School of Medicine and Health Sciences
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Welcome to School of Medicine and Health Sciences collection.This collection contains Journal articles published by faculty affiliated to the school.
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Item Implementation of User Fee Policy in Psychiatric Hospitals in Kenya: A Case of Mathari Hospital, Nairobi(Journal of Medicine, Nursing and Public Health, 2024-08) Munene, Winnie Kanana; Tenambergen, Wanja Mwaura; Muiruri, LillianIn Kenya, user fees were implemented as a form of cost-sharing to lessen the financial burden of health financing on Kenyan patients. This occurred in 2004. The Kenyan Ministry of Health offers a financing mechanism through risk pooling to the greatest extent possible to achieve universal coverage for mental health care. The use of services is based solely on need for care, with no additional tax funding or required health insurance; contributions are determined by ability to pay. Diseases such as mental health have been on the rise in Kenya due to a change in lifestyle and as a result of other emerging diseases. In Kenya, the high expense of healthcare continues to be a major obstacle to receiving timely, high-quality medical care. Despite the increase in prevalence of diseases related to mental health, the government’s user fee policy has not been able to keep up with inflation. The purpose of this study was to assess the implementation of user fee policy in psychiatric hospitals in Kenya: A Case of Mathari Hospital, Nairobi. The study was guided by objectives that were seeking to determine the utilization of user fee policy at Mathari Hospital and to establish how hospital policies influence user fee policy implementation at Mathari Hospital. A cross-sectional study design was used. Findings from this study established that utilization of the user fee policy at Mathari Hospital was aligned with the existing hospital policies. The management of Mathari Hospital should streamline user fee collection by constantly providing on the job training to the employees.Item Healthcare Workers Training and Implementation of Occupational Health and Safety (OSH) Measures at Kitale County Referral Hospital, Kenya(American Journal of Health, Medicine and Nursing Practice, 2023-08) Ngoga, Edward Otieno; Muiruri, Lillian; Ouma, Ogol JaphethPurpose: Many people, including healthcare workers, spend one-third of their adult lives in hazardous work environments. Despite significant advancements in safety management over the last few decades, occupational health continues to contribute to work-related health problems around the world, including in Kenya. The study's main goal was to investigate factors influencing the implementation of occupational health and safety measures at Kitale County Referral Hospital. Methodology: The research was cross-sectional, descriptive, and mixed-methods. The targeted study population was 246 healthcare workers at Kitale County Referral Hospital, and 146 were randomly sampled. Key Informant Interview (KII) guidelines and a structured questionnaire were utilized to collect data. Data was coded, entered, and analyzed in STATA v15. A thematic method was utilized for analyzing KII qualitative data. Findings: Spearman's correlation coefficients (0.687, p<0.05) for training show a strong link between these HealthCare’s training and OHS implementation. This means that traning directly affects hospital OHS implementation. Ordered regression results include age (Φ = 0.055; p<0.01), gender (Φ = 0.208; p<0.05), education (Φ = 0.105; p<0.01), cadre (Φ = 0.098; p<0.1), staff training (Φ = 0.090, p<0.05 confirmed that there existed a direct and positive relationship between the occupational health and safety implementation and some of the independent variables. Unique Contribution to Theory, Practice and Policy: Thus, the study proposes that public hospitals teach staff to promote occupational health and safety. The facilities should also establish a management committee to drive OSH implementation, and the county government should guarantee that policies encourage OSH in county referral hospitalsItem Factors Influencing Reporting of Medical Errors Amongst Nurses in Pediatric Wards in Three Teaching And Referral Hospitals in Nairobi Kenya(Journal of Nursing and Practice, 2022) Ngivu, Jane N; Kyalo, Carol Kawila; Muiruri, LillianService delivery is among the six health system strengthening pillars by World Health Organization. Successful health services bring about effective, quality, safe, personal and non-personal health care actions or interventions to those who need them, where they need them and when required with minimal resource wastage. Medical error is unintended commission or omission or the failure of an action which was planned which cause, or have potential to cause patient harm. It is a leading challenge in service delivery today and the incidence rates are an emerging international concern. Medical errors are underreported today, yet reporting helps in implementing measures which help prevent recurrence thereby enhancing patient safety and reducing harm and suffering. This study aimed at determining factors influencing reporting of medical errors amongst nurses in paediatric wards in three teaching and referral hospitals in Nairobi Kenya. The specific objectives of the study were to establish if nurses’ knowledge on medical errors reporting influences reporting of medical errors, to establish if management support for medical errors reporting influence the reporting, to establish if medical error reporting systems influence reporting of medical errors and finally to establish if organizational safety culture influences reporting of medical errors, all these, amongst nurses in three teaching and referral hospitals in Nairobi Kenya. The study was cross sectional and utilized both quantitative and qualitative approaches in data collection. The target population comprised of 195 nurses; from Aga Khan University hospital Nairobi, Gertrude’s Children’s Hospital and Kenyatta National Hospital, all in Nairobi Kenya. Sample size was 131 nurses and response rate was 88%. Quantitative and qualitative data was collected from the nurses using a pretested questionnaire. Key Informant Interview Guide was utilized to collect qualitative data from three nurse managers. Data was coded and analysed using SPSS version 25 and presented in form of charts and graphs. Bivariate analysis showed that nurses’ knowledge on medical errors (p < 0.039), management support on reporting (p < 0.031), and medical errors reporting systems (p < 0.002), all had significant association with reporting medical errors in the three facilities. Organizational safety culture however did not, (p = 0.623). This study recommends that nurses’ knowledge and understanding of medical errors be promoted through trainings; starting from college and university levels and later during orientation and in-service. Management to disseminate policies and procedures to staff in their health facilities and ensure the same is well understood and implemented correctly. In addition, feedback about changes put into place based on those errors need to be communicated to staff in a timely manner. Additionally, just culture need to be embraced and cultivated to ensure objective approach to medical errors. Finally, medical error reporting systems to be simplified, made readily accessible and should have capabilities for anonymous reporting.Item The Influence of Staffs’ Knowledge on Preparedness of Catholic Mission Hospitals for Health Service Delivery during Emergency Inflow of Patients in Nairobi County, Kenya(American Journal of Health, Medicine and Nursing Practice, 2022) Kiteng’u, Petronella Mueni; Muiruri, Lillian; Musa, OluochPurpose: To determine the influence of staffs’ knowledge on preparedness of catholic mission hospitals for health service delivery during emergency inflow of patients in Nairobi County, Kenya. Methodology: A cross sectional descriptive study design was used with quantitative approach for data collection and analysis. Four tier-3 Catholic Mission Hospitals were purposively selected and a stratified random sample of 647 members of staff from different cadres was taken. A structured questionnaire was used to collect data. Data was analyzed using STATA software v.16, where descriptive statistics were presented using frequencies and percentages whereas inferential statistics were presented using correlation and regression analysis. Findings: The study found out that staff training and exercises for knowledge and skills influenced preparedness of Catholic Mission Hospitals for health service delivery during emergency influx of patients. A positive and significant relationship was found at (r=0.211; p<0.01). This means that the hospitals are perceived as prepared for health service delivery during emergency influx of patients. However, staff drills (staff exercises) at (r = -0.147; p<0.05) were found insignificantly influencing services delivery. This means that the hospitals would be unprepared even if staff drills were in place. Recommendations: The study recommends that the managers of catholic hospitals should have scheduled staff trainings and drills for efficient and timely response in times of need for emergency service deliver. Policy guidelines on skills acquisition for the staff in the health institutions need to be developed to guide the trainings and frequent drills to sharpen the theory and practice of the healthcare team.Item FACTORS RELATED TO QUALITY DATA WHICH DETERMINEHEALTH INFORMATION UTILIZATION IN MAKING DECISION AMONG HEALTHCARE MANAGERS IN MOMBASA COUNTY, KENYA(American Journal of Public Policy and Administration, 2020) Otieno, Moses Ochieng; Muiruri, Lillian; Kawila, Dr. CarolinePurpose:This was a study based onHealth Information Systems pillar.The study sought toexplore factors related toqualitydatawhich influence health information utilization in makingdecisionamong healthcare managers in Mombasa County.Methodology:This was a Descriptive Survey Study design where desired data was obtained from selectedrespondents by semi-structured questionnaires. The research targeted a total of 303 healthcare managers in Mombasa County which comprised of 21 County Health Management Team (CHMT) members, 56 Sub-county Health Management Team (SCHMT) members from the four sub-counties, 43 facility In-Charges from the 43 public health facilities and 183 Heads of Departments (HODs).A sample size of91 healthcare managerswas used in the study. This was 30% of the target population and were randomly selected. Aresponse rate of 98.9% wasachieved. Descriptive and Inferential analysis was done. Data was analyzed with SPSS version 23.Findings:Resultsrevealed that quality data factors(β4= 0.298; t = 4.079; p < 0.01) were significant predictors ofhealth information utilization in making decision among healthcare managers in Mombasa County. These results imply that improvement inthese variables(dataaccuracy, completenessand timeliness)will enhance health information utilization. How these variables are accomplished influence the level of health information utilization in making decision.Unique contribution to theory, practice and policy:When the study recommendations are implemented, there will be assured qualitydata which will assist in coming up with the design of disease prevention, interventions and to monitor and evaluate the progress made on the measures put in place. By doing so, the study will have validated the theory of Evidence Based Health Information System by Carbone, (2009), on which the study was anchored.Quality data is, therefore, not only crucial in securing health status description, service coverage, and performance, but also inspires confidence in the HISamong healthcare managers. The study recommends thatthe MOH introducesHMIS as a subject in the pre-service curriculum of all healthcare cadres in order to improve HIS.Mombasa County Governmentshould ensure that qualitydatais generated (with regards toaccuracy, completeness and timeliness) at all levels of the health systemsfor purposes of accountability and more importantly its utility to improve healthcare programs, to survive and prosper in the current dynamic healthcare environment.Item FACTORS RELATED TO QUALITY DATA WHICH DETERMINE HE ALTH INFORMATION UTILIZATION IN MAKING DECISION AMONG HEALTHCARE MANAGERS IN MOMBASA COUNTY, K ENYA(2020) Otieno, Moses Ochieng; Muiruri, Lillian; Kawila, CarolinePurpose: This was a study based on Health Info rmation Systems pillar. T he st udy sought to explore factors related to quality data which influence health information utilization in making decision among healthcare managers in Mombasa County . Methodology: This was a Descriptive Survey Study design whe re desired data was obtained from selected respondents by semi - structured questionnaires. The research targeted a total of 303 healthcare managers in Mombasa County which comprised of 21 County Health Management Team (CHMT) members, 56 Sub - county Health Ma nagement Team (SCHMT) members from the four sub - counties, 43 facility In - Charges from the 43 public health facilities and 183 Heads of Departments (HODs). A sample size of 91 healthcare managers was used in the study . This was 30% of the target population and were randomly selected. A response rate of 98.9% was achieved . Descriptive and Inferential analysis was done. Data was analyzed with SPSS version 23. Findings: R esults revealed that quality data factors (β 4 = 0.298; t = 4.079; p < 0.01) w ere significant predictors of health information utilization in making decision among healthcare managers in Mombasa Coun ty . These results imply that improvement in these variables (data accuracy , completeness and timelin ess) will enhance health information utilization. How these variable s are accomplished influence the level of health information utilization in making decision . Unique contribution to theory, practice and policy: When the study recommendations are impleme nted, there will be assured q uality data which will assist in coming up with the design of disease prevention, interventions and to monitor and evaluate the progress made on the measures put in place. By doing so, the study will have validated the theory o f Evidence Based Healt h Information System by Carbone, (2009), on which the study was anchored. Quality data is, therefore, not only crucial in securing health status description, service coverage, and performance, but also inspires confidence in the HIS a mong healthcare manag e rs. The study recommends that the MOH introduce s HMIS as a subject in the pre - service curriculum of all healthcare cadres in order to improve HIS . Mombasa County Government should ensure t hat quality data is generated (with regards to accuracy, completenes s and timeliness) at all levels of the health systems for purposes of accountability and more importantly its utility to improve healthcare programs, to survive and prosper in the current dynamic healthcare environment .Item Determinants of Reporting Rates for HIV Test-kits; A Case of Meru County(International Journal of Computer Applications, 2021-09) Gathii, Paul; Kawila, Caroline; Muiruri, Lillian: Many health organizations including Ministry of Health through Kenya Medical Supplies Authority have adopted reporting rates as a measure for improving health service delivery in terms of ensuring the availability of health commodities and product supply. Uninterrupted health commodity supply is determined by ensuring commodity reports are uploaded into District Health Information System 2 platform which is a national system for consolidating consumption data. It is this data that the national allocation committee uses to quantify HIV test kits required by facilities on quarterly basis. Methods: The study embraced quantitative research design where quantitative approach was used. The study target population was 260 Healthcare workers in Meru County to assess the role or the factors that affect the reporting rates of HIV test kits. The study used purposive sampling technique to sample the respondent’s i.e. Health care workers who are responsible for consolidating facility level HIV test kits reports in Meru County Therefore the sample size was 260 health care workers. The study used semi structured questionnaires and data extraction sheet to collect the data. Majority were familiar with the recommended data reporting tools (MOH 643). Results: Majority 153(, 61.2%) were familiar with the recommended reporting tools (MOH 643) (x2=101.76, p<0.05) slightly more than half of the Healthcare workers were regularly trained in the recommended data reporting tools (MOH 643 tool) 145, (58.0%) (x2=6.4, p<0.05). Approximately 101(40.4%) that recommended data reporting tools(MOH 643) is adequate in capturing the consumption data of the HIV test kits (x2=77.67, p<0.05). Most respondents indicated that the trainings were not useful compared to a third indicated that the trainings were useful.. The respondents agreed to the statement that they were aware of HIV test kits policies that are in place and the agreed that the policies were helpful at their work. The respondents agreed that they had a supervisor whom they report to in the course of their work and that their supervisor was not always available for consultation. There was strong positive relationship that was significant (p<0.05) between reporting rates and availability of the reporting tools (rho=.693, p<0.05) while a strong positive relationship existed between reporting rates and availability of Standard operating Procedure (rho=.814, p<0.05) and a strong relationship between the reporting rates and human capacity (rho=.896, p=054) and support supervision (rho=-.407, p=.053). Conclusion: presence of enough staffs, availability of Standard Operating Procedure, supportive supervision all affects reporting rates for HIV testing kits. The coefficient of determination obtained from the model was .663 and this indicated that the regression model explained only 66.3% of the factors that affected the reporting rates on consumption data of HIV test kits in the countyItem Factors Influencing Rational Use Of Psychotropic Medicines In Mathari National Teaching And Referral Hospital In Nairobi, Kenya(International Journal of Scientific and Research Publications,, 2021-08) Bhavsar, Dipti Ashish; Njoroge, Kezia; Muiruri, LillianThe World Health Organization recommends a focus on the six building blocks of a health system in order to strength health systems. The focus of this study was medicines, vaccines and technologies, with rational use of medicines of the psychotropic variety being the area of interest. An equity, quality, affordability and efficiency of the health care system hinders due to inappropriate use of medicines. It is evaluated that, in lowincome and middle-income countries, 80% people with genuine mental issues do not get the treatment that they require. Lack of access to psychotropic medicine may be attributed to irrational use of these medicines and is seen to lead to inflated treatment costs, mortality, and morbidity and may be reason for undesirable drug reactions or discouraging psychosocial impact. According to the Ministry of Health, Kenya Mathari national teaching & referral hospital is faced with non-availability of psychotropic medications already on the essential drugs list. The main aim of the study was to assess the health care provider’s perspective on factors influencing rational use of psychotropic medicines in Mathari National Teaching & Referral hospital in Nairobi, Kenya. This was an institutional based cross sectional descriptive study. A target population for this study was 125 prescribers and dispensers who worked at Mathari Teaching and Referral hospital at the time of study. For the study simple random sampling was used to draw a sample size of 96 respondents. A structured five-point Likert scale questionnaire was used to collect the data; the data was analysed using SPSS version 23. Results showed that, 58 (62%) were female, 45(49%) were 31-40 years, 60(65%) were doctors and 47(51%) held a Bachelor's Degree, The coefficient of correlation of prescribing practices (r=0.397, p<0.001), patientcare factors (r=0.289, p=0.005), health facility factors (r=0.446, p<0.001) and complementary factors (r=0.313, p=0.002) showed a positive and significant relationship with rational use of psychotropic medicines. In a combined relationship Prescribing factors (p=0.006), Health Facility factors (p=0.011) and Complementary factors (p=0.009), all had a significant influence on the appropriate use of psychotropic medicines. Efforts to improve the rational drug use would call for prioritized improvement of health facility factors focusing on the supply chain, followed by prescribing factors, complementary factors and finally the patient care factors. This study recommends that: Prescribers and dispensers ought to be provided with policy guidelines for rational drug use, these are the guidelines for standard treatment and a list of essential medicines, in addition to the available medicines list. Training on the rational use of psychotropic medicines for staff needs to be undertaken frequently. In addition, new staff should undergo induction training on the rational drug use as part of the orientation process. Continuous education on use of Essential medicines should be incorporated in health training institutions /hospital. NHIF the Kenyan social health insurer ought to consider covering mental health as part of the benefit package to enhance affordability of psychiatric services.Item Health System Influence On Functionality of Managers in Public Hospitals: A Case of Sub County Hospitals in Bungoma County(Journal of Public Policy & Governance,, 2021-07) Mugasia, Tony Chahale; Muiruri, Lillian; Oluoch, MusaManagers tasked with leading and managing the hospitals in the developing economies often have little formal preparation and face challenges in execution of their mandates. This study therefore interrogated the influence of management knowledge, organization capacity building systems, internal work environment and hospital finance on the functionality of managers in public Sub County hospitals in Kenya focusing on Bungoma County. A descriptive approach was adopted and 170 managers from the 10 Public Sub County hospitals in Bungoma County were targeted. A structured questionnaire was used to collect quantitative data which was analysed through SPSS version 24 to give descriptive and inferential statistics. The results of the study indicated that management knowledge of a manager had a positive and significant influence on manager’s functionality to manage Sub-County Hospitals (β = 0.263; P-value <0.05); organization capacity building systems had a positive and significant influence on management of Public Hospitals (β = 0.327; P-value < 0.05); internal work environment had a positive and significant influence on management of Public Hospitals (β = 0.360; P-value < 0.05) and health finance equally had a positive and significant influence on management of Public Hospitals, this influence was not significant (β = 0.112; P-value < 0.05). This implies that a unit increase in these factors would lead to a significant increase in management of the Sub-County hospitals. Based on these, the study recommended the county government of Bungoma County to set aside a budget to recruit health workers to address HRH gaps. The county government to enhance their financial commitment towards the running of the public hospitals in the county. The County to increase proportion of their exchequer to the public hospital the current proportion is not adequate. County top leaders to revise the finance accountability frameworks for efficient funds utilization. Furthermore, the local political leaders should collectively rework their conflict resolution mechanisms with the management of the hospitals and look for alternatives problem solving mechanism to reduce interference with the normal operation of hospitals.Item Organizational determinants of health information utilization in making decision among healthcare managers in Mombasa County, Kenya(Journal of Health, Medicine and Nursing, 2020) Otieno, Moses Ochieng; Muiruri, Lillian; Kawila, CarolinePurpose: This was a study based on Health Information Systems pillar. The objective was to examine organizational factors which influence health information utilization in making decision among healthcare managers in Mombasa County. Methodology: This was a Descriptive Survey Study design where desired data was obtained from selected respondents by semi-structured questionnaires. The research targeted a total of 303 healthcare managers in Mombasa County which comprised of 21 County Health Management Team (CHMT) members, 56 Sub-county Health Management Team (SCHMT) members from the four sub-counties, 43 facility In-Charges from the 43 public health facilities and 183 Heads of Departments (HODs). A sample size of 91 healthcare managers (30% of the target population) was used in the study with a response rate of 98.9% being achieved. Data was analyzed with SPSS version 23. Findings: Results revealed that organizational factors (β2 = 0.233; t = 4.552; p < 0.01) were significant predictors of health information utilization in making decision among healthcare managers in Mombasa County. These results imply that improvement in these variables (Feedback mechanisms, Supportive supervision and Resource availability on Health Information Systems) will enhance health information utilization in making decision. Unique contribution to theory, practice and policy: Implementation of the study findings will ensure that healthcare organizations have systems and infrastructure for improving interpersonal relationship among healthcare workers and managers, providing clear guidelines and defining roles and responsibilities related to HIS thus improving evidence-based decision making. When this is done, the study will have validated the theory of Evidence Based Health Information System by Carbone, (2009), on which the study was anchored. This theory further explains that there is need for a “catalyst” which is responsible for ensuring that the overall clinical care task is performed. Organizational factors are some of the catalysts referred to in the theory that when looked into will ensure an improved health outcome. The study recommends that the Ministry of Health (MOH) introduces Health Management Information Systems (HMIS) as a subject in the pre-service curriculum of all healthcare cadres in order to improve Health Information Systems (HIS) and facilitate proper prioritization of health needs, interventions and proper resource allocation