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
14 results
Search Results
Item Understanding Home Delivery Preferences: The Role of SocioEconomic and Cultural Factors in Marsabit County, Kenya(International Journal of Research Publication and Reviews, 2025-08) Sake, Isako Sori; Tenambergen, Wanja Mwaura; Kyalo, Carol KawilaHome deliveries, defined as childbirth occurring outside hospital settings without the assistance of skilled healthcare providers, remain common in some regions despite substantial efforts to improve maternity and newborn health services. This study aimed to assess the influence of cultural factors on the preference for home deliveries in rural Marsabit County, Kenya. A descriptive cross-sectional mixed-methods design was employed, with 396 women participating in quantitative surveys and additional qualitative data gathered from 10 interviews and 2 focus group discussions. Quantitative data were processed using descriptive statistics and logistic regression, while qualitative data were thematically coded. The analysis revealed that the point prevalence of home deliveries among women of reproductive age in Marsabit County was 64.65% (n = 256, 95% CI [59.81%, 69.49%]), with 189 (55.26%) of those who had ever delivered at home reporting between 1 and 3 home deliveries. Additionally, 291 (94.17%) of home deliveries were attended by traditional birth attendants (TBAs), highlighting the significant role TBAs play in maternal health in this community. Cultural beliefs and family influence significantly shaped delivery choices, with family cultural influence reducing the likelihood of choosing a healthcare facility for delivery (OR = 0.47, 95% CI: [0.19, 0.81], p = 0.009). Socio-economic conditions, including higher education levels (OR = 1.854, p < 0.001) and stable employment (OR = 2.776, p = 0.007), were strongly associated with an increased likelihood of facility-based deliveries. The study concluded that an integrated approach addressing cultural and socio-economic factors are crucial for promoting safer delivery practices. Recommendations include integrating TBAs into the formal healthcare system and enhancing communication strategies to build trust in government health programs.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 Influence of Procurement Process on Availability of Essential Drugs in Public Health Facilities in Mombasa County, Kenya(International Journal of Health Sciences, 2024) Chikophe, Riziki Mwangolo; Tenambergen, Wanja Mwaura; Kyalo, Caroline KawilaPurpose: Procurement process and practices are crucial components in the successful realization of universal healthcare and in particular the availability of essential drugs. Despite multifaceted efforts and inputs to promote the quality of the procurement process challenges still exists in the availability of essential drugs. This study aimed to establish the influence of procurement planning, supplier selection, procurement financing and needs assessment on availability of essential drugs in the public health facilities in Mombasa County, Kenya. This was a cross-sectional descriptive study design which targeted level 4 and 5 health facilities in Mombasa County. The study target population was 1216 health workers who included medical laboratory personnel, clinical officers and medical officers, nurses, pharmacists and pharmaceutical technologists. The study sample was 301. Methodology: Stratified sampling approach was used to distribute the sample among the cadre and random sampling method was used to select the respondents from each strata. Quantitative data was collected using a structured questionnaire. Findings: The study found that procurement planning, supplier selection, procurement, financing and needs assessment were significant factors in influencing the availability of essential drugs with P<0.05. Unique Contribution to Theory, Policy and Practice: The study recommended that counties conduct a comprehensive and regular need assessment of essential drugs in public health facilities, that they develop a robust procurement planning strategy that aligns with the identified needs and available financing, that there should be a transparent and competitive supplier selection process, and to establish strategic partnerships with international organizations, non-governmental organizations, or donor agencies that are committed to improving healthcare access.Item 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, LillianService 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.Item 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 MuthoniMaternal 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.Item 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 AtienoBackground: 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 activitiesItem The Role Leadership Style Plays in the Integration of Health Management Information System(International Journal of Computer Applications, 2018-07) Kyalo, Caroline Kawila; Odhiambo-Otieno, G. W.; Otieno, George; Tenambergen, Wanja MwauraThis study aimed to establish the role played by leadership style in the integration of health management information systems (IHMIS). An integrated HMIS is a software solution that spans the range of business processes that enables organizations to gain a holistic view of the business enterprise (Alvarez, 2007). An IHMIS supports the different levels of healthcare in terms of information exchange and flow, and the integration of business functions as diverse as patient care, accounting, finance, human resources, operations, sales, marketing, patient information and even the supply chain. Three approaches of leadership styles were tested to see how they influence integration of HMIS; i) Lassiez-faire ii) Transactional and iii) Transformational. A mixed method research design was used. A sample size of 288 respondents stratified in three levels of healthcare (tier 1, 2, and 3) were purposively selected to participate in this study. The respondents included the in-charges, health records and information officers and sub-county and county health management teams members. A questionnaire and a key informant interview guide were used to collect primary data. The questionnaire was analyzed using SPSS and the Key Informant Interview using content analysis. The selection and appropriateness of leadership styles are significant factors for assuring organization success. Good execution of leadership transpires through the availability and access to information during decision making. The information system in an organization is dependent on the leadership behavior on decision making authority in groups. To a great extent Laissez-faire leadership style was found to dominate in the health sector in Kenya, with a few managers practicing Transactional Leadership Style. Laissez-faire leadership style was however found to have a negative and none significant effect in the integration of HMIS, (r=.121, P=.060), this type of leadership plays the role of fragmenting the information systems. Transactional leadership style was moderately significant (r=478**, P=.000), its role was in between fragmenting HMIS and Integrating them at the same time. Transformational leadership style was quite significant in the integration of HMIS (r=.765**, P=.000), this type of leadership style portrayed a positive and significant role in integrating HMIS. The study therefore recommends that healthcare managers should embrace the leadership style that fully encourages team work, because this kind of a leadership style automatically leads to integration of HMIS.Item Patient Perceptions on Primary Health Care (PHC) Nurses and Its Impact on Services Delivery at County Level, Machakos, Kenya(Central African Journal of Public Health, 2019-01) Nshimirimana, Desire Aime; Kokonya, Donald; Tenambergen, Wanja MwauraBackground: Patient perceptions on services delivered by nurses are crucial when assessing the quality of health services. These are most attributable to their knowledge, competent skills and other personal characteristics. These can be described in how effective they handle clients when performing their nursing duties and their effectiveness including their ability to utilize a variety of communication skills and their attitudes at their regular work place. Methodology: This is a crosssectional and qualitative study. Four public hospitals were randomly selected; Kathiani, Mwala sub-county hospital, Kangundo sub-district and Machakos county referral hospital. A systematic sampling was used for participant selection. A maximum of 12 and a minimum of 8 patients constituted a focus group for discussion (FGD) making a sample size of eighty (80) with eight (8) groups (four male and four female groups). The FGDs were conducted using standard guidelines by the researcher helped by a trained research assistant recording the proceedings with audio equipment. Participants aged 18-65 years and emancipated children were included. Data were analyzed using Atlas. ti 7 software. Results and Conclusion: (1) knowledge and competent skills of nurses, (2) personal characteristics, (3) other nurse’s behaviors are key when to effectively perform nursing duties. Participants acknowledged that nurses have the same knowledge because they can be transferred from health centers to at hospital level. Other participants added that patients need nurses who can perform their work with confidence. Personal characteristics like positive attitude, good mood, smile and willingness to provide medical information were also discussed by participants as very important when nurses have to deliver quality health care services. Lastly, other nurse behaviors like respect, honesty, confidentiality and compassion are as well other crucial characteristics on the top of knowledge which were emphasized by participants. All discussed characteristics should link together if nurses have to deliver quality health care. Nursing schools should review their curriculum to include the characteristics mentioned and introduce mentorship programs where the emphasis should be placed on the same.Item PATIENT SATISFACTION WITH EMERGENCY CARE SERVICES ACCESSED AT SELECTED HEALTH FACILITIES IN NAIROBI CITY COUNTY: PATIENTS’ PERSPECTIVE(JournalofHealth,Medicine andNursing, 2019) Edwin, Osiyel Daniel; Tenambergen, Wanja Mwaura; Muiruri, LillianPurpose:The main aim of the study was to study the factors influencing patient satisfaction with emergency care services accessed at selected health facilities in Nairobi City County.Methodology:In this study, descriptiveresearchdesign was adapted. The target population of thestudy included patients seeking emergency healthcarefrom five public health facilitiesin in Nairobi County. Stratified proportion and simple random sampling technique wereused to select 304respondentsamong patientsin emergency department.Data collection tool was used to obtain quantitative data. Nairobi City County referral facilities were purposely selected because of the high number of patient throughput. Systematic sampling was done to identify the respondents. Descriptive cross-sectional study design was used where quantitative approach was used for data collection.Findings:The results showed that there is a positive and significant influence of the physician servicefactors on accessand patient’s perspectiveto emergency healthcare services in public hospitals in Nairobi County (r = .596**, P= .001). On waiting timefactor, findings show that there is a positive and significant influence access and patients’ perspective to emergency healthcare services in public hospitals in Nairobi County(r=.407**, P= 0.001) onquality of care,findings show that there is a positive and significant influence access and patients’ perspective to emergency healthcare services in public hospitals in Nairobi County(r=.255**, P= 0.001). Lastly, results showed that there is a positive and significant influence of the health facility typefactor on access to emergency healthcare services in public hospitals in Nairobi County (r = .257**, P= .001). This implies that the fourfactors are important and significant determinants of accessand useofemergency healthcare services in public hospitals in Nairobi County. Unique contribution to theory, policy and practice: The researcher brings in a wealth of new knowledge to the field of emergency healthcare, where the health sector can adopt a strong pillar of health service delivery by introducing a physician specialty course on emergency healthcare and medicine, further, proper mechanisms can be put to reduce waiting times before a patient seeking emergency healthcare is attended to. This would rely on the quality of care the patient receives when in need.Item 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 MuthoniMissed 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.