International journal of professional Practice (IJPP)
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Item Effects of Perceived Image of NHIF Outpatient Facilities on Utilization of Primary Care Services by Private University Employees in Nairobi County(International Journal of professional Practice (IJPP), 2019-01) Kironji, Keziah M.; Tenambergen, Wanja Mwaura; Mwangi, Eunice MuthoniThe 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 primary health services after selecting their preferred facilities from a list of the NHIF outpatient ones. However, there are some members of National formal scheme whose contributions are remitted to NHIF by their employer every month but do not utilize primary care services. This study sought to determine the effects of perceived image of NHIF outpatient facilities on utilization of primary care services by the national formal scheme members in Nairobi with a focus on Private University employees. This study adopted a cross-sectional descriptive design with mixed methods approach. Multistage sampling with simple random sampling was used. Quantitative techniques were used for data collection. Descriptive statistics, F-Statistics, P-values, Pearson’s Rho ®, mean-scores, standard deviations, co-efficient of determination (R2) and the coefficient of multiple determinations (Adjusted R2) were analyzed using SPSS version 24. The rationale of this study was to inform top management of NHIF to undertake decisions in regards to utilization of primary health services by NHIF members by understanding effects of safety of healthcare services, waiting time at the health facilities, healthcare workers interpersonal skills and facilities amenities and physical outlook affect utilization of primary care services. The multiple regression results indicates that in a combined relationship only three factors on perceived image of NHIF facilities influence utilization of primary care services; safety of healthcare services (X1; β1 = .315, P ˂0.05), healthcare workers interpersonal skills (X3; β3 = .0.049, P ˂0.05), and healthcare facilities amenities and physical outlook (X4; β4 = .027, P ˂0.05). Waiting time is negative (X2; β2 = -.018, P ˂0.05) and thus does not influence utilization of primary care services. In a combined model, all four factors have no scientifically significant influence on utilization of primary health services by national formal scheme members in Nairobi County. The study recommends that NHIF should vet facilities they accredit to offer primary care services to ensure safety of healthcare services, train workers on effective interpersonal skills and improve facility amenities and physical outlook of NHIF outpatient facilitiesItem Role of County Health Governance in Implementation of Social Insurance National Scheme in Selected Counties in Kenya(Kenya Methodist University, 2019) Mwangi, Eunice M.; Mapesa, Job; Wairia, Samuel K.Health care financing (HCF) is one of the building blocks of a health system. Kenya envisions to have Universal Health Coverage (UHC) by 2022. To achieve this, the National Hospital Insurance Fund (NHIF) was identified as a vehicle towards the realization of UHC. NHIF collects revenue, pools risks, and purchases health services for its members. NHIF uses capitation as a strategic purchasing model to provide primary care health services (PCHS). This study aimed to establish the role of County Health Governance in implementation of the NHIF national scheme. Specifically, the study sought information on NHIF’s communication with the County Health Management Team (CHMT), CHMT knowledge of NHIF national scheme guidelines, suitability of county health facility Infrastructure , adequacy of NHIF capitation funds, NHIF accountability and how they all influence provision of NHIF primary care health services. This was a cross sectional research. All 120 County and Sub-County Health Management Team members were purposively sampled from Nakuru and Nyandarua Counties, a 96% (115) response rate was achieved. Results showed that, 64(56%) of respondent said NHIF was accountable to the population, 73(63%) said the county health facility infrastructure was adequate and 67(58%) said there were guidelines directing implementation of NHIF PCHS. However, 66(57%) said patients were not accessing NHIF primary care health services, 70(61%) said capitation funds were not adequate and 59(51%) said communication from NHIF to them was inadequate. Chi square results indicated that all variables, NHIF communication χ² = 5.364, p < 0.05, availability of guidelines χ² = 10.447, p < 0.05, suitability of county health facility infrastructure χ² = 13.199, p < 0.001, adequacy of NHIF capitation funds χ² = 6.956, p < 0.05 and NHIF accountability χ² = 10.982, p < 0.05 were scientifically significant and influenced implementation of the national scheme outpatient services. The study concludes that there is minimal participation of the CHMT in NHIF decision making and this hinders successful implementation of the NHIF National scheme. The study recommends that 1) NHIF improves communication with the CHMT members, so as to involve them in the implementation of NHIF national scheme, 2) NHIF to raise awareness of the strategic purchasing function in order to promote a shared understanding which will enrich knowledge of the roles and responsibilities of all the players including the County and National governments, NHIF, Citizens and providers.Item Factors influencing demand for healthcare insurance:A study of jua kali workers in Nairobi(IJPP, 2013-01) Nalebeson, Mugubi Robert N.; Odhiambo-Otieno, George W.Health systems are a means to achieving better health outcomes for all. However, where patients depend largely on out of pocket (OOP) payments to access health services, there is often lack of care for those who cannot afford. This study aimed at establishing the fac¬tors influencing the demand for health insurance among Jua Kali workers in Nairobi. This was a cross-sectional research study involving mixed approach (simple random, purposive sampling, qualitative and quantitative methods) involving 130 Jua Kali workers from Associations/Cooperatives and 258 Jua Kali workers from non-organized groups; key informants from NHIF and the Department of Micro and Small Enterprise Department and was. The study was conducted between January to March 2012 within Pumwani Division in Nairobi County. Findings indicated that 113 (29.1%); 21.1% members of Jua Kali association and 11.8% individualJua Kali workers out of 388 were enrolled in NHIF while 262 (67.5%) were not enrolled in NHIF. Inadequate Knowledge of NHIF benefit and the KShs. 480 upfront NHIF premium payment were the main contributing factors to non-enrolment of262 (67.5%) of Jua Kali workers. 42.3 % individual Jua Kali and 6.1 % members of association with a monthly income less than KShs. 9,000 did not enrol in NHIF. To enhance more enrolment of Jua Kali workers, the study recommends that NHIF should design strategies that target the younger, low income and Jua Kali workers with low level of education with key information on health insurance benefits and the benefits of enrollment in NHIF , establish satellite pay¬ment offices within Jua Kali working zones to bring services closer to them, apply KShs. 160 per month instead of KShs. 480 and enhance networking and engage Jua Kali association as strategic partners for the purpose of motivating Jua Kali workers enrollment.Item Haematological and serological findings in Cercopithecus aethiops(African green monkeys) with Cyclospora infections in Kenya(IJPP, 2013-01) Nguhiu, Purity N.; Wamae, Claire N.; Magambo, Japheth K.; Yole, Dorcas S.Cyclospora,is a common cause of gastroenteritis in humans resulting in protracted life threat¬ening diarrhoea in immunocompromised patients worldwide.Cyclospora infections have been reported in African green monkeys. The objective of the study was to determine the haema¬tological and serological parameters in African green monkeys with Cyclospora infections.A cross-sectional laboratory based study was done at Institute of Primate Research, Nairobi, from March 2008 to June 2009. Thirty three African green monkeys comprising of 10 male adults, 7 female adults, 3 male juveniles and 13 female juveniles were analysed for blood cell counts using a haematological analyser and screened for Cyclospora by ELISA. The red blood cell counts decreased in all study animals with mean decline of 1.2-1.5 (x 106/µl). The white blood cell counts varied among the study animals with highest increase among female adults from4.3-7.1 to 5.4-8.8 (x 103 /µl) and a decrease among the male adults from 3.9-8.7 to 1.5-5.3 (x 103/µl). Positive antibody responses to Cyclospora were observed in 20 of the study animals with highest mean optical density (OD) values of 0.816 ± 0.100 observed among the female juveniles and lowest among the male juveniles at mean OD value of 0.646 ± 0.055. In conclusion, Cyclospora infections triggered both cellular and humoral responses in the African green monkeys.Item The Implications of Amenity Wards On The Equity of Health Care at Meru District Hospital(IJPP, 2012-10) Kaimuri, MaryjoyAmenity wards in public hospitals were established with the aim of retaining specialists in public sector and for generating additional funds to run the health facilities. However, the effects of these establishments on equity of health care have not been assessed. The purpose of this study was to assess the implications of amenity wards in public hospitals on equity of health care. This study aimed at achieving four main objectives to include determining the material resources allocated for patient care in amenity wards and general wards; to determine the number of human resources allocated for patient care in amenity wards and general wards; to determine the waiting time for patients in amenity wards and general wards and to establish the quality of the facilities in amenity wards and general wards. The study was carried out at Meru district hospital in 2010. The study utilized com¬parative design. The sampling designs utilized are stratified and simple random sampling designs. The total sample size was 189 respondents. A questionnaire and a check list were used as data collection tools. Data was analyzed using descriptive statistics. The nurse to patient ratio for the amenity wards was 1:2 compared to 1:9 in the general wards. As regards to drugs, all the respondents (100% (n=l5)) in the amenity wards reported to having received all the drugs prescribed to them compared to 90% (n=99) of the respondents in the general wards. 40% (n=6) of the respondents in the amenity wards who were scheduled for an elective surgical procedure were taken to theatre immediately and 35% (n=5) were taken after one day compared to 1 % and 25 %( n=28) respectively for the general wards. There is inequitable distribution of human resources for health where more health care providers are allocated to the amenity wards to provide care for very few patients compared to the general wards. Similarly, the amenity wards have higher quality facilities and shorter waiting time compared to the general wards.Item The Caves of Mount Elgon and Their Sandfly Fauna David K(IJPP, 2011-01) Sang, David K.A survey of the Kenyan side of Mount Elgon revealed numerous caves which were found harbouring phlebotomine sandflies. Among the morphologically identifiable males of rwo species of the genus Phlebotomus, sub-genus Larroussius were indistinguishable females, a proportion of which were infected with promastigotes of Leishmania. The suspected vector of this parasite, Phlebotomus pedifer was found predominant in a relatively low altitude escarpment belt at l 750- l 900m, and represented over half of the identified male sandflies detected from the slopes of Mount Elgon. These male sandflies were associated with females infected with Leishmania and those which bit man. At intermediate and higher altitudes, the caves harboured mainly P.elgonensis and were associated with river valleys and major promontories. The escarpment which is a proven focus of cutaneous leishmaniasis was approximately 257 sq km and 10% of the study area, and took the form of a narrow, elongate cliff along the entire southern slopes of the mountain. Details of the distribution of caves on the slopes of Mount Elgon and their sandfly fauna are presented.Item Prevalence of CCR2 gene polymorphisms among HIV infected individuals from different regions in Kenya(IJPP, 2012-07) Wachira, Dorcas; Khamadi, Samoel; Wamachi, Alex; Mueke, Jones; Ng'ang'a, Zipporah; Maraka, MoureenChemokine receptor-2 (CCR2) is a co-receptor for the entry of human immunodeficiency virus- I (HIV-I) into the target cells. Patients with the CCR2 mutations may progress to AIDS at least 2-4 years later than individuals carrying the normal gene. A G-to-A transition at position 190 characterizes the CCR2-64I mutation. This mutation has been identified as an important factor for delaying progression to AIDS. The effect of CCR2 polymorphism on HIV-1 disease progression has not been explored in depth within Africa. The status of CCR2 gene polymorphisms among HIV infected individuals in the Kenyan population is unknown. The objective of this study was to determine the existence and distribution of CCR2 gene mutations and to identify the different polymorphic groups of the co-receptor gene among HIV infected individuals in the Kenyan population.Item Factors Influencing the Utilization of Zidovudine and Nevirapine among HIV Positive Perinatal Women at Pumwani Maternity Hospital in Nairobi, Kenya.(IJPP, 2014-01) Imbaya, Christopher L.; Odhiambo-Otieno, George W.; Okello-Agina, B.M.Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) is a key strategy aimed at protecting babies from being infected with HIV by their mothers. Treatment with combination rather than single Antiretroviral (ARV) drugs has been found to be more effective in PMTCT. The objectives of this study were: 1. to determine the rates of utilization of single drug and combinations of Zidovudine (AZT) and Nevirapine (NVP) for PMTCT and 2. To determine the factors that influence the choice of treatment among HIV positive perinatal women at Pumwani Maternity Hospital (PMH) in Nairobi, Kenya. This was a cross-sectional descriptive study. The study site was Pumwani Maternity Hospital, which is a public health facility on the eastern suburbs of Nairobi County. A total of 326 post natalHIV Positive women were sampled and administered with questionnaires either at the Postnatal Clinic (PNC) or postnatal ward in Pumwani Maternity Hospital. Among the 326 HIV positive women, 299(91.7%) acknowledged having been given ARV's for PMTCT where 160(53.5%) and 139(46.5%) of them were given single and combination drug treatments respectively. Single dose NVP was used by 132(44.1 %) of the women while AZT alone was prescribed in 28(9.4%) of the women. The other 139 (46.5%) of the women received a combination of NVP and AZT. The frequency of Antenatal Clinic (ANC) visits was significantly related to the number of ARV's dispensed (p=0.001). Late ANC attendance and health problems were given as reasons why AZT was not dispensed while the main reason that was cited for NVP not being used was the lack of its availability. More than half of the HIV positive women delivering at PMH received single drug PMTCT. Availing combination PMTCT therapy should be enhanced. Success could be realized by encouraging frequent ANC attendance, availing alternative ARV treatment options and addressing health conditions that contribute to the use of monotherapy.Item The Relationship between Policy Availability and Capacity Levels for Disaster Preparedness in Hospitals within Nairobi County.(IJPP, 2014-01) Simiyu, Cynthia Nekesa; Otieno, Odhiambo; George, W.; Okero, DominicIncreased disaster cases coupled with the fact that Nairobi County joined the World Disaster Reduction Campaign among which one of the themes was 'Hospitals safe from disasters', made it important that disaster preparedness in hospitals within Nairobi County be examined. No studies have been done regarding disaster preparedness in hospitals within Nairobi County, making this study a key resource for evidence-based decision making, especially in resource needs prioritization. The broad objective of this study was to determine the relationship between policy availability and capacity levels for disaster preparedness in hospitals within Nairobi County. The specific objective was to determine the relationship between availability of policies and level of capacities in hospitals within Nairobi County. This was a descriptive cross sectional study. The study setting was in Nairobi County, Kenya. A total of 32 hospitals and 263 respondents were sampled. Research instruments used comprised questionnaires and key informant interviews. Quantitative and qualitative data was obtained. Quantitative data was of use in determining the statistical significance of the study. Qualitative data aimed at obtaining in depth information regarding challenges and recommendations to hospital disaster preparedness on the basis of how policy availability and capacity levels relate. Study results revealed that there were problems related to staffing, hospital equipment, hospital infrastructure, policies, training and drills. In conclusion, a positive relationship existed between policy availability and capacity levels with capacities being dependent on policies. Policy availability was established to be dependent on the finance and stewardship health system pillars. This study recommends that for maximization of health resources towards disaster preparedness in hospitals within Nairobi County, policy formulation and implementation should be prioritized with emphasis on funding and good stewardship. This will result in a strengthened health system with institutional capacities in place.Item Characteristics of Nurses Upgrading to Higher Levels of Nursing Education at a Regional Referral Hospital in Eastern Kenya(IJPP, 2014-01) Kathuci, Rosemary K.; Simba, Justus M.; Nyangena, Elijah N.; Nephat, N.Upgrading refers to the process of nurses improving their initial educational qualification to a higher level. It enables nurses to add to their knowledge and skills, professional value, self -esteem and are rated higher within the nursing cadres. The number of nurses upgrading in Kenya has continued to increase over the years with adult students becoming the new majority in the student body. The upgrading nurses enter the academic programs with varied characteristics making them a unique group. This study sought to describe the characteristics of nurses upgrading to higher educational levels at a regional referral hospital in Eastern Kenya. The study design was a descriptive cross-sectional survey. Data was collected from 160 nurses using a structured self-administered questionnaire. Data collected was checked for accuracy, coded and analysed using STATA Version 10. Results showed that 63.2% of the respondents were above 35 years with a mode age of 40-44 years and >50 years. The ratio of male to females was 1:5. 53.2% of the respondents had Enrolled Community Health Nursing (ECN) as their initial qualification. 47.7% of the respondents had upgraded while 20%were currently upgrading. Age and initial qualification significantly influenced nurses to upgrade (p= 0.000 and p= 0.04 respectively) with the younger and those with certificate qualification more likely to upgrade. The preferred mode of study was distance learning with 83.65% of those upgrading opting for it. It was recommended that institutions of higher learning should strive to provide upgrading programs in nursing via distance learning mode and work closely with the professional bodies and the hospital to see how best to have it delivered. Nurses could also benefit from continuous medical education especially on the significant characteristics of age and initial qualification to use them for their advantage to take up upgrading.