Thesis

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Analysis of factors that influence drugs and substance abuse among secondary school students in Imenti North District.
(KeMU, 2014-06) Mukomunene, Pamela
Drug and substance abuse has continued to be an issue of great concern during the past several years with a great number of people reported as drug abusers in the world and being a serious problem affecting secondary school students. Drug and substance abuse has numerous biological, psychological and social adverse consequences. The menace has been reported as being influenced by different factors which include mass media, availability of drugs, peer pressure, curiosity, and availability of funds, boredom, harsh school rules and poor parenting. The study being carried out is aimed at analyzing the factors that influence drug and substance abuse among secondary school students in lmenti North District. The research objectives for the study were whether peer pressure, mass media, amount of money given to students and availability of drugs influence drug and substance abuse among secondary school students in Imenti North. The target population was composed of 10,663 students from the 43 secondary schools in Miriga Mieru East and West divisions. Questionnaires were prepared and used in the collection of primary data from the deputy principals, teachers and students. Prior to administration, the questionnaires were pilot tested to facilitate validation and assessment of reliability. The data was analyzed manually at the end of which results were displayed using frequency distribution tables, percentages and pie charts. The study concluded that drugs and substance abuse was influenced by different factors. These were categorized into major and minor factors, the major factors included mass media, peer pressure, availability of. Drugs and the amount of pocket money given to the students. The study, therefore, recommends that parents and guardians should avoid giving a lot of pocket money to their children; the government should come up with ways to fight drugs found within the students' reach.
Assessment of factors affecting healthcare waste management system in Machakos County, Kenya
(KeMU, 2019-09) Mwania, Michael Musango
In general, most local authorities in Kenya have been unable to cope up with the segregation, the treatment and methods of waste disposal especially healthcare waste. Health facilities in Machakos County have poor practices when it comes to the segregation of healthcare waste, its treatment & disposal; the general population, the patients, the health workers including waste handlers are exposed to certain risks such as needle stick injuries, a higher risk of infection of HIV/AIDS and hepatitis B&C. This study, therefore, focused on the reinforcement of the service delivery pillar of Health Systems, through addressing aspects of securely managing healthcare waste in medical facilities in Machakos County. The general objective of this study was to ascertain factors affecting the management system of healthcare waste in Machakos County in Kenya. The study was governed by four specific objectives; to determine the process of healthcare waste management, the role of health Managers, human resource factors, and how the implementation of healthcare waste management policy affect the management of wastes in the healthcare facilities in Machakos County. To obtain data for the study, a survey research-based study was used. Stratified random and purposive sampling techniques were used in drawing a sample size of 187 respondents. Questionnaires and interview guides were used in the collection of primary data, whereas existing literature that is related to the current research topic under study was used for the purposes of secondary data. The study findings showed that all the four independent variables healthcare waste management process health manager’s role, human resource factors, and healthcare waste management policy implementation had positively and significantly influence on the management of healthcare waste system. From the findings, the health manager’s role had the strongest positive and significant influence on the management of the healthcare waste system. The study concluded there is an inefficient healthcare waste management process in Machakos county health facilities, Health Managers understands their role in waste management but lack capacity building and enough funding to purchase required healthcare waste management commodities. Main human resource factors were lack of capacity building through continuous medical education on healthcare waste management and enough healthcare waste management commodities hence leading to inefficiencies on waste management. Most Health workers had little or no information on customized healthcare waste management policies and guidelines. The study recommended there a need for training on healthcare waste management to all healthcare staff and waste handlers in line with existing healthcare waste management policies for the healthcare waste management in Machakos County and in Kenya. County governments need to provide adequate budgets to health facilities to enable procurement of adequate healthcare waste management commodities and also adopt safe treatment technologies.
Assessment of health workers perinatal knowledge and practices related to service delivery in Makueni County,Kenya
(KeMU, 2019-09) Benard, Kasanga David
A health system has six interdependent and interrelated pillars: health workforce; service delivery; information; financing; medical products, vaccines and technologies; leadership and governance. This study addressed health workforce pillar in order to strengthen maternal and new born services delivery in Makueni County. Globally, new born (neonatal) mortality remains unacceptably high. Neonatal mortality accounts for 60% of infant mortality rate in Kenya. In Makueni County, 1 in 22 children does not live to his or her first birth day. This unacceptable high mortality is despite existence of cost-effective evidence-based interventions which could reduce up to 70% of current deaths. Review of client complaints in Makueni has revealed gross medical mismanagement raising concerns whether health workers attending to them are knowledgeable. This study assessed perinatal knowledge and practices among health workers in Makueni County. It specifically established prenatal care knowledge and practices, pre-eclampsia knowledge, postnatal care knowledge, home visits and hand hygiene knowledge among health workers in Makueni County. The study was cross sectional in design where 163 health workers selected randomly were interviewed using a structured questionnaire and a checklist used to observe antenatal care consultation practices. Data analysis was done using SPSS v25 and chi-square statistic test used to examine associations within variables. On prenatal care, 89 (54.6%) of health workers were rated as having good knowledge. However, practice did not conform to guidelines since 10 (30.3%) and 23 (69.7%) of mothers didn’t have full history taken and general physical examination done respectively. On pre-eclampsia 78 (49.4 %) had poor knowledge while on use of recommended drugs for pre-eclampsia, 70 (42.9%) had moderate knowledge and 39 (23.9%) poor knowledge. On postnatal care, 132 (80%) had good knowledge on young infant feeding while 35 (21.5%) had poor knowledge on new born care. On management of neonatal infections, 58 (37.4%) had good knowledge while on home visits 80 (48.5%) knew the importance of home visits but 88 (80.4%) did not know the optimal time for the visits. On hand hygiene 127 (77%) of health workers knew the four critical times for washing hands with soap under running water. The study concluded that workers had good knowledge on prenatal care, young infant feeding and hand hygiene. There were critical gaps in knowledge on pre-eclampsia, use of recommended drugs for pre-eclampsia, new born care, management of neonatal infections and home visits. Prenatal care practice did not conform to guidelines. The study recommended refresher courses and continuous medical education in focused antenatal care, management of pre-eclampsia, newborn care, management of neonatal infections and home visits. It also recommended strengthening of supportive supervision to ensure guidelines are available and adhered to in practice.
Assessment of nutrition counseling services offered to diabetic patients and its effect on adherence to therapies and treatment at the Nakuru Provincial General Hospital, Kenya
(KeMU, 2012-06) Karanja, Lucy W
Poor health has been a global issue which has been associated with the impediment of productivity, economic growth and poverty eradication. It has been estimated that 32 percent of the global burdens of disease are caused by dietary complications. All millennium development goals are in one way or the other related to good nutrition intake. Nutritional Counseling has been credited for ensuring that people are aware of their dietary choices hence avoiding nutritional complications. This is more essential to diabetic patients. The purpose of this study was to assess the effectiveness of Counseling services offered to diabetic patients in Nakuru Provincial General Hospital, Kenya. In order to have the study carried out successfully, a descriptive survey was used to assess the effectiveness of nutritional Counseling services. The sample consisted of 283 respondents that included 8 dieticians and 275 diabetic patients. Stratified random sampling where the total population was split into two distinct samples (diabetic patients and dieticians) based on their demographics. After obtaining permission from all relevant authorities, the researcher collected the data in form of responses through structured questionnaires. Expert judgment was used to improve on content and construct validity of the items. The Statistical Package for Social Sciences (SPSS) was used to analyze the data. The study established that there was a significant relationship between the patient’s nutritional knowledge and recovery rate. Majority of the patients were not adhering to the recommended therapy. There was a statistically significant influence of nutritional counselors’ knowledge of diabetic management and diabetics’ recovery rate. There was also a significant relationship between the economic status of patients and adherence to therapy. This study recommends that the government must take an active role in promoting the nutritional counseling services offered in hospitals by employing more dieticians, intensifying awareness campaigns on the recommended diet for the diabetics. Civil society and religious groups must also take an active role by holding workshop and seminars to sensitize the community about the diabetic condition, psychological support and fighting against stigma to the patients. Additionally, dieticians need to be aware of the current recommendations for diabetic patients so as to pass it on to their clients. Male nutritionists/dieticians should also be trained to encourage more male patients to attend counseling sessions. The researcher suggests a further research on the level of stakeholders input in promoting nutritional counseling in hospitals and an assessment on whether patients actually adhere to the diet by doing a 24 hour recall.
Community health information system utility.
(2015-12) Pepela, Wanjala David
A wealth of data is available within the healthcare systems more so at community level. However, lack of effective use of information shared during dialoguing at the community level in Bungoma County posed a great challenge despite efforts by government in recognising community care services as critical level 1 service. Health indices have remained on a worsening trend with service utilisations very low. The purpose of the study was to inform service utilisation, promote use of community health information to improve health outcomes. The main objective was to determine the community health information system utility to improve health outcomes in Bungoma County. The specific objectives were to assess the community units level of use of information processes for improved community health services; to identify the technical tools for sharing information during community dialogue and action days; establish community health information system capacities affecting sharing of available information and determine what organisational factors influence sharing and use of community health information. The study was descriptive cross-sectional design. The study employed a combination of stratified clusters proportionate to population size and applied simple random sampling technique with a proportion of 30% of target population as representative sample. The target population was (N =163) with a sample size of nh =54 community units. A structured interview questionnaire both closed and open-ended was administered to Community Health extension workers and 3 in-depth focus group discussions. Data analysis generated univariate frequencies and interpretation using tables and charts. The expected outcome was utility of health information. Results showed that response rate 44 (81.5%), 35 (79.5%) with knowledge on data management and 39 (88.6%) generated monthly summaries with 34(77.3%) with overall utility of community information using white/chalkboards. 27(60.6%) provided feedback and shared information during dialogue days monthly at 41(93.2%) and 17(38.6%) respectively. Information had inadequate involvement in design 14(32%), unavailability of data tools in 39(89%) and less use of appropriate technologies. 26(59.1%) had knowledge on kind of information required, 27(61.4%) analysed this information while, 42(95.5%) used information for evidence based-decision making. Income generating activities supported by partners in 6(13.6%) of the units. Community formal structures was in 32(72.7%) units and shared information in dialogue 54(100%), 36(81.8%) using "Barazas" while, 31(70.5% through health promotion and education. Majority 40 (90.7 %) were empowered through support supervision using standard procedures and checklists. Regression analysis using ANOVAa showed that results were moderately correlated with utility of community information with correlation Coefficientsa 0.017 at 13 0.538b, while Pearson Chi-Square Tests compared with use of information with linear association of 0.910 had a likelihood ratio of Fisher's Exact Test of 0.658 thus, result moderately significant. In conclusion knowledge was above average; information was regularly shared through community dialogues; while design, technical tools and empowerment of communities were weak and inadequate and finally the system was well structured though not resourced and uncoordinated. It was recommended that both National and County governments to emphasize on regular feedback to promote information utility; adequately provide technical capacities and mentorships;
Determinants of a functional refferral system in Kisumu County,Kenya. Patient perspective.
(KeMU, 2019-09) Nango, Wilbert Otieno
Most referral health facilities are faced with challenges ranging from congestion of patients at these health facilities, limited resources both human and material to deal with the voluminous clients, slow rate of service delivery due to high numbers as a result of the by-passing tendencies. Self-referrals normally results in compromised quality of medical care provided to the patients. The problems mentioned above affects most of the high level health facilities which are traditionally meant to be referral health facilities. The study conducted in the month of August 2017 therefore aimed to find out the determinants of a functional referral system in two level 5 health facilities; Jaramogi Oginga Odinga Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCH). The objectives of the study were to; examine the extent to which the primary health care centres characteristics, patients’ characteristics, receiving health facility characteristics and proximity to a health facility influence a functional referral system. A cross sectional study was conducted using a qualitative approach to data collection. Three hundred and thirty eight patients were systemically selected to participate in the study. Data was collected using an individual questionnaire through one on one interview between the dates 14th- 22nd August 2017. The collected data were coded and analyzed using the SPSS 25.0 Computer program. The qualitative data collected were analyzed quantitatively using the descriptive statistics and linear regression models. The results indicates that there was a positive and significant influence of the primary health facility characteristics (r=.474**, p<0.001) and receiving facility characteristics (r=.475**, p<0.001) on a functional referral system at the two high level facilities. There was also a negative but significant influence of proximity to health facility (r=- 0.137**, p=0.017) on a functional referral system at the two level 5 facilities. On patients characteristics, a significant interaction was found on gender χ2 (1) = 4.64, p= 0.031, education level χ2(2) = 20.37, p<0.001 and Marital status χ2(2) = 8.78, p= 0.012 with a functional referral system. Conclusion – Factors influencing functional referral system are primary health centre characteristics, patients’ characteristics, proximity to a health facility and referral health facility characteristics. It is therefore recommended that the County government of Kisumu should improve the supply of drugs and quality of service delivery at the primary health facilities to attract more patients seeking primary care services, specialists movement especially to the lower level health facilities need to be reinforced by the Ministry of Health to boost the citizen’s confidence in quality of care at these facilities, more sensitization strategies need to be put in place to educate both the patients and health care providers on the recommended referral practices that should be upheld to improve efficiency and effectiveness of service delivery.
Determinants of availability of tracer essential medicines in public health facilities in Nyeri County, Kenya
(KeMU, 2016-07) Kawira, Micheni Stella
The goal of the health system is to improve health and health equity in ways that are responsive, financially fair and make the most efficient use of the available resources. This is supported by six Health Systems Strengthening (HSS) pillars of medicines, vaccines and technologies, human resource, financing, leadership and governance, service delivery and health information systems. A well-functioning health care system ensures equitable access to medicines, vaccines and technologies which results in overall HSS. Tracer essential medicines are supposed to be 100% available at all times to treat the common ailments in a region. Despite the large number of patients that visit public health facilities, the inadequacy of trained pharmaceutical personnel, inefficiencies of the supply chain system and inadequate funding, no study has been carried out to ascertain the availability of tracer essential medicines in these facilities. The objectives of the study were to determine the stocking level of tracer essential medicines, to establish human resource factors affecting availability of tracer essential medicines, to find out the supply chain factors affecting availability of tracer essential medicines and to assess the organizational factors affecting availability of tracer essential medicines. A cross sectional study design with a mixed method approach was used. A questionnaire was used to collect data on the human resource factors and supply chain factors affecting availability of tracer essential medicines. A Focus Group Discussion (FGD) guide was also conducted with seven respondents comprising of six sub County public health nurses and the County pharmacist. The sample population comprised of 17 public health facilities and 30 pharmacy personnel. The response rate was 25 (83.3%). The average stocking level in tier three facilities was 94% while that in tier two facilities was 63.75%. The overall mean percentage stocking level of the 20 tracer essential medicines in all the facilities was 72.65%. Human resource factors that affected availability were unavailability of Standard Operating Procedures (SOPs), inadequate training of pharmacy personnel and pharmacy personnel not aware of tracer medicines. There was a significant relationship between availability of tracer essential medicines and pharmacy personnel awareness of tracer list (r=0.850), pharmacy personnel receiving training in commodity management (r=0.834), availability of SOPs (r=0.817) and designation of pharmacy personnel (r=0.746). The supply chain factors that affected availability of tracer essential medicines were long lead times, unavailability at Kenya Medical Supplies Agency (KEMSA), long ordering and delivery schedules and incorrect quantification. The organizational factors that affected availability were inadequate supportive supervision, inadequate financing and absence of Revolving Drug Funds (RDFs) within the facilities. The study concluded that the stocking level of tracer essential medicines in Nyeri County was below the World Health Organization recommendation of 100%. In addition, human resource factors, supply chain factors and organizational factors affected availability. The researcher recommends that a community pharmacy with subsidized medicines prices be introduced in the facilities; the County should facilitate training of all pharmacy personnel on commodity management, all facilities should have buffer stocks to cover at least two months as they await new stocks and the County should provide supportive supervision to the facilities.
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 public primary health facilities preparedness for service delivery in Nyandarua County, Kenya
(KeMU, 2019-09) Njoroge, Haron Mukora
The Kenyan primary health care (PHC) system is currently going through a major transformation, especially in the effort of actualizing the universal health coverage which is part of the “Big Four” national government agenda at a time when WHO regrets that at least half of the world’s population, especially in the Sub-Saharan Africa cannot obtain primary health care services. Health service is one of the building blocks in any health system. A health system with a strong PHC model delivers better outcomes. The main objective of this study was to evaluate the determinants of public primary health facilities preparedness for health service delivery in Nyandarua County. Specifically, to determine the influence of basic amenities, infection control precautionary measures, basic equipment and essential medicines on public primary health care services delivery. Data was collected using structured questionnaires from May to December 2018. The study was descriptive cross sectional with a desired sample of 47 facility in charges drawn from 47 facilities in three sub counties (Kinangop, Olkalou and Ndaragwa) out of the all the five sub counties. The study used both descriptive and inferential statistics in data analysis where 23 (49%) of the respondents indicated that their facilities had basic amenities, 32 (69%) said their facilities had basic equipment, while 39 (85%) said that infection control measures were in place and 29 (64%) said that there were essential medicines. The study found that health facilities with adequate basic amenities (p<0.05, OR=0.312, 95% CI), basic equipment (p<0.05, OR=0.195, 95% CI) and essential medicines (p<0.05, OR=0.728, 95% CI) were more likely to be prepared with primary health service delivery and added significantly to the primary health service delivery preparedness. The study concluded that the level of health care provided in primary health facilities is dependent on the level of the availability of adequate basic amenities, basic equipment and essential medicines. This study recommends that the department of health in the county should ensure timely delivery and availability of basic amenities, basic equipment and essential medicines. The department of health should also work in close collaboration with the department of roads to ensure all the primary health facilities are accessible to people seeking health services by improving the road network. A further audit can be done to all the primary facilities in the County to establish similar gaps and work towards improving them.
Determinants of uptake of national hospital insurance fund primary care scheme among service providers within the scope of NHIF Nakuru town branch
(KeMU, 2019-09) Wagura, Elizabeth Wanjiku
There is a growing international consensus on the importance of providing social protection through financing and providing access to healthcare services. Kenya has embraced this through the National Hospital Insurance Fund (NHIF). Despite these efforts, the uptake of the NHIF primary care scheme among service providers in the country is still low. This study sought to assess the uptake of NHIF primary care scheme amongst service providers within the scope of NHIF Nakuru Town branch. The study objectives were to: determine the influence of knowledge of service providers, examine the influence of perceived benefits of the NHIF primary care scheme, establish the influence of health facility organization capacity, and determine the influence of barriers associated with NHIF and health facilities on the uptake of NHIF primary care scheme. The study adopted a cross-sectional research design targeting 120 service providers from 60 health facilities as well as getting key information about the scheme from officers in NHIF office managing the scheme as key informants. A random sample of 96 service providers was drawn from 48 health facilities and 2 officers from NHIF Nakuru branch. Data was collected using a structured questionnaire and an in-depth guide. Quantitative data was analyzed using descriptive and inferential statistics with the aid of Statistical Package for Social Sciences version 21.0 while content analysis was used to analyze qualitative data. From the findings of this study, there was a significant, weak, positive correlation between knowledge of NHIF and uptake of NHIF primary care scheme (r =.266, p<.05). Pearson correlation computed between perceived benefits of NHIF Primary care scheme and uptake of NHIF scheme was significant, moderate and positive (r=.297, p<.05). The health facilities had adequate; ICT facilities, human resource and physical facilities for effective implementation of NHIF primary care. Pearson correlation coefficient between health facility organization capacity on the uptake of NHIF scheme was not significant (r=.109, p<.05). Thus, it was concluded that variations in the level of the health facility organization capacity was independent of the uptake of NHIF primary care scheme. All the constraints combined were likely to negatively impact on the uptake of NHIF primary care. Results of Pearson correlation revealed that the relationship between barriers of the health facilities on the uptake of NHIF primary scheme was moderate, significant and negative (r =-.246, p<.05). The study therefore concluded that NHIF should develop clear policy details on the various benefits and risks involved for health facilities that are not willing to take up the implementation of the scheme. The study recommends that the management of the NHIF scheme should i) embark on a campaign of knowledge dissemination and education of all potential consumers of their services, ii) develop clear policy details on the various benefits and risks involved for health facilities, and iii) sensitize the management of health facility on the requirements for accreditation for provision of NHIF out patient services.
Determinants of utilization of national hospital insurance fund outpatient services by private university employees in Nairobi
(2019-09) Kironji, Keziah M.
The NHIF is a mandatory health insurance fund covering public and private formal sector workers and their dependents as the main health insurer in Kenya. NHIF has embarked on an ambitious reform program intended to convert it to a Social Insurance Health Scheme with an aim of serving as workers’ first pillar of social insurance. The national formal scheme members are entitled to all outpatient services after selecting their preferred facilities from a list of the NHIF accredited ones. However, there are some members on the National formal scheme whose contributions are remitted to NHIF by their employer every month but do not utilize the outpatient services. This study sought to determine if the NHIF benefit package, the perceived quality of care, the NHIF communication strategy and the administrative processes influence utilization of outpatient services by the national formal scheme members in Nairobi County with a focus on private University employees. It sought to assess the reasons for none or underutilization of NHIF outpatient services. This study adopted a cross-sectional descriptive design. Multistage sampling with simple random sampling was used. Quantitative data was corrected using self-administered questionnaires and analyzed using descriptive statistics. Likert and semi-structured type of questions were used as the main tool for collecting data. SPSS version 24 was used to analysed the data. The rationale of this study was to inform top management of NHIF to undertake decisions in regards to utilization of outpatient services by NHIF members in the formal National Scheme by understanding how quality service, benefit package, NHIF communication strategy and administrative processes influence utilization of outpatient services. The study finds that respondents have and will utilize NHIF outpatient services (M=3.80, SD= 0.84). They agree with NHIF administrative processes (M=3.4, SD= 0.89) and have knowledge of NHIF benefit package (M=3.42, SD= 0.82). They disagree with quality of NHIF outpatient services (M=3.21, SD= 0.66) and NHIF communication strategy (M=2.94, SD= 0.73). The study found that knowledge of NHIF outpatient benefit package (X1; t = 1.142, p = 0.255 ˃ 0.05), perceived image of NHIF outpatient services (X2; t = 1.196, p = 0.241 ˃ 0.05) and NHIF communication strategy (X3; t = 1.196, p = 0.241 ˃ 0.05) have no influence on utilization. However, NHIF administrative processes (X4; t = 4.579, P = 0.000 ˂0.05) positively contribute to and have a significant influence on utilization of NHIF outpatient services by private university employees in Nairobi county. The study recommends that a) NHIF creates awareness on the NHIF outpatient benefit package to the members, b) NHIF should vet facilities they accredit to offer outpatient services to ensure safety of healthcare services, availability of physicians, sufficient number of health workers and a well-stocked pharmacy, c) NHIF should improve on their means and frequency of communication, feedback and complains mechanisms, engage the citizens more for improvement and ensure staff are available to respond to issues, and d) Staff in NHIF accredited facilities should be made aware of patient’s entitlement to care, ease patients identification and facility selection process. This will strengthen health systems and thus improve utilization of primary health care services.
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.
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 the Relationship between Dietary Patterns and Colorectal Cancer among Meru County Residents
(KeMU, 2018-09) Kinanu, Grace Safari
Colorectal cancer (CRC) is the fourth leading cause of death and third most commonly diagnosed cancer around the globe. Although diet plays an essential role in the development of colorectal cancer, there is little information on the role of diet in the rising CRC cases observed in Meru. The study sought to determine whether there is a connection between dietary patterns and colorectal cancer etiology in Meru County. The research was a retrospective case control study design involving 25 CRC patients and 50 CRC undiagnosed participants as controls. All stable CRC patients receiving treatment in the three cancer treatment and palliative care centers in Meru County between April and June 2017 were included in the study. Each CRC patient was identified and matched with two persons from the general population according to similarity by sex, date of birth, and place of residence. A food frequency questionnaire was used to collect data which was then averaged to daily consumptions. The data was analyzed using t-test, Chi-square and Odds Ratio. The study revealed that dietary patterns of Meru County residents include moderate intake of fruits (2.5 servings), vegetables (4.0 servings) , and starch staples (9.2 servings), low intake of pulses (1.5) , white meat (1.2), milk and its products(1.3) , and nuts and seeds (0.3) ,and high intake of red meat (5.1 ) servings for daily pattern intakes with no significant statistical difference between dietary patterns of CRC and non CRC persons (p- values > 0.05). No statistical association was established between dietary patterns of red meat and risk of developing CRC (p- values > 0.05) on chi-square test and Odds ratio (within the 95% CI). Our study therefore indicates that, there is no conclusive evidence associating dietary patterns and colorectal cancer etiology and incidences in residents of Meru County. This research recommends that other causes of cancer be explored so as to establish evidence based conclusions on the main causes of colorectal cancer in Meru County
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 non-adherence to antitroviral therapy (ART) among people living with hiv/aids (PLWHA): A case of Isiolo district, Kenya
(KeMU, 2012-06) Godana, Robe
In HIV/AIDS treatment adherence to antiretroviral therapy is of paramount importance. To achieve suppression of viral replication, decrease in viral load and improving quality of life needs near perfect adherence of 95%. The researcher had sort to establish factors influencing non adherence among people living with HIV/AIDS in Isiolo District. The researcher used descriptive survey design. Sample population of 193 participants which is 30% of the 640 total study populations was used. This was obtained from the district comprehensive care clinic through document analysis. The raw data was collected using structured questionnaires and focused group discussion which was cleaned, classified, coded processed, analyzed and presented using pie-charts, graphs and tables. Findings show: individual’s income, multiple drugs combination, health care workers perceptions, beliefs and taboos influence non adherence to antiretroviral therapy while counseling helps to create positive altitude and minimizes stigma. The study recommends: Ministry of Health with other stakeholders to solicit funds to form support groups that will stabilize clients emotionally, psychologically and economically. To improve infrastructure, health care workers and public perceptions and altitudes through trainings, public education, barazas and pamphlets. Free treatment of opportunistic infections for patients with pneumonias, malaria and others infections to minimize admissions and improve quality of life.
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.
Factors influencing rational drug use in public hospitals among doctors and pharmacists in Meru County
(KeMU, 2019-09) Wahome, Dennis Mwiti
Access to essential medicines, vaccines and medical technologies is the anchor pillar in this study. Medical products must be of assured quality, safety, effective, scientifically sound and cost effective. Rational use of medicines requires that a patient receives appropriate medications to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time and at the lowest cost to them. It is concerned with how commodities are selected, procured, used and stored to ensure that the patients receive quality and efficacious products appropriate to their medical needs. There are a number of challenges that have been encountered in the rational use of drugs. These include lack of essential drugs, gaps in training and weak implementation of policy guidelines. The broad objective of this study was to assess the factors that influence rational drug use among doctors and pharmacists in public hospitals in Meru County. Specifically the study sought to determine how staff awareness on policy guidelines, management practices, product selection and inventory management influence rational drug use among doctors and pharmacists. A cross sectional study design was adopted having quantitative approaches. The sample size was 102 doctors and pharmacists who work in the public hospitals in Meru County. Both stratified and simple random samplings were used to sample the staff. A five point Likert scale based questionnaire was used to collect data. Quantitative data was analyzed using SPSS Version 23. Correlations were done between the dependent variable RDU and independent variables Staff awareness, inventory management, production selection and management practices. Significance levels were done at both 5% and 1%. There was a significant relationship between RDU and staff awareness (r=.232*, p=0.019) and inventory management (r=.324**, p=0.001). Coefficient of determination (R) of 0.402 was obtained compared to overall R2 of 0.162 and this explains 40.2% of total variations that explained factors that influence rational drug use among the healthcare workers in Meru County. The ANOVA findings (F (4,97)=4.68, p=0.002) shows that there is correlation between the predictors variables Staff awareness, management practices product selection , Inventory Management, and the dependent variable Rational drug use. This study recommends: i)The hospitals develop training manuals on rational drug use that will be used to create awareness on importance of Rational drug use among doctors and pharmacists to enhance knowledge and build capacity, ii) departmental heads to offer support supervision, quarterly assessment, appraisals and implement RDU in collaboration with doctors and pharmacists, iii) All the hospitals to constitute active Drugs and Therapeutics Committees in all the facilities to ensure that formularies are developed, policies are communicated and SOPs implemented, to enhance uniformity and build capacity, iv) to constitute procurement committee with all stakeholders including the doctors and pharmacists to ensure they are involved in the budgeting, selection and monitoring of Essential drugs.
Factors influencing routine health management information use in public health facilities in Tharaka Nithi County, Kenya.
(KeMU, 2016-07) Mucee, Elizabeth Munda
Routine health management information systems are the foundations of all health systems which strengthen other five pillars hence, strengthening health systems performance. But despite their essential benefits, at the facility level, health workers commonly spend 40 percent or more of their time filling in Health Information Systems forms but may make little or no use of the information for decision making. Information use is determined by multiple factors ranging from technical, organizational and behavioural factors which were drawn from the theoretical framework. The objectives of the study were to determine the technical factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County; to establish the organizational factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County and to establish the behavioural factors influencing Health Management Information use by health managers and information producers in the public health sector in Tharaka Nithi County. A descriptive cross-sectional study was conducted in 12 Dispensaries, three Health Centres and one Sub County Hospital in Tharaka Nithi County. Data was collected through researcher administered questionnaires and observation checklist. The respondents were purposely selected from the sampled public health facilities, which included 22 information producers and 53 users in Tharaka Nithi County. The study results identified a set of factors influencing health information use for each of the three categories of factors: technical factors (lack of staff competence at 74 (98.7%), multiple HIS tools at 74 (98.7%) and lack of computers at 74 (93.7%); organizational factors (lack of information use culture promotion at 73 (97.3%) lack of staff training in HIS skills at 69 (92%), and lack of support supervision on information use at 71 (94.7%) and behavioural factors (lack of staff motivation at 73 (97.3 %) and recognition for well done job at 74 (98.7%). The researcher concludes that, for health systems to use health information for evidence-based decisions, technical factors, organizational and behavioural factors must be provided to information producers and users in public health facilities in Tharaka Nithi County. The study recommends: To provide adequate positive technical factors in terms of competent personnel, computers and user-friendly HIS tools to enhance information use; To promote positive organizational factors in terms of promotion of information use culture, support supervision on HIS and support staff training in HIS skills to enhance information use; To initiate and implement motivation and recognition mechanisms in workers' accurate information for use in evidence-based decisions. The researcher suggests further studies to; establish other factors influencing health information use in the public health sector other than those covered by this study; establish interventions to enhance health information use in decision making in public health setting.
Factors influencing uptake of antenatal care in Taita Taveta County, Kenya
(2019-09) Ndegwa, Mwanyoha Ndegwa
49% of pregnant women are able to make four or more ANC visits in Sub Saharan part of Africa. General objective of the study was to find out factors influencing uptake of ANC in public health facilities in Taita Taveta County. The specific objectives were; to assess influence of early initiation of ANC on uptake of ANC in, determine influence of skilled health providers’ attitude on uptake of ANC, establish influence of availability of community health volunteers on uptake of ANC and determine effects of skilled health providers’ availability on uptake of ANC. A total of three hundred and eighty four mothers and eighteen health facility in-charges participated in the study. The study adopted survey research design and data collected using structured questionnaires for the sampled mothers and key informant interview for the in-charges. The researcher analysed data using Statistical Package for the Social Sciences (SPSS) version 23. Descriptive analysis (percentages and frequencies) and inferential analysis (Chi-square and Spearman’s correlation tests, and regression analysis at significance level of alpha=0.05) were performed. Results indicated 43.6% of the mothers managed 2 ANC visits, 41.7% 3 visits and14.7% just 1 ANC visit. The findings also indicated that timing of ANC initiation had significant association (X2 (6) = 102.854, p < 0.001) and weak negative relationship (Spearman’s R = -0.201, p < 0.001) with uptake of ANC. An R2 of 0.071 (7%) showed early ANC initiation had low degree of influence on ANC uptake. Reception during ANC visits had significant association (X2 (8) = 564.235, p < 0.001) and strong positive relationship (Spearman’s R = 0.905, p < 0.001) with ANC uptake; and adequacy of privacy had significant association (X2 (8) = 459.447, p < 0.001) and moderate positive relationship (Spearman’s R = 0.763, p < 0.001) with ANC uptake. An R2 of 0.819 (81.9%) showed skilled health providers’ attitude had high degree of influence on ANC uptake. Moreover, number of CHVs visits had significant association (X2 (8) = 317.099, p < 0.001) and high positive relationship (Spearman’s R = 0.870, p < 0.001) with ANC uptake; and CHVs perceived importance had significant association (X2 (8) = 321.872, p < 0.001) and strong positive relationship (Spearman’s R = 0.863, p < 0.001) with ANC uptake. An R2 of 0.784 (78.4%) showed that availability of CHVs had high degree of influence on ANC uptake. Lastly, the results indicated that waiting time had significant association (X2 (6) = 354.829, p < 0.001) and moderate negative relationship (Spearman’s R = -0.745, p < 0.001) with ANC uptake; presence of skilled health providers had significant association (X2 (4) = 668.9, p < 0.001) and strong positive relationship (Spearman’s R = 0.947, p < 0.001) with ANC uptake; and adequacy of sessions had significant association (X2 (8) = 321.872, p < 0.001) and strong positive relationship (Spearman’s R = 0.899, p < 0.001) with ANC uptake. An R2 of 0.920 (92%) showed that availability of skilled health providers had high degree of influence on ANC uptake. The researcher concludes that; pregnant women in the county are knowledgeable about ANC, however initiation is poor; Staff attitude contributes significantly towards improved ANC uptake; Pregnant mothers who have been visited by CHVs initiate ANC in time; Availability of healthcare providers in the right number and mix contribute to improved ANC uptake. The researcher, therefore recommends that County should recruit additional healthcare providers to render better quality ANC services