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 INFLUENCE OF ACCESS DETERMINANTS ON SELFREFERRALS AMONG PREGNANT WOMEN SEEKING DELIVERY SERVICE IN COAST GENERAL REFERRAL AND TEACHING HOSPITAL MOMBASA, KENYA(Global Journal of Health Sciences, 2021) Kivuva, Elizabeth Muthoki; Njoroge, Kezia; Wanja, TenambergenThe purpose of this study was to establish influence of access determinants on selfreferrals among pregnant women seeking delivery service in Coast General Referral and Teaching Hospital (CGTRH). Methodology: The study adopted a descriptive cross-sectional research. The study target population was all pregnant women seeking delivery services in coast general teaching and referral hospital at the maternity unit. Therefore, 6,420 formed the study population as it is from this sampling frame that a sample of mothers was obtained. A sample of 376 pregnant women was obtained. Systematic random sampling was used to select the pregnant women to be included in the sample. Data was collected using a structured questionnaire. The data collected were cleaned and coded, quantified and analyzed quantitatively. Quantitative data were analyzed using IBM SPSS where descriptive and inferential statistics were used to capture the data in order to understand the pattern and nature of relationships. Univariate analysis was done using descriptive statistics (frequencies and percentages,) in order to summarize the data, and the results were presented using charts, graph and tables. Results: The findings revealed a significant relationship between the operating hours of CGTRH and self-referrals to the facility. The results indicated that pregnant women who indicated the 24 hours operating nature of CGTRH as their reason for seeking services at the facility were 2 times more likely to make self-referrals compared to those who disagreed that they sought services at the facility because the facility is open 24 hours in a day. A multivariable logistic regression analysis at a significance level of 0.05 further indicated that the operating hours of CGTRH had a significant influence on self-referrals pregnant women seeking delivery services at the facility. Unique contribution to theory, practice and policy: The study recommended that The Mombasa county department of health should find ways of ensuring that primary health facilities in the county are open for 24 hours in a day to attract more pregnant women seeking delivery services at the facilities and thus minimize the number of pregnant women seeking delivery services directly from the Coast General Teaching and Referral HospitalItem Factors influencing upward referral system of patients in Nairobi County(International Journal of Community Medicine and Public Health, 2021-08) Osoro Epony Nyakong’anyi; Njoroge, Kezia; Wanja, TenambergenBackground: The referral system forms main health systems coordinating a mechanism ensuring the harmonious movement of patients between different levels of health care institutions for effective and efficient service delivery. The study aimed at establishing the determinants of upward referral system of patients in Nairobi County. Methods: Cross-Sectional data collected from 204 respondents from 2 May to 30 June, 2021, through a structured questionnaire from level 3-5 public facilities in Nairobi County was used. Data was analyzed using SPSS. Doctors, nurses and clinical officers who have referred patients in the previous three months were included while those who had not were excluded. Results: Bivariate analysis results revealed that knowledge of referral system (r=179* , p=0.011) and complexity of patient disease (r=097, p=0.170) had positive and significant correlation with upward referral system. Multivariate analysis results showed that proximity to the referral health facility had positive and statistical significant (β4=0.640, p<0.002) to upward referral system. Conclusions: The results revealed that although healthcare workers know about the referral strategy, they lack full comprehension of the referral strategy. Patients are mostly referred when higher diagnostic equipment are needed and when the medical conditions are dire. The study recommends professional medical education to equip the human resources for health with the requisite knowledge on the referral system and establishment of effective communication systems between the lower levels health facilities and the higher or specialized facilities to ensure there a smooth referral system in Nairobi County.Item PROFESSIONAL HEALTH PROVIDERS’ GOVERNANCE ACCOUNTABILITY MECHANISMS AS A DETERMINANT OF DELIVERY OF QUALITY HEALTH SERVICES IN KENYATTA NATIONAL HOSPITAL, KENYA(International Academic Journal of Health, Medicine and Nursing (IAJHMN), 2020-09-10) M'Nabea, Lumbi Wa; Wanja, Tenambergen; Njoroge, KeziaIntroduction: Governance in essence is exercise of authority. It entails decision making and implementation, competent control, provision of standards and accountability. Objectives: The study set out to determine influence of professional health providers’ governance accountability mechanisms in delivery of quality health services in Kenyatta National Hospital, Kenya. Specific objectives were to establish influence of continuous professional education for health providers and peer review on delivery of quality health services in the hospital. Methods: This was a cross-sectional descriptive study, that used mixed methods design. Stratified and purposive sampling was used to get sample of 369 respondents and four key informants respectively. Results: Logistic regression results indicated that professional health providers not registered with professional bodies were 0.216 times less likely to deliver quality health services on time as compared to those who are registered. There being consequences for breach of self-regulation was 2.086 times more likely to enhance delivery of quality health services as compared to having no consequences. Significant relationship exists between continuous professional education for professional health providers and delivery of quality health services on timeItem Professional health providers’ governance accountability mechanisms as a determinant of delivery of quality health services in Kenyatta national hospital, Kenya(International Academic Journal of Health, Medicine and Nursing, 2020-10) M'Nabea, Lumbi; Wanja, Tenambergen; Njoroge, KeziaGovernance in essence is exercise of authority. It entails decision making and implementation, competent control, provision of standards and accountability. Objectives: The study set out to determine influence of professional health providers’ governance accountability mechanisms in delivery of quality health services in Kenyatta National Hospital, Kenya. Specific objectives were to establish influence of continuous professional education for health providers and peer review on delivery of quality health services in the hospital. Methods: This was a cross-sectional descriptive study, that used mixed methods design. Stratified and purposive sampling was used to get sample of 369 respondents and four key informants respectively. Results: Logistic regression results indicated that professional health providers not registered with professional bodies were 0.216 times less likely to deliver quality health services on time as compared to those who are registered. There being consequences for breach of self-regulation was 2.086 times more likely to enhance delivery of quality health services as compared to having no consequences. Significant relationship exists between continuous professional education for professional health providers and delivery of quality health services on time (p<0.05). Continuous training made application of clinical guidelines 2.157 times more likely in delivery of quality services on time. Not having the right people in the right job was 0.307 times less likely to deliver quality health services on time as compared to having the right people in the right jobs in the hospital. Conclusion: The study concluded that professional health providers’ governance accountability mechanisms is a determinant of delivery of quality health services in KNH. Recommendations: The study recommends that the hospital should ensure: i) professional health providers are registered and licensed to practice by their professional bodies, ii) continuous professional education opportunities for professional health providers are available and monitored for actual improvements in professional and clinical governance accountability, and iii) hospital management invests in technologies and infrastructure that improve patients waiting time.Item Influence of institutional reorganization on the access to primary care health services in a transition period: A case of IFO camp, Dadaab refugee complex, Kenya(European Journal of Public Health Studies, 2020) Jaji, Ann Reggie; Wanja, Tenambergen; Muiruri, LilianThe refugee population verification exercise in 2016 indicated the Dadaab Refugee Camp population to be on a declining trend. The declining trend was due to relocations, and voluntary repatriation of the refugees. Health service delivery has transmuted from difficult situations on previous years to serve Dadaab refugee, through soliciting sufficient funds to provide quality essential services like Primary care services for care and protection. With the call for repatriation, it was expected that health service delivery would be affected. Therefore, the study sought to assess the influence of institutional reorganization on the access to primary care services during the transition period in IFO Camp of Dadaab Refugee Complex, Garissa County. The study adopted cross-section descriptive study design that combined both qualitative and quantitative methods of data collection. A total of 384 respondents were included in this study. Random sampling was used to select the respondents. Data collection was face to face using structured questionnaires. In depth interviews were done with camp leaders and institutional managers. Study findings revealed the respondents were aware of the institutional reorganizations that had taken place in the primary care health sector of IFO Camp during the transition period, namely: management process (51.3%), resource re-adjustment (11.7%), structure re-organization (9.9%), and stakeholders’ role (5.5%). The chi-square analysis showed that there was positive correlation between structural adjustment (Χ2=204; P< 0.001), resource adjustment (Χ2 = 67.9, P< .001) and access to primary health care services. Hence it was concluded that there was an association between structural adjustments, resource adjustment, and access to primary health access among the refugees. The study recommends that; i) all stakeholders inside the refugee camp should be involved for effective resource re-adjustments in order to ensure continued access to primary care health services during the transition period and ii) the UNHCR should ensure that there is effective management during the reorganization period in order to ensure efficiency use of resources for better access to health services during the transition.