Master of Public Health

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Factors Associated with Stunting among Children Aged 0-23 Months.
(KeMU, 2016) Musyoki, Clementina Ngina
Globally, childhood stunting is one of the most significant impediments to human development, affecting approximately 162 million children under the age of 5 years (WHA Global nutrition target, 2025). Stunting, or being too short for one's age, is defined as a height that is more than two standard deviations below the World Health Organization (WHO) child growth standards median. In Kenya, stunting rates are at 26% according to Kenya Demographic Health Survey 2014 (KDHS, 2014).The study was conducted on stunted children who visited the maternal child clinic (MCH) at Mbagathi sub-county hospital in Nairobi County. The study objectives were to investigate the social —economic and demographics variables, Child feeding and care practices and maternal feeding and care practices of the population under the study. The study adopted a across-sectional design and the sampling process was calculated using Emergency Nutrition Assessment software (ENA). The sample size included in the study was 287 children. Data was entered using the CSPro software Version 6.1 while the analysis was done using SPSS version 22. The study revealed that 80% of the households were headed by male while 82.9% of mothers interviewed were married. The mothers who had attained secondary education was at 53% and most of the families were less than five at 81.5%. Mothers who initiated breastfeeding within the first hour of life was at 87%. Exclusive breastfeeding was at 28% while complementary feeding was at 66.7%. Under health seeking behavior,97.6% of the mothers took their children for treatment to health facilities during illness .Hospital delivery was well practiced at a rate of 94.1% while ANC visits at least four times was at 39.4% with majority of the ANC visits happening within the third trimester. Extra foods during pregnancy and lactation were at 69.3% and 71.4 % respectively. The study concluded that there was inappropriate breastfeeding practices and early introduction to complementary foods as well as poor ANC attendance. Nutrition education should begin from ANC and continued at the MCH as a key recommendation.
Factors Influencing Provision of Nutrition Education and Counselling To Pregnant Women by Nurses during Antenatal Care in Nairobi County.
(KeMU, 2016-06) Njoroge, Charity Wairimu
Good maternal nutrition is essential for health, development and reproductive performance of the pregnant woman, and for the growth, survival and general health of the child. One strategy for ensuring pregnant women get information on the importance of adequate nutrition is through nutrition education and counselling. However many barriers hinder effective provision of nutrition education and counselling; one may be inadequate nutrition knowledge by nurses among other factors. The objective was to determine the factors that influence provision of nutrition education and counselling to pregnant women who attend antenatal care by nurses in Nairobi County. A cross-sectional descriptive study was used. The sample comprised of 150 nurses working in the antenatal clinics from 30 health centres in Nairobi County. A semi-structured self-administered questionnaire was used to collect quantitative data, and seven key informant interviews with clinic in-charges for qualitative data. Data was analysed using SPSS version 21. Descriptive statistics was done on all variables. The chi-square tests was used to determine relations between key study variables. Nurses who had a clear understanding of nutrition education and counselling were 36%. The nurses who had knowledge on the importance of nutrition to birth outcomes were more likely to provide NEC (P=0.002). Nurses self -perceived knowledge and skills for provision of nutrition education was 34%. 66% reported that they were not adequately trained. Inadequate knowledge on was similar to all levels of nursing training, whether trained in private or public institutions. Majority (73%) reported they provided nutrition education in group sessions. However the content and quality provided is likely to be affected by inadequate knowledge and skills of nurses and lack of structure. 47% reported they had guidelines at the health facilities. In conclusion, this study has found that nurses' self—perceived knowledge and skills for provision of nutrition education and counselling was inadequate. Secondly. lack of structure lead to inconsistency in the content and quality provided. Thirdly, unavailability of guidelines and irregular use affected delivery of services. It is recommended that basic nursing training should provide trainees with adequate competences. Nurses should have continuing education on nutrition to enhance their knowledge and skills. There should be a structure to guide and ensure uniformity of NEC service provision and guidelines should be provided to all health facilities and used as reference materials.
Drivers of Health Services' Sustainability in Selected Mission Hospitals in MT. Kenya
(KeMU, 2016-07) Ndege, Josephine Muthoni
Mission hospitals were initiated by missionaries and were heavily subsidized. The situation has changed; donor support is no longer reliable and cost of providing services has increased tremendously. The subsidy which enabled the services to be cheap and accessible has largely ceased hence the full cost of delivering services has to be met by the patients. A number of mission hospitals are befallen by crisis due to weak governance structures leading to poor oversight of health institutions. The health providers market has also become very competitive with private and public health units mushrooming in both urban and rural areas. Due to the financial constraints, sustainability of mission hospitals has been difficult and is in dire need of exploring other factors to enable it sustain health services. The study was conducted to explore drivers of health services' sustainability in mission hospitals so as to enhance service provision, accountability and growth while embracing best practices. The specific objectives were to find out if governance, continuous quality improvement and stakeholders engagement influence sustainability. The study was carried out in 10 faith based Hospitals in Kirinyaga, Murang'a, Embu, Nyeri and Meru counties with bed capacity of 60 and above. A descriptive cross sectional study design was used and a non-probability sampling method was used to select subjects of the study. Questionnaires and key informant interviews with selected chief executive officers was used to collect data that was analyzed using Statistical Package for Social Sciences and presented in the form of frequency tables at p < 0.05. A multivariate regression model was applied to determine the relative importance of each of the three variables with respect to Health Services' Sustainability. The study found out that mission hospital adheres to quality improvement practices such as presence of quality improvement teams and standard operating procedures but lacks top management support; they have a board of directors but lack a clear documented organization structure (organogram) while board composition was biased to church leaders. Study also indicated that stakeholder's engagement was a key drive to sustainability but there was little engagement within the catchment population. The study concluded that Mission hospitals lack sufficient funds from their sources of income to sustain quality health services since main source of funds is user fee which is also affected by dwindling patient numbers. The study recommends that Governance of mission hospitals should be strengthened and professionalized to ensure that it has the essential competence and Mix of skills and employees trained on sustainable procurement concept. It is recommended to further research on how mission hospitals can gain competitive advantage through service differentiation.
Impact of Point of Use Water Treatment and Safe Storage in Reducing Diarrhea Morbidity among Children under Five Years Old in Kawangware, Nairobi County
(KeMU, 2016-07) Banga, Christine Wambui
Diarrheal diseases are one of the major causes of morbidity and mortality in developing countries particularly in children. This study took the form of a cross-sectional study to determine the impact of Point of Use (POU) water treatment and storage practices in reduction of diarrheal morbidity among a target population of children of between 0-59 months. The study setting was Kawangware sub-location, Kawangware Location, Dagoretti Sub County in Nairobi County, while the study respondents were parents of children below the age of 59 months. Three study objectives namely: Households' perception on point of use water treatment practices, households' methods of POU water treatment, as well as households' water storages practices and their impact on diarrheal morbidity among children under- five years of age were assessed. Multi-stage sampling method was utilized in the selection of the 301 children whose parents were respondents for the study. Both quantitative and qualitative method of data collection were utilized where face to face interview with parents of the children ages 0-59 months were done using questionnaires, while interview guides were used in group discussions with mothers, as well as in-depth interview guide with health facility administrator. Raw data from questionnaires was analyzed using Statistical Package for Social Sciences (SPSS) version 22, while qualitative data from group interviews with mothers was analyzed manually and summarized based on themes and patterns. The study utilized descriptive statistics as well as inferential statistics to test level of association between variables. From the study findings, it was evident that households' perception on quality of their drinking water affected uptake of PoU (p=0.839, 99% CI), and that households that treated their drinking water at point had lower incidences of diarrhea (p= -0.914, 99% CI) among children under the age of five. Additionally, a strong positive relationship (p=0. 614, 99% CI) was realized between method of PoU water treatment and diarrhea prevalence among children under five years. Lastly, a weak positive association was found between the method of water extraction from storage container and (p= -0.177, 99% CI). The researcher concludes that point of use water treatment significantly reduces diarrhea morbidly among children under the age of five years, and therefore recommends that households with children under the age of five should take up the practice. The findings will also provide requisite information to policy makers to enable them design and implement health promotion and preventive programs aimed at diarrhea reduction among under-fives. The researcher lastly suggests that further studies be carried out in households that reported treating their drinking water but also reported incidences of diarrhea among under-fives, to establish the factors contributing to water re-contamination at household level.
The Effect of Mobile Phone Technology in Bridging the Gaps in ARV Uptake Care Service Delivery in Kenya: A Case Study in Kibera, Nairobi County
(KeMU, 2019-07) Ndwiga, Alice Muthoni
The Kenyan constitution seeks to guarantee every citizen the right to quality healthcare services but is hampered geographical location, socio-economic statuses, and education among other factors of intended recipients. The country has a high mobile phone penetration rate and mobile devices have revolutionized the way people interact. Digitalization of the healthcare sector is a vital aspect that contributes to effective delivery of care services. This study set out to assess about the impact of mobile technology in closing the gaps within the health care service delivery. It focused on Kenya as the case study, where, just like many other developing countries, the challenge of unequal healthcare services delivery. The objective of the study was to identify the gaps in healthcare delivery in Kenya with a focus on Kibera, an informal settlement in Nairobi by the use of mobile technology on clinical services to MSF patients. To evaluate how mobile technology would help in bridging gaps in healthcare service delivery by assess how it improves self-care among the visiting patients, to establish how far the mobile technology has change lives of patients in healthcare service delivery. The study target population was patients visiting Médecins Sans Frontiers (MSF) clinic. A cross-sectional study design was employed in this study. Purposive and simple random sampling method was used to select the study sample of 210 participants. Quantitative data was collected using survey questionnaire as the instruments of data collection. Pretesting of the questionnaires was carried. To analyze the data, SPSS 17 software was used. The main findings showed that n=66.12% of the respondents (n=14.29% strongly agreed + n=55.24% agreed) that the use of mobile phone technology improved their access to healthcare services. Hypothesis testing using p value of 0.05 also showed that use of mobile phone technology positively impacted the delivery of healthcare services. The findings showed that n=66.12% of the respondents agreed that the use of mobile phone technology improved their access to healthcare services. The study recommends that governments should strive to equip healthcare clinics and hospitals with mobile technology such as internet enabled communication devices as a way of linking healthcare providers with patients for easier access to free health information and concluded that with those interventions in place, we would be able to deliver healthcare services that are equal and efficient to all.
Factors Influencing Willingness to Use Pre-Exposure Prophylaxis among Male Homosexuals at the Sex Workers Outreach Program Clinic
(KeMU, 2019-09) Gitau, Apollo Kamau
The use of antiretroviral agents in an HIV negative person before engaging in coitus with a HIV-positive partner is termed as pre-exposure prophylaxis. The objective of this study was to assess the factors influencing acceptance and willingness to use of pre exposure prophylaxis as a prevention strategy in a group of men who have sex with men. This study sought to examine the participant’s knowledge on HIV transmission, explore the attitudes and behaviors related to HIV among Male Homosexuals, assess the awareness on the methods of preventing HIVAIDS in MSM and finally explore the stigma faced by MSM at the SWOP CITY clinic. This was a cross sectional study that focused on the factors influencing acceptance and willingness of using pre exposure prophylaxis as a HIV prevention method among HIV negative individuals in homosexual relations at Sex workers outreach program clinic, a sample size of 196 individuals was used out of the 386 active HIV negative MSM enrolled at the clinic as per end of July2017, data collection was carried out in August 2017 where Standardized questionnaires were used to collect data from the MSM in SWOP CITY until the sample size for the study was reached. Three focus group discussions were utilized to collect qualitative data on the factors influencing acceptance and willingness to use pre exposure prophylaxis from the selected individuals, collected data was entered, cleaned and exported into SPSS Version 20.0 for analysis, and the data generated was presented in form of tables, pie charts and bar graphs. Only a third were married (opposite sex). Half of the respondents were self-employed. Among those employed, majority [87, 64%] earned from 10,000 to 30000. All of the respondents were aware of HIV AIDs and the majority of the MSM were of the view that transmission was through sexual contact. Less than half indicated that Syphilis was also transmitted through sex compared to a quarter who indicated gonorrhea as also being transmitted sexually, a third just indicated generally STIs with no specific infection in mind. Most of the respondents agreed that the presence of sexually transmitted diseases increased the likelihood of acquiring HIV/AIDS [p value <0.05]. use of condoms, knowing people’s HIV status and sero sorting was found to be most effective methods of preventing the HIV infection [p value <0.05].it was found out that Taking an oral medicine daily to protect oneself from getting infected was to most effective. The qualitative data concurred with the quantitative data as it affirmed that condoms were easily accessible and easy to use, MSM were prone to engage in risky sexual behaviors, stigma was still a major threat in MSM and that they knew about PrEP and the benefits of this intervention. In conclusion PrEP being a newer intervention and recently rolled out, interventions that will address stigma and the risky sexual behaviors that MSM engage in needs to be addressed so that PrEP uptake can be optimized as this will translate to reduction in the HIV/AIDS prevalence in MSM.
Determinants of Feeding Knowledge and Practices among Infants Born of HIV Positive Female Sex Worker Mothers’ Sex Worker Outreach Programme Clinic
(KeMU, 2019-09) Tanui, Carolyne
Feeding of infants is determined by many things which including the nature of work done by the mother. Sex worker outreach Programme (SWOP) is a clinic that caters for medical needs of the women selling sex in Kenya. The legal standing of sex work in Kenya means that sex workers are often marginalized and unable to make a meaningful income from the same. Consequently, they often have little resources available to them as savings. This means they often engage in sex work when pregnant and have to resume sex work soon after delivery. The urgency to resume income generation means that they are not able to employ exclusive breast feeding to their infants. Because of low income, they are unable to afford refrigeration and thus may have challenges storing expressed breast milk. The purpose of this study, which was done in SWOP clinic, was to understand the feeding knowledge, attitude and practices employed by female sex workers to their infants. The study concentrated on HIV positive female sex workers who face additional challenges in feeding their infants as PMTCT guidelines recommend either exclusive breast feeding or complimentary feeding practices. We have scarce information concerning the dangers that come with early weaning and the use of alternative feeding formula among HIV positive sex worker infants. Thus, this study aimed to understand the knowledge and practices employed by HIV positive FSW in feeding their infants. A good number of the mothers in the study were single and a few marred ones. Slightly more than half of them had primary level education compared to a quarter that had more than secondary education. The working hours were mostly both day and night giving them a very limited time to attend to their infants, a good number had enough/good knowledge on infant feeding as well as positive attitudes towards the same. There was no association between the feeding practices and the recommendation in the national guidelines. It is hoped this study will help the government develop a policy to support HIV positive sex worker mothers by educating them on the importance of EBF to avoid mother to child transmission. Health education needs to be all across the family members, them to give support to these mothers, no importance is there in educating mothers of infants only, we need to establish a movement that helps and educate every single family member and the society at large, for the reason to make breastfeeding a natural to feed a baby again. a baby. A longitudinal study is recommended to be used to conduct the study to track infant and young child feeding practices throughout the period from birth to 24 months of age. This is to effectively link feeding practices and individual growth patterns. Further research should be conducted to establish the association between the nutrition status of mothers living with HIV and the nutrition status of their infants.
Determinants of Adherence and Retention in Care of Hiv Positive Adolescents in Murang’a County Hospital, Kenya
(2020-10) Peter, Kabugua Ndungu
The burden of HIV amongst teenagers in Kenya is increasing, yet the adolescence period can be a window of maximum prevention, testing, and treatment HIV. The prevalence of HIV among adolescents (10-19 years) was 0.9% in 2018. Adherence to medication and retention in care is important in improving clinical outcomes and quality of care. Disaggregated data particularly for the adolescent age group is a challenge in Murang’a County. The study aimed at determining the factors associated with retention and adherence in care for HIV positive adolescents attending Murang’a HIV Comprehensive Care Center (CCC). A descriptive cross sectional study was carried out at Murang’a County Comprehensive Care Center involving 93 purposively sampled adolescents. 2 key informants were conveniently sampled. Retrospective Retention data of the preceding 12 months (Nov 2018-Nov 2019) was collected from the hospital records. Data was collected using a questionnaire, FGD and key informant guides. Data was analyzed using SPSS, both descriptive and inferential statistical techniques were used i.e chi square and cox to regression analysis, time to event data was used to analyses survival of adolescents in care. Qualitative data was manipulated manually through thematic analysis. In the preceding 12 months, the number of adolescents enrolled in care was 350. 250 (71%) were retained in care and 100 exited in that period. The average period till exit was 3.463 years. Transfer to other facilities, deaths and loss of follow up resulted to exit. The median survival time was 3.00 years. Retention had a significant association with adherence at (p=0.043). The results showed that 91(98%) of the respondents were adhering to HIV management. Increasing level of education improved adherence and retention to care. From the FGD, disclosure, family and hospital support system, reduced waiting time, health education and counselling were contributed to good retention and adherence. Stigma, fatigue from medication and peer pressure were cited obstacles. The study recommends development of cost-effective, scalable, and sustainable evidence based strategies to strengthen adolescent retention in care and adherence to ART. HIV data reporting systems on adolescents should be improved more so adolescent specific data should be disaggregated. Continuous strengthening of health education through operation triple zero (OTZ) and counselling is important for improvement and maintenance retention to HIV care. There is need for continuous HIV/AIDS awareness in the community to reduce some of the barriers like stigma and discrimination to HIV care. There is also the need for continuous improvement and adjustment of HIV/AIDS care service to meet the needs of adolescents to maintain good retention and adherence. Further research on challenges facing transition from paediatric to adolescent care is recommended.
Relationship between Low Birth Weight and Maternal Periodontitis: A Case Study of Kiambu County.
(KeMU, 2020-11) Gichuki, Rachel Njoki
Periodontitis is defined as a long-term inflammatory disease of the periodontal ligament and alveolar bone occurring as a response to bacterial plaque. Periodontal diseases are estimated to affect more than 95% of the adult population in Kenya. Low birth weight is defined by the World Health Organization as neonatal birth weight of 2500 g or less, regardless of gestational age. It is estimated to contribute 60 to 80 percent of all neonatal deaths The Kenya Demographic Health Survey (KDHS) of 2014 estimated low birth weight to be 7.6% countrywide and 9.2% in the Central region showing an increase in prevalence by 3.7% in 5 years. In addition, among all early childhood mortality rates in Kenya, neonatal mortality has showed the slowest rate of decline. With the high prevalence of periodontal diseases in females in Kenya and the increase in neonates born with low birth weight in central region, there was need to evaluate if there is a relationship between low birth weight and periodontitis. We further sought to determine the incidence of periodontitis in mothers delivering low birth weight neonates in Kiambu and to evaluate the relationship between low birth weight and oral hygiene practices in the same County. We carried out a cross sectional study using 384 post-partum mothers distributed across five hospitals in Kiambu between June and December 2019. Mothers who had delivered singleton low birth weight neonates within 48 hours, according to the medical records, were enrolled for clinical examinations and interviewed using a structured questionnaire. The incidence of maternal periodontitis in Kiambu was found to be 92% with 53% of the mothers having severe periodontitis. All oral hygiene practices were significantly associated with low birth weight (P0.001). Incidences of maternal periodontitis are significantly associated with low birth weight with an R2 = 0.732, P  0.001 and a correlation of r = 0.875, P  0.001. Statistically significant associations were found between age and maternal periodontitis (p = 0.045), highest level of education and maternal periodontitis (p = 0.007) and dental visits prior to pregnancy and maternal periodontitis (p = 0.012). In conclusion, there is a high incidence of periodontitis in mothers delivering low birth weight neonates in Kiambu County. Poor oral hygiene practices are a potential predictor of low birth weight. A positive relationship exists between low birth weight and maternal periodontitis in this population. The ministry of health should incorporate oral health preventive and curative services in antenatal programs in Kenya. Public health awareness on the importance of proper oral hygiene practices and routine dental care is required especially among expectant women. Large prospective cohort studies are required to investigate the relationship between low birth weight and periodontitis in different populations in the country. Further research is required on misconceptions surrounding dental care during pregnancy and barriers limiting utilization of dental services during pregnancy.
Evaluation of the Effect of Isoniazid Preventive Therapy among Children Living with HIV in OLA During Children’s Hospital-Freetown, Sierra Leone
(KeMU, 2020-11) Anyango, Buoga Dolphine
The second biggest killer disease triggered by a single infectious agent and the leading cause of mortality for children living with HIV (CLHIV) is Tuberculosis (TB), rendering it an significant public health concern that needs aggressive preventive steps. In some nations, Isoniazid Preventive Therapy (IPT) has been introduced to shield children from the development of latent TB infection to active disease and also to avoid TB reinfection after exposure to an open case of childhood TB. The impact of IPT among CLHIV who completed IPT at the Ola Children's Hospital in Sierra Leone was evaluated. The study objective was to evaluate the effect of IPT among CLHIV at ODCH who completed IPT before February 2018 and still on HIV care and treatment. A cross sectional study with both qualitative and quantitative data collection was employed. Target population was 323 CLHIV enrolled and completed IPT before February 2018, 4 pediatric specialists and all Health care workers who provided treatment and care to these children in the previous one year. We used a cross sectional and mixed methods design. We collected quantitative data using self-administered semi structured questionnaires and qualitative data through Key informant interviews with the pediatric specialists. Data analysis was conducted using descriptive statistics and Multivariable logistic regression analysis to determine factors associated with TB incidence, mortality and quality of life among CLHIV. Majority of the children [200, 61.9%] weighed between 11-20 kg and were in WHO stage II [176, 54.5%]. With most children on 3TC [184, 57.7%] compared to 80[25.1%] on first line ART regime. Most respondents thought that TB was curable [281, 87%] [x2=176.84, p<0.05] and that TB was not a curse [271, 83.9%] [x2=148.48, p<0.05]. CLHIV aged less than 12 weeks compared to older children are more likely to be infected with TB (OR=2.777, p<0.05). Minority [205, 63.5%, x2=23.43, p<0.05] of the children were diagnosed with TB since February 2018. To moderate extent pain and discomfort was worrying [3.28, .862] and moderately handled any pain or discomfort among the child/children [3.23, .815] [x2=267.07, p<0.05].The study demonstrated efficiency of IPT in reduction of TB incidence in CLHIV. TB is can effectively be prevented through IPT prophylaxis alongside the ART regiment. This would significantly prevent pain and discomfort in HIV positive children. The study recommends that all CLHIV should be initiated on IPT to prevent them TB which is an opportunistic infection in HI/AIDS. Adequate funds allocation in the acquisition of adequate IPT treatment alongside proper coordination in the administration of the treatment by health workers. There is need for effective management of symptoms so as to improve quality of life among CLHIV
Utilization Factors of Surgical and Antibiotic Treatments for Potentially Blinding Trachoma in Loodokilani Ward, Kajiado County, (Household Survey)
(KeMU, 2020-11) Parsimei, Ruth Nataana
A number of studies carried out in the county show that poor utilization of eye treatment services is seen as lack of confidence by the community for the eyecare professionals. Various reasons for not accessing eye checkups are multifaceted, although some can be easily addressed than others. This study focused on tertiary (surgical) and secondary (antibiotics) levels of prevention of trachoma. The scope of this study was consistent with the Andersons health utilization model. The study objectives included; To determine the proportion of persons of 18-60 years with potentially blinding trachoma; To determine the proportion of persons with potentially blinding trachoma utilizing surgical and antibiotic therapy; To determine the accessibility of surgical and antibiotic therapy services for persons with potentially blinding trachoma; To determine the social factors influencing utilization of surgical and antibiotic therapy among persons with potentially blinding trachoma. Multistage sampling technique used involved a two-stage sampling process where every location was used as one unit. The initial stage used the random sampling which was used for listing of households of persons with potentially blinding trachoma. The second stage involved going through the listed households to collect data to identify persons with potentially blinding trachoma. The population under study were 422 adults of age eighteen to age sixty years, both male and female. The independent variables included the utilization factors which included, prevalence factors, social factors and accessibility factors of surgical and antibiotic therapy of potentially blinding trachoma whereas the dependent variable was the utilization of surgical and antibiotic therapy. Descriptive statistics was used to find the proportions (i.e. %) for categorical variables while the analytical statistics was used to test the null hypothesis and the factors associated with the dependent variable. Data collection tools included household checklists and community household questionnaires. The proportion of those with disease were 188 (44.5% prevalence). Out of those with disease, only 12.2% were utilizing surgical treatment, 60.1% used antibiotics, and 27.7% went for regular eye checkups. All socio-demographic factors except for gender (p>0.05), influenced utilization. On access, the factors that influenced utilization (p<0.05) were, mode of transport, waiting time, operational hours, and referral systems while on social factors, only cultural beliefs influenced utilization with (p<0.05). All F&E indicators influenced utilization except for impermeable toilet floors and presence of eye seeking flies (p<0.05). The study noted lower utilization of surgical treatment as compared to antibiotic treatment for potentially blinding trachoma. The County Department of Health in Kajiado was recommended to ensure consistent implementations of SAFE (surgical, antibiotics, facial cleanliness and environmental hygiene) programs to reduce prevalence of disease to 5%, encourage the utilization of surgical and antibiotic treatments through improvement of health infrastructure for easier accessibility of eye care services, and ensure improvement on the social aspect of the community towards utilization of eye care services through positive cultural beliefs and education.
Aflatoxin Analysis in Staple Food Cereals and Assessment of Households’ Awareness on its Management in Tharaka-Nithi County, Kenya
(KeMU, 2021-09) Marangu, Victor Mwiti
Aflatoxin is a poisonous substance produced by fungi. Crops infestation is inevitable and numerous evolving nations collectively with Kenya do not regularly test their main foods for aflatoxins contamination. Consumption and sale of mycotoxins infested cereals and grains has the risk of contributing to a diversity of severe medical complications in people. Context-specific information on the aflatoxin occurrence in the County makes it possible to document vulnerable staple crops and the level of toxicity in the County. Measurement of exposure using the factors that influence the choice of the food together with the presence of these harmful mycotoxins can be used to demonstrate how this contamination occurs in food, map the aflatoxin hot spots in the County and inform the choice of the most effective control approaches. However, there is lack of local data on aflatoxin contamination in Tharaka-Nithi County to inform interventions chiefly due to lack of local research, testing facilities, and qualified personnel. The main purposes of the research included: to evaluate the levels of aflatoxin in cereals commonly used as staple foods sourced from households and marketplaces, to evaluate households’ awareness on suitable conditions for storage of foods regarding aflatoxin contamination, and to identify factors contributing to aflatoxin contamination. Samples were collected from Tharaka-South and TharakaNorth Sub-Counties which had three Wards with a total of 24 Sub-Locations. 3 Households per Sub-Location that had some stock of the crops of interest were randomly chosen from the villages in each Sub-Location. Three major open-air markets were also selected based on size for the collection of the samples. During the collection of the samples, observations were done, and a questionnaire used to determine the study respondents’ awareness of aflatoxin contamination and knowledge of the potential causes of contamination. Analysis for aflatoxin levels was conducted using the ELISA Kit. The information collected during household interviews was analyzed using SPSS version 22. The main cereals used as staple foods among households in the County as per the study results included: pearl millet, sorghum, maize, green grams, and cow peas. Overall, aflatoxin contamination in 25.8% of sampled cereals was above the legal threshold of 10ppb Kenyan standards with 17.2% of cereals exceeding the established human tolerance levels of greater than 20ppb. The aflatoxin contamination levels of 44.4% of the market samples was greater than the Kenyan tolerable limits. Based upon the Chi-Square test for association, it was evident that level of aflatoxin was associated with the type of cereals and grains (p-value 0.001, which was less than 0.05 at 95% confidence level). Therefore, cereals and grains levels of contamination differed as they were exposed. Based upon the t-Test for Equality of Means, the difference was not significant (p-value for Maize= 0.89, Sorghum= 0.47 and Pearl Millet=0.64, all of which are greater than 0.05). Thus, there was no difference in mean level of aflatoxin in the cereals and grains in the two study areas. Furthermore, the t-Test for Equality of Means, showed that there was no difference in mean level of aflatoxin in the cereals and grains collected from the markets and households (p-value for Maize=0.294, Sorghum=0.422 and Pearl Millet=0.918, all of which are greater than 0.05). Majority of the farmers (84.7%) were aware of aflatoxin as a dangerous poison found in cereals and grains especially those that are not properly dried to safe moisture content. However, detailed information on the nature, formation, effects, prevention, and control of aflatoxins was scanty and inconsistent. The study provided crucial information on the aflatoxin contamination levels of these major cereals and grains and on households’ knowledge on aflatoxin management. This data will be key in bringing issues to light of the presence of these harmful mycotoxins in staple foods and increase the community’s knowledge and skills on the use of sustainable, low-cost post-harvest management practices to decrease the contamination. This will enhance the well-being of populations in the County and ultimately the national food security.
Factors Influencing Adherence to Antiretroviral Therapy among Youth (15-24 Years) in Selected Health Facilities in Nyeri County, Kenya
(KeMU, 2021-10) Irakoze, Huguette
The antiretroviral therapy combinations introduction in 1996 disrupted the natural course of the HIV/AIDS infection. In fact, ARVs induced an effective reduction in the morbidity and incidence of new cases; they have changed the prognosis of infected patients by conferring on this pathology a chronic character. However, ARV treatment requires rigorous adherence. Adherence constitutes the main factor for the success of ART, a fundamental element of the HIV infection response. The danger of low adherence is the emergence of resistance to HIV. Understanding factors that influence positively or negatively the adherence is essential to maximize viral suppression and reduce mortality. Globally, there are numerous reported cases of non-adherence. Adolescents and young people (15-24) are the epicentre of the pandemic, according to UNAIDS, with 30 percent of new HIV infections happening in this age group in 2019`. Nyeri County is one of the counties that have an emerging epidemic as evidenced by the consistent in rise in their HIV burden. The study’s main objective was to determine factors influencing adherence to antiretroviral therapy among youth aged 15-24 years attending the various selected health facilities in Nyeri County. The study used a cross-sectional descriptive design and an interviewer-administered questionnaire to collect data in 3 health facilities: Karatina district hospital, Nyeri referral hospital, and Tumutumu PCEA hospital. A focus group discussion approach was incorporated as well. The participants in the research were patients that had been on ART for at least for 6 months, selected via probability sampling. The examined variables were demographic factors, economic, socio-cultural, and ART regimen factors as the independents, and adherence to ART as the dependents variable. The Statistical Package for Social Sciences (SPSS software version 25) was used for quantitative data analysis, whereas the qualitative data obtained from the open-ended questions were analysed with the aid of the conceptual content analysis and presented in quotes. Results show that the proportion of young people of the 15 to 24 years age bracket, with undetectable viral load, who are adherent is 67%. The only demographic factor which is seemed to be associated with adherence is gender (𝑋2=5.810, p=0.016). Economic factors such as occupation (X2=5.33, P=0.017), and balanced diet (𝑋2= =9.343, p=0.002) were found to be significant predictors of the viral load. Stigma (𝑋2 =49.811 P=0.0001), social support (X2=8.147, P=0.0004), social avoidance (𝑋2=13.925, P= 0.0001), beliefs such as thinking stop the ARVs (𝑋2=8.706, P=0.003), denial of the condition (𝑋2= 8.472, P= 0.004) are also good predictors of the adherence among youth. The ART regimen factors like the count of pills to swallow per day are also linked to adherence (𝑋2=0.0816, P= 0.04). To improve adherence to ART among youth, the study recommends that the community should provide the necessary support to young people living with HIV by banishing stigmatizing and discriminatory practices and remarks. Continuous strengthening of health education through operation triple zero (OTZ) and counselling is important for improvement of adherence.
Effect of Covid-19 on Uptake of Routine Immunization in Goma, Democratic Republic of Congo.
(KeMU, 2022-10) Mukanda, Saleh
The routine immunization process continues to save millions of children's lives worldwide. The previous pandemic like Ebola impacted the health system in Africa. There was a need to investigate if COVID-19, with its restrictions and containment measures, affected the Democratic Republic of Congo health system, particularly the routine vaccination programme. The study examined the effect of the pandemic on coverage/uptake, sequence, and timing process during routine vaccination. The study was cross-sectional. The quantitative method was used to collect data from 423 children aged of 12-23 months and 27 health workers through structured interview and self-administered questionnaires, respectively, at Mabanga area in Goma city, in DRC. The Chi-square test was used to test the independence between out-of-sequence vaccination and full immunization coverage, and the chi-square test for Goodness of fit was used to test the difference between full immunization in this study and the country target. Differences in vaccine coverages, out-of-sequence, and timely and untimely vaccination were compared by using a T-test. Simple and multiple logistic regressions were used to determine the predictors of full and partial immunization coverage. Simple and multiple ordinal regressions were used to determine the predictors of attitude and perceptions of change among the health workers at a 95 % confidence interval. The full and partial immunization coverages were respectively 96.7% and 99.3%. The children whose parents were aged 18- 25years and 26-33years had a high probability of being fully immunized than those whose parents were aged 34 and above years old. The likelihood for unemployed parents to fully immunized their children was 3.17 when compared to employed parents. The children whose parents possessed the vaccination cards were more likely to be fully immunized compared to their counterparts. The likelihood of full immunization was high for the children whose parents declared the immunization completion during the interview than for their counterparts. The predictors of partial immunization coverage before COVID- 19 occurrence period were caretakers bracket age18-25years (OR: 0.21, P< 0.05),child sex (OR:0.45,p<0.05).During the pandemic: the likelihood of parents aged between 18- 25 years old partially immunizing their children was high ( OR:3.57,p<0.05) likewise the likelihood of female children(OR:2.234, P<0.05), the uptake mean of BCG, OPV0,1, Pentavalent1,Rotavirus1, and PCV1 decreased from 48 to 17 doses while it increased from 17 to 81 doses for the other vaccines, and the untimely mean doses of all vaccines were high also.39.24 % was the overall out-sequence vaccination; the out-of-sequence vaccination was independent of the full immunization coverage( p >0.05). The health workers with less than 4 years of experience had more positive attitudes and perceived the change more than those with more than 4 years. The study revealed the disruption of routine immunization outcomes specifically the out-of-sequence and untimely vaccination which are essential in the prevention and control of childhood mortality, despite the high full immunization coverage.
Prevalence and Factors Contributing to Hypertension among Patients in Nairobi: A Case Study of Mbagathi Hospital
(KeMU, 2022-10) Oirere, Moseti
Hypertension has become a major concern for public health globally. With 40% of people in the world's population suffering from hypertension, Africa ranks the highest with a prevalence of 46%. The high burden in developing countries is due to increased levels of risk factors (Sani et al., 2010). In Kenya 20-30% of the adults were said to have hypertension (Department of Non-Communicable Diseases, 2014). However, there is limited data about prevalence of high blood pressure as well as the factors that contribute to it among adult patients seeking treatment in Nairobi. The research's purpose was to give a better understanding of the factors that are associated with hypertension among patients attending Mbagathi hospital with an aim of curbing the associated risk factors in order to manage increase in hypertension. The main objective of the study was to determine the prevalence and factors associated with hypertension. Fisher’s formula was adopted for calculating the sample size in the study population and systematic random selection was applied. The study used a descriptive cross-sectional design. Data collection was done using questionnaires that included open and closed ended questions. Participants were allowed to exercise an informed consent before responding to questions. Anthropometric and blood pressure measurements were obtained using appropriate measuring instruments. The instruments used included a sphygmomanometer, stadiometer scale and a weighing-scale. Descriptive statistics mainly means and frequencies were used to analyze data. Inferences were made using chi-square statistic. P<.05 was used as the statistical significance level. The prevalence of high blood pressure was 29.3%. A prevalence of hypertension of 42.2% was found among patients with hypertensive parents. A significant relationship between family history and hypertension (P<0.05) was found using a statistical chi- square test while 69.9% of the participants had a family member who had hypertension. About 4.7% of the participants smoked while 13% were obese. Most of the respondents (60.5%) ate vegetables daily, 32.2%ate weekly while 6.8% ate occasionally. Eating vegetables was inversely related to high blood pressure. The high prevalence seen in hypertension as well as family history being an associated risk factor, calls for urgent interventions to address the high hypertension prevalence which will lead to its control. The County government of Nairobi needs to put more emphasis on intervention programs for hypertension and prioritize on factors contributing to hypertension in particular family history and age so as to bring out better from interventions in the population.
Proposed Solutions to Address the Challenges of Medical Waste Management in Health Facilities in Kamukunji Sub- County, Nairobi City County, Kenya
(KeMU, 2022-10) Mbuvi, Caxton K.
Medical waste management in Kenya has been greatly affected by the country's elevated production levels. The majority of medical facilities do not have an extensive medical waste management system, or if they do, it does not handle waste thoroughly, and therefore is detrimental to humans and the environment. This research focuses on health facilities’ management of medical waste in Kamukunji sub-county, assessing the specific problems of medical waste management in that area. This was a study focusing on healthcare workers that looks at their working conditions and habits. This study was an analytical cross-sectional study design that used Fischer formula for sample size determination. Multistage sampling methods for the selection of 10 health facilities and 141 study participants Before the actual data collection, the questionnaires were pre-tested in one of the public health facilities in Starehe Constituency (Casino Health centre) which was not sampled in the main study. Data was entered, cleansed of errors, and statistically analyzed using SPSS (Version 26.0). Majority of respondents (95.7%) use color to identify different types of medical waste with slightly less than half (49.6%) using labelling, 88.7% store medical waste receptacles inside a health facility, 90.8% had given a contractor to dispose some medical waste with 36.2% and 15.6% of wastes are incinerated and burning respectively. Most of health facilities (39.0%) had daily medical waste weighing less than 26kg with 34.8% and 12.1% weighing between 26-50 kg and 46-100 kg respectively, on observation, the quantity of health facility waste generated at most of selected health facilities was approximately 15 kilograms to approximately 80 Kg. Pumwani Maternity Hospital had the most quantity of medical waste (80Kg), with St Teresa’s Parish Health Centre (50 Kg), Makkah Nursing Home (45 Kg) and the least from Bahati Health Center (15 Kg) during the study period. Majority of respondents (87.2%) did not associate medical wastes with various problems with 12.8% associated medical waste with accidents (55.6%), diseases (27.8%), and drainage blockages (27.8%). The R Square was 0.746, indicating that medical waste management was harmed by a lack of funding, insufficient logistics, a lack of disposal sites, and a lack of understanding. This demonstrated a 74.6 percent variance in healthcare waste management due to a lack of funding, insufficient logistical supply, a lack of disposal site, and a lack of awareness. The remaining 25.4% implies that there were additional issues affecting the healthcare waste management systems of the ten health facilities evaluated. By explicitly identifying a given color with a certain category and its accompanying hazard, segregation aids to safer waste processing. During the research period, Pumwani Maternity Hospital created the most medical waste (80Kg) and Bahati Health Center generated the least (15Kg). The study concludes that periodic updates in medical waste management are necessary, as is refresher training for healthcare professionals and waste handlers. A safe and hygienic system for the handling, segregation, collection, storage, transportation, treatment, and disposal of medical waste should also be in place at every healthcare institution. According to the report, Kenya's National Policy on Injection Safety and Medical Waste Management should be followed by all medical institutions. The strategy aims to emphasize the need of advocating for both the support and execution necessary to adequately manage healthcare waste. Future research might focus on various technologies involved in the treatment and disposal of this waste, or on increasing community knowledge about health care waste.
Occupational Health Risks among Solid Waste Handlers in Nairobi County
(KeMU, 2022-10) Nguyai, Timothy Mwangi
This study analyzes and quantifies the occupational health risks faced by those who handle solid garbage in Nairobi County. Despite the numerous worries raised about the potential harm that trash could cause to the environment and the general populace, occupational hazards in waste management have received little consideration in terms of risks and associated costs in the rush to adopt or embrace technology like composting. The study findings were presented using a descriptive research design. Percentages, means, standard deviations, and frequencies were prepared for presentation as a result of the quantitative analysis of the collected data using SPSS. The qualitative component consists of in-person interviews, open-ended surveys, and field observations. 79% of the respondents were men, whereas only 21% were women. The study's key conclusions showed that human waste, toxic paper, empty containers holding chemical waste, including heavy metals in batteries, solvents, and traces of medical waste such injections and soiled bandages are among the hazardous wastes in the informal enterprises in Nairobi County. Skin infections, diarrhea, and coughing, according to the majority of respondents (89%), are signs of diseases associated with solid waste management. Additionally, a major issue and obstacle to efficient countywide solid waste management is the inaccessibility of sites for trash service providers. According to the report, hazardous waste includes items like human waste, paper and containers that include poisons or chemical residues, medical waste, and heavy metals found in batteries. The study found that insufficient funding, poor infrastructure, and outdated technology, together with the inaccessibility of locations to waste service providers, pose substantial obstacles to the county's successful solid waste management. The study recommends awareness campaigns on 4R’s; Rethink, Reduce, Reuse, Recycle) as a method of solid waste management and mandatory source separation in Nairobi County, the public authority ought to likewise have the option to give workshops to the unskilled workers and show them how to exploit the waste for livelihood while protecting themselves from occupational health risks.
COVID- 19 Containment Policy Measures and Their Effect on Access to HIV Services for Persons Living With HIV in Ruaraka Sub-County
(KeMU, 2022-10) Chirchir, Purity Jerop
The spread of the novel coronavirus disease 2019 (COVID-19) globally led to the introduction of mitigation and containment responses designed to stem the heightened transmission of the virus. These measures hindered face-to-face provision of healthcare, which has traditionally formed the foundation for HIV treatment, testing, and prevention services. Research evidence demonstrates that the mitigation guidelines disproportionately affected people living with HIV. Although the containment policy guidelines might have been effective in limiting infections, they caused serious economic ramifications, which indirectly caused fear and anxiety among people living with HIV. Accordingly, the rationale of this study was to determine the effect of COVID-19 containment policy measures on access to HIV services for persons living with HIV. In so doing, the study explored containment policy measures that affected access to HIV services and the impact of these guidelines on psychological health of people living with HIV. Moreover, knowledge on the novel coronavirus as well as coping strategies used by People living with HIV to enable access to HIV services amidst COVID-19 were also explored to inform future responses to epidemics. The study adopted a cross-sectional research design. The study population for the study encompassed of 914 people living with HIV. The sample size constituted of 298 people living with HIV. Proportionate stratified, purposive, and systematic random sampling approaches were used to select respondents, while semi-structured questionnaire was used for data collection. The study used a self-reported questionnaire (SRQ-20) to screen for existence of psychological distress. The validity and reliability of the questionnaire was established through pretesting. Based on the overall results of the study, COVID-19 containment policy guidelines, such as closure of public transport (p=0.00), cessation of movement (p=0.00), stay at home requirement (p=0.00), curfew (p=0.00), public transportation limitation on passenger capacity (p=0.00), quarantine (p=0.00), and reduction of service hours in clinics (p=0.00), negatively affected access to HIV. The prevalence of psychological distress among people living with HIV was 20.2% (95 % CI: 15.2%, 25.1%). The study concluded that the outcomes of COVID-19 containment policy measures contributed significantly to psychological distress; people living with HIV used various coping strategies to enable them access HIV services under the COVID-19 control measures; and people living with HIV had knowledge on the symptoms and high risk factors of COVID- 19. The study recommends that enhanced investment in psychological counseling be made at every health centre to provide support mechanism to PLHIV during the COVID- 19 outbreak period. The study recommends the Ministry of Health to adopt multi-month dispensing of ART, including mailing, home delivery, and integration of digital health into the delivery platforms of HIV services to ensure minimal interruption. The study recommends sensitization campaigns by the Government on COVID-19 given the evolving nature of the symptoms of the virus.
Factors Associated with Measles Outbreak among Children below 5 Years in Oltepesi Location in Kajiado North Sub County
(KeMU, 2022-11) Sawani, Eileen Naisianoi
Measles is a viral illness that has been demonstrated to be extremely contagious and to cause morbidity and death in both developing and industrialized nations but also one of the top vaccine-preventable diseases in the world. Kajiado has experienced several measles disease outbreaks before 2012 despite the FIC coverage of 80% slightly below the national coverage of 83% in the same year. The objectives of this study was to find out the factors contributing to measles outbreak in Oltepesi in Kajiado North Sub County despite the good immunization coverage and an existing cold chain system. The specific objectives of the study included: establishing the role of health worker knowledge on the cold chain management, finding out the contribution of immunization coverage data accuracy, determining the socio-economic & demographic characteristics of the care givers associated with measles outbreak and to ascertain the unvaccinated population factors on measles outbreak. This was a mixed method design which involved a mixture of retrospective case control study design of caregivers, quantitative, qualitative interview of facility staff and use of secondary data from the Kenya Health Information System (KHIS) for aggregate reporting and analysis, and the health facility records including the registers, tally sheets and reporting tools. Findings: A quantitative study was conducted to identify factors affecting vaccine cold chain management related to measles outbreak. The health facilities were sampled randomly. Approximately 14.7% had indicated that their child was below 9 months compared to 1.1% of the respondents who indicated that their second child was below the same age limit. Knowledge and awareness of measles was significant [x 2=7.021, p <0.05] as there were few respondents in Oltepesi who were not aware of the measles vaccine. The results were significant [x 2=7.72, p <0.05] while on query if child was immunized against measles before the year 2012 [x 2=6.684, p <0.05] thus knowledge and awareness of measles vaccine is important in eradication of measles as well as adhering to the measles vaccination schedule. Utilization of the growth monitoring services at the two areas was significant. On the coverage of immunization in 2012 and it was established that coverage was low i.e. In January and February 15.8% and 16.7% while in the months of May, June, October and November, there were no data on immunization in Oltepesi and thus coverage was zero. Conclusion: According to the study, there is a knowledge gap and a scarcity of health professionals who work in cold chain management, and mentorship on cold chain management is urgently needed to increase understanding and practice. Recommendations: In accordance with the Kenya Expanded Program on Immunization (KEPI) objectives, the Ministry of Health should keep stepping up immunization efforts nationwide. Data cleaning and audit is necessary as the data in the KHIS might be giving false indicators to the world about health as a whole. This should be done periodically within the health systems. In order to stop any measles outbreaks and advance toward the eradication of the disease, it is imperative that the County implement enhanced ways to increase health workers' awareness of vaccine cold chain management and attain high vaccination coverage nationally.
Prevalence and Patterns of Psychoactive Substance Use Among Somali Youth Living in Eastleigh, in Nairobi, Kenya
(KeMU, 2023-09) KORIO, ADEN ABDI
The usage of psychoactive substances is on the rise in many communities, particularly among the youth, and is having detrimental effects on people's health, leading to millions of deaths annually. According to a report by National Authority for the Campaign Against Alcohol and Drug Abuse (NACADA) in 2004, the use of substances like alcohol, tobacco, marijuana, khat, and inhalants such as glue was widespread among young people between the ages of 10 and 24 in Kenya. Although the use of psychoactive substances leads to significant social and public health problems, the extent of the issue in sub-Saharan Africa is yet to be determined. This study aims to establish the prevalence and patterns of psychoactive substance use, as well as the demographic characteristics associated with its use, among the Somali community residing in Eastleigh, Nairobi, Kenya. This study was a cross-sectional survey study among consenting youth living in Easleigh North. Data is presented both in descriptive and inferential statistics. The sampled three areas in Eastleigh, known for drug abuse concerns, among sampled 270 households, out of a total of 9,408 households, aiming to interview one person per household. Data collection involved trained interviewers using questionnaires to inquire about demographics and drug use, focusing on the past 12 months. The study also utilized focus group discussions with youth aged 18 to 25, visiting sampled households for this purpose. Data collected was analyzed using SPSS version 23 to provide descriptive statistics, presented in tables and graphs illustrating psychotropic drug use categories, and significant consumption patterns were identified through t-chi-square tests based on demographic and environmental factors.This study found that 75% of youth use at least one psychoactive substance, miraa was the highest used Illicit substance (47.9%), while cannabis was the highest illicit used substances (23.9%) and prescription medication was found to be 10.3% use. Onset of all psychoactive substances was below 18 years of age. Comorbid use varied between Illicit psychoactive, (32.0% to 73.5%); illicit psychoactive substances (9.8% to 100%), Illicit substances and prescription medication (11.8% to 22.7%) and illicit substances and prescription medication (26.7% to 100%). 66.% reported reason for use to be peer pressure. Contributing factors to psychoactive substance use were other family members use (p=0.000), living conditions (p=0.003), family income (p=0.014) and gender (p=0.044). This recommends that policy makers for advocacy, sensitization, provision of appropriate treatment programs, and review training for public health workers. Recommendations for public health workers include the establishment of programs for preventions, treatment and databank, networks and linkages for referrals that incorporate other partners in mental health that include psychoactive substances