The study recommends that 1) TL5H should improve the contents of the service charter to make it clear, to ensure that the patients fully understand the contents, 2) there should be proper monitoring of the members of staff to ensure that the service charter is fully implemented to minimize the amount of complaints by patients, 3) the service charter contents should be embedded in the organization culture to ensure that is fully and properly implemented to the satisfaction of the service users.
Attitudes of Primary Health Care (PHC) Gatekeepers Towards Patient Referral Policy, Machakos County, Kenya
(Science Journal of Public Health, 2016-06) Nshimirimana, Desire Aime; Mwaura-Tenambergen, Wanja; Kokonya, Donald; Adoyo, Maureen
Primary Health Care (PHC) serves as the foundation for building a working healthcare system that provide good health outcomes. The quality of PHC delivery and the decision to refer patients depends on some behavioural factors (knowledge, skills and behaviour) of primary care providers. The study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for analysis. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). About 62% of the respondents reported to know about PHC gatekeeper system and 38% don’t know about PHC gatekeeper system. The gate keepers at a majority rate 86.7% reported to have participated in workshops of which at least 40.3% participated in at least one workshop per year, means that the majority of gatekeepers don’t fill the required continuing professional development (CPD) to renew their licenses. Bad behavior, poor communication, don’t care attitude, long waiting time and no courtesy were mentioned by patients by 60% of respondents as the main contributing factors to non-compliance of patients with the national patient referral policy. Attitudes (knowledge, skills and behaviour) are crucial in primary care gatekeeper policy implementation. It has been made clear that nurses acquire enough knowledge from college to take care of patients but still need more practical knowledge and experience to increase their performance. This study recommends an innovative plan using incentive driven model and performance rewards in the implementation process.
Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya
(American Journal of Health Research, 2016-07) Nshimirimana, Desire Aime; Mwaura-Tenambergen, Wanja; Kokonya, Donald; Adoyo, Maureen
The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of out-patients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients’ referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers’ non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.
Correlates of alcohol consumption in rural western Kenya: A cross-sectional study
(BMC Psychiatry, 2017) Takahashi, Risa; Wilunda, Calistus; Magutah, Karani; Mwaura-Tenambergen, Wanja; Wilunda, Boniface; Perngparn, Usaneya
Background: Studies on alcohol consumption in rural areas in sub-Saharan Africa are scarce. This study aimed to determine the prevalence and determinants of alcohol consumption in rural western Kenya. The study was conducted as a preliminary stage of a community-based intervention to reduce hazardous alcohol consumption. Methods: A cross-sectional survey of 478 participants aged 18–65 years residing in Ikolomani Sub-county, Kakamega County was conducted in April 2015. Data were collected using an interviewer-administered questionnaire. We defined current drinkers as participants who consumed any alcoholic product in the preceding one month, and hazardous/high-risk drinkers as participants with an Alcohol Use Disorders Identification Test (AUDIT) score of 8 and above. We summarised data using descriptive statistics and used logistic regression to explore for the correlates of each of current alcohol consumption and hazardous/high-risk alcohol consumption. Results: The sex-standardized prevalence of current alcohol drinkers was 31.7% (95% confidence interval (CI): 26.8%–37.2%). The prevalence was higher in men (54.6%) than in women (8.9%). The mean AUDIT score among current drinkers was 16.9 (SD 8.2) and the sex-standardized prevalence of hazardous/high-risk alcohol drinking was 28.7% (95% CI: 24.1%–34.0%). Traditional brews were the most commonly consumed types of alcohol and most drinkers took alcohol in the homes of alcohol sellers/brewers. In multivariate analyses, the number of drinkers in the family, the number of friends who are drinkers and the attitude towards alcohol intake were positively associated with current alcohol drinking status, and with hazardous/high-risk alcohol consumption. Women were less likely to be current drinkers and hazardous/high-risk drinkers than were men. Other socio-demographic factors were not significantly associated with alcohol consumption. Conclusions: The prevalence of alcohol consumption in the study area was higher than the national level estimate of 13.3%. The results suggest that the social environment is the main determinant of alcohol consumption in this setting. These findings imply that interventions to mitigate alcohol consumption in this area will have to target the social networks of the alcohol consumers, change the drinkers’ attitude towards alcohol, and tackle the issue of availability of unlicensed homemade brews.
Towards a Well-functional Computerized Health Management Information System: A case of Mbagathi County Hospital, Kenya
(International Journal of Computer Applications (0975 – 8887), 2017-03) Kyalo, Caroline Kawila; Otieno, George W. Odhiambo
Health Management Information Systems (HMISs) initiatives in Kenya have traditionally been donor-driven with minimal, if any, organizational input in their design. This has consequently led to predictable failures due to lack of sustainability of these initiatives upon donor pullout. The objectives of the study were to investigate the design, implementation and operation of Medboss computerized system at Mbagathi County Hospital in Kenya. Medboss is a locally developed computerized HMIS software, specifically designed for government hospitals in Kenya. However, private hospitals have also adapted it. A descriptive case study research design was conducted in the month of August 2015. The target population was sixty staff members who use Medboss, out of the sixty, thirty two participated in the study. Semi-structured questionnaires and key interview guides were used to collect data. Ten key informants, involved in the design and implementation of the system were interviewed. Questionnaires were used to collect data from twenty two health workers on their knowledge of the factors affecting the operation of the system. Collected data was analyzed using descriptive statistics and multiple regression analysis. Results: Design, implementation and operationalization revealed 73.3% effect on functionality of HMIS. Design was found to significantly influence functionality of HMIS, with a coefficient of 0.815. The coefficient of implementation of HMIS was 0.703, which was equally significant. Operationalization had the least influence on functionality of HMIS with a coefficient of 0.412. Recommendation: Establish a fully functional computerized system. Develop an HMIS policy for the Hospital that documents its vision, mission and objectives therefore implementation will be based on the policy. Fully implement the remaining modules of the system, such as, pharmacy, nursing, human resource, logistics management, and special clinics to enable well-functioning in the operation of the system. Invest more in IT infrastructure in order to enjoy the full benefits of the current system.
Efficiency and Organizational Arrangements in the Utilization of Resources at Primary Health Care (PHC) in Machakos County, Kenya
(International Journal of Health Economics and Policy, 2017-05) Nshimirimana, Desire Aime; Kokonya, Donald; Mwaura-Tenambergen, Wanja; Adoyo, Maureen
Health care is costly and there is need for rational use of health care resources for the world to achieve universal health coverage (UHC). The preventive Primary Health Care (PHC) service is cheaper than the Secondary Health Care (SHC). PHC is strengthened through gatekeeper system, so the emphasis on the PHC for cost control is self-explanatory. This study aimed at determining the efficiency and organizational arrangements using human resources for health (HRH), laboratory services and supply of drugs as the performance indicators that determined rational use of resources in Machakos County, Kenya. This was a convergent parallel mixed methods cross-sectional study that employed qualitative and quantitative data collection techniques. The study targeted facility health managers in charges and policy implementers namely the Chief Officer of health, the Director of Prevention and PHC and the Medical Superintendents and patients seeking health care. A response rate of 83%was achieved (n=83), of whom 84.3% were nurses and 15.7% diploma medicine practitioners. Over (70%) of the health facilities had less than 3professional health workers. Exactly 75% of the community-based self-referrals cases would be treated at PHC level. Self referrals were largely due to patients’ perceived need for laboratory services (53.8%) and medicines (60%). On the contrary, 89.6% of the residents of Machakos County, Kenya were informed about PHC services, 91.7% were accessible to PHC and 93.7% had faith in health care providers at PHC level. The HRH, diagnostic equipment and essential drugs were not the main reasons for self-referrals, but perceived needs for drugs and laboratory services. The inverse and disproportionate attendances of patients at both PHC and SHC levels caused dissonance in service delivery and subsequent inefficiency in service delivery in Machakos County, Kenya. Proper supervision and implementation of referral policy available at county level should be emphasized.
Determinants of Uptake of Health Insurance Cover Among Adult Patients Attending Bungoma County Referral Hospital
(International Journal of Health Economics and Policy, 2017-07) Masengeli, Nathan Lukhale; Mwaura-Tenambergen, Wanja; Mutai, Joseph; Simiyu, Ben Wafula
Health insurance is currently being considered as a mechanism for promoting progress to Universal health Coverage and reducing out-of-pocket payments in many African countries including Kenya which is prompting the use of NHIF. In Kenya, penetration of health insurance is 20% and 11% in Bungoma County. The main objective of the study was to establish the scheme-related factors influencing uptake of health insurance cover among patients attending Bungoma County Referral hospital. The study adopted across sectional descriptive survey of 300 systematically sampled patients, 4 purposively sampled departmental heads in Bungoma County Referral Hospital and all the 5 insurance company branch managers. Data was collected using questionnaires administered and Key Informant Interview schedule. Crude odds ratio was used to establish association between ownership of health insurance and scheme-related factors. Findings showed that 37% of patients owned health insurance covers mostly public health insurance cover (NHIF). Ownership of health insurance covers increased with age, household income, education levels, awareness of insurance benefits and concepts. Covers were also more prevalent among married patients. Ownership of health insurance covers increased 12.5 times with affordability of covers premiums. Stock-out of essential drugs and supplies and longer waiting time in covered health facilities discouraged enrollment to schemes.
Uptake of health insurance among Muslims in Nairobi county, Kenya
(Pan African Medical Journal., 2017-12) Hassan, Mohammed Abdi; Tenambergen, Tenambergen1; Eunice, Muthoni Mwangi
Introduction: In Kenya and the world across, health insurance has been reckoned as an important health policy that serves to protect households from the direct financial consequences of health care and meet the Sustainable Development Goal of Universal Health Coverage and Poverty Eradication. However, health insurance uptake has remained to be a major challenge for universal health care coverage especially among Kenyan Muslims who have conflicting religious faith towards conventional health insurance. This study had two main objectives: (1) to determine level of uptake of health insurance among Muslims and (2) to examine the role of religion in health insurance uptake among Muslims. Methods: The study adopted a cross-sectional study design. Post-stratified sampling was used to select 389 respondents who participated in the survey questionnaires. Descriptive statistics, cross-tabulation and Test of independence (Chi-square) were used to analyze quantitative data using SPSS Version 20. Results: Findings revealed that only 86(22%) of Muslims were enrolled in a health insurance scheme. Among the 86 Muslims who had an insurance cover, Majority were enrolled in National Health Insurance Fund (65,70.6%) while 21(29.4%) were enrolled in private health insurance schemes. Among the 303 Muslims who had no insurance cover, 285 (94.1%) preferred being enrolled in Takaful Health insurance which is Shariah Compliant. Religion played a significant role on choice and enrollment of Muslims to health insurance schemes. Religious beliefs and Shariah teachings had a statistically significant relationship with uptake of health insurance (p < 0.05). Conclusion: Uptake of health insurance among Muslims is low despite the growing population of Muslims in Kenya partly due to Muslims strong religious belief and Shariah laws, which prohibits them from enrolling into conventional insurance hence limiting freedom of individual decisions on the insurance schemes to enroll in. Despite high demand for health insurance products among Muslims, there lacks health insurances products aligned to the religious beliefs and needs of Muslim hence exposing them to hefty medical bills which deepens poverty and inaccessibility to basic health care
Alcoholic Beverage Use Among Somali Youth Living in Eastleigh, an Urban Suburb in Nairobi, Kenya
(European Journal of Preventive Medicine., 2018) Korio, Abdi Aden; Nyavanga, Eunice Jemalel
Background: Harmful use of alcohol causes a large disease, social and economic burden to societies. Alcohol use is the third largest disease risk factor for deaths among youths between 15-29 years that contribute to 4% of the global burden of disease. Eastleigh also is known as “Little Mogadishu” is a suburb in Nairobi that is mostly inhabited by both Somali Community from Kenya and majorly from migrations from Somalia. It hosts about 30,000 Somali refugees and characterized by extremes of wealth and poverty. Objective: The aim of this study is to identify the prevalence of alcohol use and the patterns of use among Somali Youth living in Easteigh suburb in Nairobi. Method: This is an exploratory cross-sectional study among youth aged between 18-25 years of age that used a face-to-face interview. Results: Findings indicated a high prevalence among those who are male, of younger age, with married parents, born in Eastleigh, with lower educational level, the singles, the unemployed and those with high family income. Alcohol use is comorbid with other licit psychoactive substances that include tobacco products, miraa and shisha. Conclusion: These participants have relatively high alcohol use that is comorbid with other licit psychoactive substances. Recommendations include further studies to be done in this community using standardized instruments to cover a larger area and interventions to target younger youth of below 15 years of age and policy on treatment of young people with mental disorders to include substance abuse as well.
Organizational Factors Influencing the Adoption of the District Health Information System 2 in Uasin Gishu County, Kenya
(International Journal of Medical Research & Health Sciences, 2018) Kuyo, Richard Ole; Muiruri, Lillian; Njuguna, Susan
Background: Sound and reliable information is the foundation of decision-making across all health system building blocks that include service delivery, health workforce, health information, medical products, vaccines and technology, financing, leadership, and governance. This study is built on health information system pillar. Objectives: To determine the organizational factors influencing the use of DHIS2 in Uasin Gishu County. Methods: Study was conducted in Uasin Gishu-Sub County health facilities. A questionnaire was used to collect quantitative data from 283 health workers selected randomly while 10 key informants were selected purposively from this sample for in- depth interviews. Results: Total 50.0% of the participants acknowledged that finances were adequate to run DHIS2. The main champions of DHIS2 used in decision-making were the county health records and information officers (56.2%) and the sub-county health records and information officers (39.0%). Up to 78.5% agreed or strongly agreed that organizational hierarchy influenced DHIS2 use and 80.8% agreed or strongly agreed that there was improved staff performance due to DHIS2 utilization. On the other hand, the major challenges experienced in the use of DHIS2 for evidenced-based decision-making were the lack of management support (34.3%), poor skills among the users (48.6%), lack of adequate computers (36.7%), unreliable internet connectivity (47.1%), lack of power backup (27.6%), and resistance to change (21.0%). Conclusion: The main funding for the DHIS2 system comes from the County government while health records and information officers are the main promoters of DHIS2 use. The main determinants of DHIS2 used are the availability of computers, network and internet services, trained staff and legislation. The main challenges inhibiting DHIS2 use are lack of management support, poor skills among the users, lack of adequate computers, unreliable internet connectivity, lack of power backup and resistance to change.