Master of Public Health

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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.
Assessment of Nutritional and Lifestyle Risk Factors Influencing Clinical Remission in Multiple Sclerosis Patients in Nairobi County
(KeMu, 2025-11) GIKUNGA, CYNTHIA WAMBUI
Multiple sclerosis (MS) is a condition identified by acute inflammation in the cerebrospinal axis, that brings about demyelination and nerve dysfunction. This incapacitating condition presents diverse neurological symptoms, including fatigue, compromised mobility, sensory disturbances, and cognitive impairment. This investigation, conducted in Nairobi, aimed to explore the influence of dietary risk factors on disease activity and clinical remission in MS patients, utilizing a mixed-method approach. Nairobi faces distinctive healthcare challenges and comprehending how dietary factors interact with MS outcomes can lead to tailored interventions that enhance the well-being of patients in this environment. The study employed a cross-sectional study design encompassing qualitative and quantitative data collection methods. A total of 150 participants with multiple sclerosis (MS) were studied, with a mean age of 41 years; 58.67% were male and 41.33% female. Most had Relapsing-Remitting MS (80%) and were primarily managed by neurologists (88.67%). Mediterranean (39.33%), low-carb (27.33%), and vegetarian (26%) diets were the most common dietary patterns, with 84% of participants reporting supplement use and 67.33% consuming whole grains daily. A large proportion (88.67%) achieved clinical remission. Statistically significant associations were found between dietary compliance and remission (χ² = 15.495, p = 0.004), with 92% of those reporting “very close” adherence attaining remission. Dietary patterns such as gluten-free (100%), low-carb (95.12%), and vegetarian (92.31%) were significantly associated with higher remission rates (χ² = 8.3824, p = 0.039). Supplement use (OR = 36.05, p < 0.001), avoidance of sugary foods (OR = 209, p < 0.001), and occasional dairy intake (OR = 16.33, p = 0.006) were strongly linked to remission. Logistic regression showed that disease stage (OR = 0.099, p < 0.01) and disease progression markers (OR = 0.301, p < 0.05) negatively influenced remission. While most demographic factors showed no significant effect, poor dietary adherence significantly reduced the odds of remission. Non-dietary factors such as physical activity (χ² = 105.87, p < 0.001), sleep quality (χ² = 18.85, p = 0.001), psychological health (χ² = 19.69, p < 0.001), and environmental triggers (χ² = 15.04, p = 0.001) were significantly associated with clinical remission. High levels of daily physical activity (61.33%) and satisfactory sleep (88%) were common among participants who attained remission. Qualitative findings confirmed that stress, diet, exercise, sleep, and family support jointly influenced symptom control and compliance. Based on the findings, promoting adherence to anti-inflammatory dietary patterns, regular supplement use, and consistent physical activity is crucial for achieving clinical remission among MS patients. Integrating holistic lifestyle interventions including stress reduction, quality sleep, and psychological support can further enhance disease management and symptom control. The findings revealed that adequate dietary diversity, higher protein intake, and regular physical activity were positively associated with clinical remission, whereas sedentary lifestyle and poor dietary habits were significantly linked to relapse or prolonged symptom activity. Socioeconomic factors such as income level and educational status also influenced dietary compliance and overall disease management. The study concludes that nutritional quality and lifestyle practices play a vital role in modulating remission among MS patients. These findings contribute to understanding the behavioral and dietary determinants of remission and underscore the need for comprehensive dietary counseling and lifestyle interventions in MS care programs.
Association of Carcinogenic Heavy Metals in Foods, With Colorectal Cancer, In Nyambene, Meru County, Kenya,
(KeMU, 2025-10) Onduso, Brian Moindi
Colorectal cancer is a growing public health concern in Kenya, especially in the Kiegoi sub-location of Nyambene region where incidence rates are rising without clear etiology. This study aimed to quantify arsenic, cadmium, chromium, mercury and lead in staple foods from Kiegoi and explore their association with colorectal cancer incidence in the area. Cross sectional retrospective review of Meru Teaching and Referral Hospital oncology department records from 2018-2024 was conducted which limits the causal inference of heavy metals in colorectal cancer. Samples of beans, arrowroots, potatoes and maize were collected using simple randomized stratified sampling from each of the five agro- ecological zones in Kiegoi. The samples were then digested with nitric v acid, perchloric acid and hydrochloric acid and analyzed by inductively coupled plasma mass spectroscopy (ICP-MS). The overall crude incidence of colorectal cancer in Kiegoi was 1211 per 100,000 of the population. The age specific standardized rate (WHO standard population) was599 per 100,000 of the population. Cadmium levels were significantly below regulatory thresholds (below FAO/WHO limits) in all foods. Mercury and chromium levels exceeded limits in 100 % of the samples; arsenic and lead exceeded levels in 50 %. Multivariate logistics regression identified lead (OR=17.7), mercury (OR=3.5) and arsenic (OR=2.5) as significant predictors for colorectal cancer. Cadmium showed a negative association while chromium’s effect was marginal. Widespread contamination by mercury chromium and lead in staple foods most likely contributes to Nyambene’s colorectal cancer burden. Policy measures should include routine environmental surveillance, soil remediation and targeted public health screening.
Barriers to Uptake and Utilization of Linda Mama Initiative Among Women of Reproductive Age (15-49 Years) in Kajiado North Sub-County, Kenya
(KeMU, 2024-09) KENDAGOR, LYDIA
Maternal mortality remains a significant concern globally, with substantial improvements observed over the years yet persisting challenges, particularly in resource-constrained regions like Kenya. From 2000 to 2018 according to the World Health Organization (WHO), approximately 295,000 women died during and following pregnancy and childbirth in 2017. Kenya, like many countries in sub-Saharan Africa, faces challenges in reducing maternal mortality rates despite efforts to improve maternal healthcare services. According to the Kenya Demographic and Health Survey (KDHS) 2014 estimates, Kenya's maternal mortality ratio (MMR) was 362 maternal deaths for every 100,000 live births. In Kajiado North Sub-County, Kenya, despite governmental efforts such as the Linda Mama program, aimed at sponsoring maternal care services to alleviate financial burdens on expectant and pregnant women, uptake and utilization of these services remain low. This study, conducted between 2018 and 2020, targeted childbearing mothers aged 15-49 in Kajiado North Sub-County, with a population of 310,696. The study employed inferential statistics, specifically chi-square tests, to reveal significant relationships between socio-demographic factors, health system factors, and the uptake of the Linda Mama Initiative, with p-values less than 0.05. It was found that only 26% of women had registered for the initiative, a figure significantly lower than the national target, despite high levels of knowledge and positive perceptions of the program. The analysis further demonstrated that health system factors, such as infrastructure and support from health workers, had a more substantial impact on the uptake of the initiative compared to socio-demographic factors. Findings indicate that the Linda Mama Initiative program is accessible and straightforward, with easy enrollment processes primarily conducted in health facilities and minimal paperwork requirements. Information dissemination about the initiative is facilitated through various media channels, including social media, radio, television, and community forums like Chief's Baraza. The study underscores the importance of promoting the utilization of Linda Mama initiative services, emphasizing their accessibility, affordability, and critical role in safeguarding the health and well-being of mothers and newborns. The study recommends policymakers to improve infrastructure and possibly increase funding. Implementers should make use of social media for dissemination, expand insurance coverage and involve local leaders for credibility.
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.
Design and Automation of the Food Exchange List for Meal Planning Among Nutritionists in Kenya.
(KeMU, 2025-07) OMWOYO, CATHERINE AYIENDA
The integration of information technology into nutrition care has emerged as a transformative approach to enhancing service quality, efficiency, and personalization, surpassing the limitations of traditional manual methods. Despite global progress in digitizing healthcare, Kenya’s Food Exchange List (KFEL) was unautomated, posing challenges to effective meal planning. This study aimed to automate the KFEL for application in meal planning among nutritionists in Kenya. It led to the development of a meal planning application known as Diet Wizard. Diet Wizard guided the nutritionists step-by-step to input personal data of the patient, calculate nutritional needs, and generate customizable meal plans using a standardized food exchange system. Specific objectives included determining the metric measures of selected foods missing in the KFEL, developing a prototype application, and assessing its feasibility for use in clinical nutrition settings and analyzing the demographic characteristics of the nutritionists in Kenya. A cross-sectional study design was employed, targeting a population of 48 selected Kenyan foods and 297 nutritionists. Purposive sampling was used for the selected foods and random sampling for the nutritionists. Data collection involved laboratory-based food measurements, followed by an online app development and app feasibility survey using a structured online questionnaire. Due to limited digital access, 103 dietitians participated, and data were analyzed using SPSS Version 20 and Excel. The study analyzed 48 commonly consumed food samples to add onto the KFEL by determining their actual nutrient composition using laboratory measurements and standard values from the Kenyan Food Composition Tables. This information was incorporated into the Diet Wizard application data bank. Feasibility results indicated that the application significantly improved both the efficiency and accuracy of meal planning among nutrition professionals, with 73% reporting improved accuracy and 76.47% reporting reduced planning time. Usability was rated positively by 95.1% of respondents, and 87.3% expressed willingness to adopt the tool in professional practice. These findings highlight a strong need for digital innovations in nutrition care. Adopting Diet Wizard will help improve service delivery, save time, and enhance patient outcomes through efficient and modern nutrition care.
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.
Determinants of Antibiotic Prescription Practices For Pneumonia Among Clinicians at Mbagathi Level 5 Hospital, Nairobi County- Kenya
(KeMU, 2024-09) KASANDI, BRENDAH
Antibiotic prescribing practices play a critical role in addressing the rising concern of antibiotic resistance and optimizing patient outcomes. While a majority demonstrated a good understanding of the importance of antibiotic stewardship, there were instances of inappropriate prescribing which have become highly persistent in low resource settings. Factors such as patient demand, lack of diagnostic resources, time constraints, and perceived pressure from peers influenced prescribing decisions. In local context, there is paucity of data regarding clinician-prescribing practices. Purpose of the study was to investigate determinants of antibiotic prescription practices for pneumonia among clinicians at Mbagathi level 5 hospital, Kenya. Through a cross-sectional study design, the study explored the level of compliance with pneumonia antibiotic prescription guidelines, socio-economic factors influencing prescription practices, health system-related determinants, and the knowledge and awareness of clinicians regarding pneumonia antibiotic prescription. A census approach was utilized where a total of 151 clinicians participated in the study. Data was collected using a structured questionnaire. Descriptive and inferential approaches were used for analyzing data. Categorical data was summarized using frequencies and percentages. Chi square test was used to investigate determinants of compliance. Level of significance was considered at 0.05. Stata version 17 was used for data analysis. Majority, 92(60.5%) of the respondents were male, 64(42.1%) were aged between 31 to 40 years and 59(38.8%) were aged between 41 to 50 years. The findings also showed that 66 (43.4%) were medical officers, 55(36.2%) were clinical officers while 31(20.4%) were consultants. The findings established that 68.4% of the clinicians had high compliance to antibiotic prescription practices for pneumonia while 31.6% had low compliance. Gender of clinician, designation, presence of medical insurance, perception on diagnostic tests availability, availability of drugs presence of staff and knowledge were significant determinants of compliance to antibiotic prescription practices for anemia. There is still gap in compliance to prescription practices which must be effectively addressed through enhancing education, improving resource availability, addressing socioeconomic barriers, promoting gender sensitivity, ensuring adequate staffing, and regular audits.
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.
Determining Occurrence of Hypertension Disease & Associated Risk Factors Among Hiv Patients on Anti-Retroviral Treatment in Nairobi County
(KeMU, 2024-09) Eria, Mary Adonga
In Sub Saharan Africa region, age-adjusted prevalence of hypertension has exceeded the global index with an estimated prevalence of 30%, it has the highest figures in the world. Even though a lot of evidence indicate raising numbers of cardiovascular diseases in HIV infected persons, there is no clear information on an association between hypertension disease, HIV infection and ARVs. The purpose of the study was to determine occurrence and risk factors associated with hypertension among HIV patients on antiretroviral treatment in Nairobi City County. The specific objectives were to evaluate occurrence of high blood pressure among HIV patients who are on antiretroviral treatment; determine hypertension associated risk factors among HIV patients who are on antiretroviral treatment; determine the effects of exposure to multiple and changing antiretroviral drugs among patients who are on antiretroviral therapy; and determine association of adherence with ARV medicines intake and possible development of hypertension in HIV infected patients on antiretroviral therapy in Nairobi City County. The study adopted cross-sectional research design among 552 HIV infected patients who are enrolled on ART in Nairobi County. They were sampled using stratified and systematic sampling methods. Qualitative and quantitative data was collected whereby questionnaires, observation checklist, weighing scales, Blood pressure machines, stadiometers, tape measure and BMI wheel were instruments that were used to collect data. SPSS was used to analyze data and generate descriptive and inferential statistics including, cox regression, assessed the different variables. Data was presented in text, tabular and graphical form. The study established that the average age was 39 years which a line with advancing age being a risk factor, females were 65% and males 35%. Majority of the participants were married 56% the rest composed of unmarried, separated and widowed. Education: completed primary 43.6%, secondary 39.3%, college 13.8% and non-formal educated 3.3%. The study population as 98.5% predominantly Christians. Hypertension prevalence revealed 14.5%. The risk factor that stood out were age, gender, family history, Body mass index, and waist circumference among the study population, On association blood pressure and family history (P = 0.021) at 95%CI. Blood pressure and gender (P= 0.040) at 95%CI, blood pressure and BMI (P =0.035) at 95%CL and blood pressure and waist circumference (P=0.04) at 95%CL There was also relationship with earnings, large increase in heart rate (physical activity). No link was found with fruit intake, alcohol consumption and cigarette smoking in this study. It also recorded that 92.2% of these study population are on TDF/3TC/DTG (Tenofovir Disoproxil Fumarate/Lamivudine/ Dolutegravir). The study thus concluded that hypertension is public health concern in HIV patients, and integration of services is recommended. Further, it is critical to incorporate thorough cardiovascular monitoring into standard healthcare programs in addition to HIV treatment, given the high frequency of hypertension among HIV-positive patients.
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.
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.
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.
Evaluation of Factors Associated With Utilization of Postnatal Care Services at Kajiado County: NHIF Linda Mama Programme
(KeMU, 2024-09) NYAGA, DAISY CATHERINE WAWIRA
Post-natal care has been demonstrated as an integral component in the continuum of care, as it greatly helps in reducing maternal and infant morbidity and mortality. However, the uptake of the post-natal services has been low despite the fact that these services are offered for free by the government through the Linda Mama program. The general objective was to evaluate factors associated with the utilization of post-natal care services in Kajiado County. The study examined socio-demographic characteristics of mothers, perception of mothers on Linda Mama PNC, knowledge and attitudes, and the availability of healthcare facility infrastructure. This is because there was low PNC utilization which was linked to upsurge of post-maternal deaths in Kajiado county. The study adopted Anderson behavioral model for health services utilization. A cross-sectional study using both qualitative and quantitative data collection methods. A target population of 6,322 mothers who had deliveries 1st April 2019 to 30th sept. 2019 in Kajiado County was considered. Additionally, there Key Interview Informants selected included a representation of the mothers receiving care at the facility, government official (local administration), a community elder, a sub county nursing officer, and a disease surveillance officer, were included in the study. The sample size of the mothers was determined using Heinisch formular to have 363 mothers that were selected using simple random method. The mothers answered questionnaires while the Key Informants were interviewed. The research instruments were pretested in nearby facilities in Machakos County as part of the Linda Mama program. Three types of validity such as content, criterion, and construct were examined and Cronbach Alpha was used in measuring reliability. Authority to carry out the research was sought from the KeMU university, NACOSTI and from the office of the county director of health sciences, Kajiado County. The findings on the perception of mothers were that, majority of them were not aware of the existence of free PNC services offered through the Linda mama program. The study findings further point out that only 12(4%) of the mothers knew that there were free PNC services offered under Linda mama program. It was also discovered that only 3(1%) of the mothers had actually utilized the PNC free services of the program. The study’s conclusion on socio-demographic characteristics of the mothers is that most mothers lacked money to buy nutritious food, so as to have more supply of breast milk and also pay for any emerging post-delivery complications related to the baby or their health. On the perception of mothers is that, majority of them were not aware of the existence of free PNC services offered through the Linda mama program. On knowledge and attitudes is that mothers made assumption that since they had prior experience in child bearing, they did not require the PNC services. On availability of infrastructure is that hospital did not have a proper documentation of the Linda mama PNC services. The study recommends that the hospital management should recruit added number of CHVs, nurses and nutritionists to offer mobile PNC services. Their services should involve offering vigorous sensitization trainings of Linda mama program services such as on the importance of PNC services. To ensure a smooth flow, the hospital management should empower work policies that allow frequent spot check audits of PNC service documentation.
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
Factors Affecting The Utilization of Family Planning Services Among Women of Reproductive Age in Eldas Sub-County, Wajir County
(KeMU, 2024-09) SULEKHA, MOHAMED IBRAHIM
Wajir County in Kenya has seen a rapid increase in its population over recent decades, leading to resource shortages. Factors contributing to this include high birth rates, early marriages, unmet needs for family planning, and low levels of education. Despite efforts by the Kenyan government and other stakeholders to improve access to family planning services through policies and interventions, the county still faces challenges such as high rates of large families, irregular birth spacing, unintended pregnancies, unsafe deliveries, abortions, and maternal mortality. The objectives of this study were to establish the factors influencing the use of family planning (FP) services in Wajir County among women of childbearing age (15–49 years), with a special emphasis on the sub-county of Eldas. In particular, the research aimed to investigate the prevalence of use of FP services among women of childbearing age (15–49 years) in Eldas sub-county in Wajir County, to evaluate the social-cultural factors influencing the use of FP services amongst women of childbearing age (15–49 years) in Eldas sub-county in Wajir County, and to study the socio-economic factors affecting the use of FP services amongst women of childbearing age (ages 15–49) in the Wajir County sub-county of Eldas. The research used a cross-sectional study method. There were around 20,002 women aged between 18 and 49 years in Eldas Sub-county in Wajir County. A total of 388 households were sampled using a stratified random sampling method. Research instruments, validated for content by experts, were pre-tested in Wajir West sub-county. Ethical approval was obtained from Kenya Methodist University and the National Commission for Science, Technology, and Innovation, with informed consent secured from all participants. The results from this study show that less than half of the women interviewed—4%—were using a method of FP, while 95.3% were not. The findings further indicated that socio-economic factors, social-cultural factors and health system factors were the statistically significant contributors to FP utilization. It was concluded that socio-economic factors, social-cultural factors and health system factors affected family planning services in Eldas sub-county, Wajir County among women of childbearing age (15–49 years). The study recommended that programmers should ride on the low demand for FP in the area and create awareness and advocacy for long-acting FP methods. The findings indicated that most respondents relied on short-acting contraceptive methods, which are costly and less reliable over time. To address this, enhancing access to primary education across the population and implementing adult learning programs in rural areas to boost literacy levels is crucial. Moreover, involving men and engaging religious leaders in family planning initiatives at all community levels is essential. Additionally, implementing a communication campaign emphasizing spousal communication can effectively encourage discussions about family planning among couples.
Factors Associated With Common Mental Health Disorders among Pregnant and Parenting Teenagers in Korogocho Slums, Nairobi County, Kenya
(KeMU, 2023-09) MIRITI, JENNY BETH GAKII
Global healthcare trends demonstrate a rise in mental health disorders. Notably, mental health disorders have a considerable negative impact on academic performance, work, close relationships, the global economy, and one’s ability to make positive contributions to the community. Worth noting is that teenage pregnancy shows a positive correlation to mental disorders, most of which are aggravated by the teenagers’ immediate environments hence the need for in-depth understanding of the specific factors associated with common mental disorders (CMDs) among this cohort. This cross-sectional descriptive study sought to establish association between individual factors, sociocultural factors, healthcare services and common mental disorders among pregnant and parenting teenagers. The ecological system theory guided the study. The study employed a mixed method approach under the descriptive study design and was conducted in Korogocho slums, Nairobi County. The Cochran formula was used to obtain the sample size of 185 from a target population of 357 pregnant and parenting teenagers recorded in antenatal, or post-natal registers in health facilities in Korogocho slums. Proportionate stratified random sampling was adopted. The researcher used the health facilities as the strata and subdivided the sample population of 185 proportionately relative to the number of registered pregnant and parenting teenagers in each facility. The participants in each stratum were then purposively selected from the registers, contacted, and followed up in their households. A structured interviewer administered questionnaire was used to collect sociodemographic data and a Self-Reporting Questionnaire (SRQ-20) by WHO was used to collect data on the prevalence of CMDs among the study cohort. Three focused group discussions were held with Key Informants using an interview guide. The research tools were piloted to ensure validity and reliability. Data collected was analyzed using SPSS version 25 and presented using frequency tables. Interdependence chi square test and fisher’s test were used to examine the association between common mental disorders with p value of <0.005 considered statistically significant. A total of 153 out of 187 (82.7%) participated in the study. The study findings indicated that n=84 (55%) of the respondents had symptoms of CMDs. Moreso, n=49 (32%) of the respondents reported alcohol use, n=40 (26%) bhang use and n=41 (27%) Miraa use. Additionally, study findings showed no significant association between CMDs and Age, or level of education. However, there was significant association between CMDs and income status, gender-based violence, and social support among the study cohort. Notably, the study findings revealed significant association between affordable and adolescent friendly services and CMDs. However, there was no significant association of CMDs with availability of mental health services. In conclusion, mental health disorders are relatively high among pregnant and parenting teenagers in Korogocho slums. Sociocultural and healthcare factors significantly affect the mental wellness of the pregnant and parenting teenagers. The respondents who manifested symptoms of CMDs were advised to seek further healthcare services in facilities of preference. The study recommends integration of responsive mental health services in antenatal care, awareness creation campaigns on mental wellness, community based support groups and income generating programmes targeting pregnant and parenting teenagers.
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.
Factors Associated with Sarcopenia Status Among the Elderly in Mandera County, Kenya
(KeMU, 2025-08) IBRAHIM, HAMDI MOHAMED
Sarcopenia, is characterized by the progressive loss of skeletal muscle mass in human body, strength, and function, has emerged as a significant public health concern among aging populations globally, yet limited data exists in resource-constrained settings like Mandera County, Kenya. This study was conducted to assess the status of sarcopenia among the elderly in Mandera County and to establish its relationship with protein intake, physical activity levels, and socioeconomic determinants. The study was guided by four specific objectives: to determine the prevalence of sarcopenia among the elderly, to evaluate protein intake, to assess physical activity levels, and to identify socioeconomic determinants influencing sarcopenia within the population. The study employed a descriptive cross-sectional research design The target population consisted of elderly individuals aged 65 years and above residing in Mandera County. A sample size of 186 participants was determined using the Fisher’s formula, and a multistage sampling approach was adopted to ensure representation across different sub-counties and villages within the County. Data collection involved the use of structured questionnaires, physical anthropometric measurements for muscle handgrip, leg calf, Gait speed, MUAC and BMI. and validated tools such as the International Physical Activity Questionnaire (IPAQ) and SARC-F screening tool for sarcopenia assessment. The findings revealed that 60.7% of the elderly participants had confirmed or severe sarcopenia, highlighting it as a critical public health issue within this community. It was established that 40.7% of those with low protein intake were more likely to present with confirmed or severe sarcopenia, whereas only 5% of those with high protein intake fell within this category (p < 0.001). Physical activity levels were also significantly associated with sarcopenia; 61% of individuals with low physical activity levels had confirmed or severe sarcopenia compared to only 7% among those with high activity levels (p < 0.001). Socioeconomic factors were found to influence sarcopenia status, with 86% of participants without health insurance exhibiting confirmed or severe sarcopenia compared to 14% with insurance (p = 0.019). Education levels showed a strong inverse relationship with sarcopenia; participants with no formal education recorded 38% prevalence of confirmed sarcopenia compared to 4% among those with tertiary education. In conclusion, the study objectives established that there was high prevalence of sarcopenia among the elderly in Mandera County. Poor protein intake, low physical activity levels, and socioeconomic disadvantages as key contributing factors to severe Sarcopenia. The study underscored the need for targeted interventions focusing on improved nutrition, promotion of physical activity, improve protein intake and enhance access to healthcare services tailored to the elderly population. It is recommended that county health authorities integrate routine screening for sarcopenia into existing elderly healthcare programs, alongside community-based nutrition and physical activity initiatives. This study provides new evidence on sarcopenia in a resource-constrained context, emphasizing the need for integrated community-based interventions focused on dietary improvement, physical activity promotion, and socioeconomic support to reduce the burden of sarcopenia.
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.