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 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, SusanBackground: 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.Item 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, WanjaIntroduction: 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.Item 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, SusanTimely 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.Item Technical Factors Affecting Electronic Medical Record System Information Use: A Case of Kakamega County Referral Hospital Outpatient Department(IOSR Journal of Nursing and Health Science (IOSR-JNHS), 2018-04) Nandikove, Peter; Wanja Mwaura, Tenambergen; Njuguna, SusanThe recent worldwide focus on healthcare quality improvement, cost containment and enhanced patient experience has led to increased need for adoption of Electronic Medical Record systems (EMR) ( Waithera L, Muhia J, Songole R , 2017). This technology agitates for paperless transactions health care and would significantly reduce clinician workload and medical errors while saving the institution major expenses. Kenya is globally acclaimed as a leader for its Information Communication Telecommunications (ICT) innovations such as M-PESA (Graham, 2010). Many studies have been done in other countries to study the factors influencing adoption and usage of EMR technology, but a small number of studies exist in Kenyan situation (Ministry of Health, 2010). This study sought to examine why the application of EMR technology has not kept pace with its demand. This study therefore sought to answer two key research questions derived from the study objectives which include the influence of network infrastructure, EMR system design and staff ICT skill levels on information use of electronic medical records technology in a public health institution in Kakamega County The study was guided by technology acceptance model as its theoretical framework (Seok Kim, Kee-Hyuck Lee, Hee Hwang and Sooyoung Yoo, 2016). The study adopted a cross-sectional survey design with a target population of 80 respondents working in Kakamega county referral hospital. A descriptive survey research design was used. Stratified random sampling was embraced to divide the population into homogeneous subgroups as per the professional cadres then did simple random sampling in proportion to their number in the population. A questionnaire with a 5-point Likert scale was constructed and used. Data was collected using structured questionnaires and analyzed using SPSS version 23. Both content and construct validity were used to ensure validity of the research instrument’s while reliability was determined by using the Cronbach-Alpha Coefficient. Pilot testing to pre-test and validate the research instruments was done prior to the main study. One of the two hypothesis was rejected, there seemed to exist no significant differences among professionals with regards to EMR information use F (9,62) = 1.745, p > 0.05, one hypothesis was accepted, there seemed to exist a significant relationship between technical factors and EMR information use (r = 0.583, p <0.05). The study recommends that health facilities should increase infrastructure and resources that support EMR use, employees should be supported for further training on EMR operation and suppliers should regularly support and train health staff on how to use EMR effectively. The study results may be useful to hospitals as they gear towards integrating all their process by using technology.Item Influence of patients’ rights charter on health systems responsiveness in selected counties in Kenya: health care provider perspective(International Journal of Community Medicine and Public Health, 2019-10-14) Njuguna, Susan; Wanja Mwaura, Tenambergen; Mapesa, JobBackground: The role of health care providers in the implementation of responsiveness of health systems is unclear. Responsiveness of health systems is one of the goals set out by WHO in 2000. Effective leadership and governance of health systems incorporates all players involved in policy implementation. The objectives of the study were to establish how the health care provider’s awareness of patients’ rights charter influence health systems responsiveness and to establish how the health care provider practice of patients’ rights charter influence responsiveness of health systems in primary care settings. Methods: This was an exploratory cross section descriptive study design that used a psychometric semi- structured questionnaire to collect qualitative data that was analyzed quantitatively. Respondents were 62 purposively sampled health care providers from four, primary care health facilities. Key informant interviews from the four health facilities in-charges were carried out. Data was analyzed using SPSS vs 25 and themes. Results: Health care provider awareness of the content of patients’ rights charter (r=0.612*, p<0.001) and practice of patient’s right charter (r=0.610*, p<0.001) were statistically significant and influenced health systems responsiveness. Conclusions: Implementation of patients’ rights charter has an influence on responsiveness of health systems. Leadership and Governance of health systems requires a structured approach to implementation of policies that positively influence responsiveness of health systems. Supervision of health care providers for best practice can provide a basis for replication in other primary care facilities and lead to achieving responsiveness of health systems.