Master of Public Health
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Item 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, CarolyneFeeding 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.Item Factors Influencing Willingness to Use Pre-Exposure Prophylaxis among Male Homosexuals at the Sex Workers Outreach Program Clinic(KeMU, 2019-09) Gitau, Apollo KamauThe 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.Item 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 MuthoniThe 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.Item 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 WambuiDiarrheal 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.Item Factors Influencing Provision of Nutrition Education and Counselling To Pregnant Women by Nurses during Antenatal Care in Nairobi County.(KeMU, 2016-06) Njoroge, Charity WairimuGood 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.Item Factors Associated with Stunting among Children Aged 0-23 Months.(KeMU, 2016) Musyoki, Clementina NginaGlobally, 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.Item Drivers of Health Services' Sustainability in Selected Mission Hospitals in MT. Kenya(KeMU, 2016-07) Ndege, Josephine MuthoniMission 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.