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Alcohol, tobacco and other Drug Use and Bullying among High School Students in Nakuru District, Kenya
(IJPP, 2010-09) Kariuki, M.; Oteyo, J.s.; Ndege, P.K.
The objective of this study was to determine the prevalence of alcohol, tobacco and other drugs (ATOD) use among secondary school students in Nakuru District, Kenya, and its association with bullying. A total of 1000 form one to four male and female students aged between 13 and 19 years were selected from 40 private and 45 public secondary schools were surveyed between January and June, 2009. The mean or median age for male students was 14 (SD=4.90) and for female students 13.8 (SD=4.8). GSHS was used to collect data which was analyzed by frequencies, chi-square and logistic regressions. In the study, 33.7% of students reported having been bullied by students abusing ATOD in the last 30 days preceding the survey and 15.9% reported the use of alcohol, 12% cigarettes and 8% smokeless tobacco in the last 30 days preceding the survey. Cumulatively, 9.6% of students recorded having used other drugs. There was a significant relationship between alcohol and tobacco use with bullying. However, there was no statistically significant association between the use of other drugs and bullying (X2 = 3.583, df= 1, p=0.058). The prevention of ATOD and bullying among students represents an essential public health measure that may allow for total children's development, qualifying them for a healthy and safe social coexistence. The researchers recommend that focus on prevention programs against alcohol and drug use in secondary schools in general should be mounted to reduce or eliminate bullying altogether.
Assessment of nutritional status and biomarkers among chronic haemodialysis patients
(IJPP, 2013-06) Barwecho, M.J; Thaimuta, Z.L;
Although biomarkers have significance on the nutritional status, there is little information about its relationship among patients on maintenance haemodialysis (MHD). The study was done to determine the significance of the relationship between nutritional status and biochemical markers among chronic haemodialysis patients. The study was done at Kenyatta National Hospital (KNH), Nairobi-a teaching and a referral hospital. This was a cross-sectional, prospective study among chronic haemodialysis patients. Fifty patients on chronic maintenance haemodialysis for 3 months and more were included in the study which was carried out May 2012. All eligible study subjects gave informed consent. Biochemical tests of albumin, electrolytes: sodium and potassium and urea were done and anthropometric measurements taken. The reagents for all biochemical analysis were provided by JAS INC., Court Miami Lakes Florida. The relationship between nutritional status and dietary intake, anthropometric status primary diagnosis, co-morbid, socio-demographic factors and dialysis related factors were determined. Fifty subjects were recruited in the study. The consent for the study was sought at Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UON ERC). Electrolytes mainly potassium were elevated. Sodium and albumin was low. There were significant correlations between albumin and hospital attendance, albumin and nutritional counseling and BMI with anthropometric parameters. The electrolyte levels of sodium and potassium are useful nutritional biomarkers for HD patients coupled with regular nutritional advice. Anthropometric parameters and BMI can be used for nutritional status assessment.
Assessment of Pre-Service Nursing Students’ Perception of Competence Acquired in Skills Laboratory Training in Bomet Medical Training College
(KeMU, 2018-07) Ariko, Phillisters; ;
In recent decades, globally, nursing instructors have tended to use skills laboratory in training skills for pre-service nursing students rather than traditional methods due to benefits such as increased self-confidence and competency levels. The basic nursing skills/procedures taught to these students are of great importance during initiation into clinical placement. This study attempted to assess skills laboratory training program for pre-service nursing students with the aim of identifying infrastructural and staff related factors that influence the program, determine strategies applied and perception of level of competencies acquired by a student after training. The study was guided by the following specific objectives: To identify infrastructural related factors that influence pre- service skills laboratory training program; To identify staff related factors that influence pre- service skills laboratory training program; To determine the strategies utilized in skills laboratory and To determine the perception on the level of competency acquired by pre-service nursing students after skills laboratory training program in Bomet Medical Training College. Semi-structured questionnaires were used to collect primary data from respondents. The study was a cross- sectional descriptive survey, where 150 students in the 1st year of study in nursing school, in Kenya Medical Training College, Bomet campus were systematically selected. The data was analysed using Statistical Package for Social Sciences SPSS version 22. Analysed data was presented using simple tables, percentages, pie charts and chi-square. The study established that simulation was an effective method of teaching skills in the skills laboratory. Students acknowledged peer teaching was also being utilized. In addition, pre-service nursing students agreed that they are able to collect specimens and take patient’s vital signs. From the findings, respondents agreed that skills laboratory area is adequate to accommodate at least 10 students per session. The study established that most of the respondents agreed that skills laboratory had equipment they needed to practice nursing procedures. The study revealed that skills laboratory trainers were knowledgeable and competent in training skills while. A small number of the respondents agreed that skills laboratory had adequate number of simulated patients equally few agreed that skills laboratory was open every day. Correlation analysis using chi-square at 95% confidence level; revealed a statistically significant association between teaching strategies and perception of competence; performance of skills and perception of competence; infrastructural and staff related factors and perception of competence. The study recommends that; NCK to implement structured skills lab training for pre-service nursing students; other skills lab teaching strategies like peer learning should be utilized more, it is an effective strategy as it ensures students engage more and relieves strained faculty staff. Nursing colleges should schedule daily and after 5pm access strategies to skill labs to enhance skills acquisition.
Availability and Utilization of the Mechanisms for Monitoring and Evaluating Continuing Professional Development in Kenya: A Case of Middle Level Health Training Institutions
(IJPP, 2014-01) Mwita, Nzomo; Mwanzo, Isaac; Muthwii, Sammy M.; Kabiru, Ephantus W.
In Kenya, middle• level health training institutions (MLHTls) produce the bulk of health workers at continuing professional development (CPD) training level. However, information on whether monitoring and evaluation (M&E) mechanisms for CPD training are available and utilized at MLHTIs in Kenya is scarce and may not be relied on to develop appropriate M&E systems. The main objective of this study was to determine the availability and utilization of the mechanisms for monitoring and evaluating CPD training among public, private and faith-based MLHTIs in Kenya. The study was guided by two hypotheses: there are no significant differences in the availability of M&E mechanisms for CPD training among institutions in the three categories (public, faith-based, private); and, there are no significant differences in the utilization of M&E mechanisms for CPD training among institutions in the three categories. The respondents were 375 tutors from public, faith-based and private MLHTIs, selected using a mix of sampling techniques: stratified, purposive, proportionate to size and simple random. Data collection was conducted using a questionnaire, key informant interviews, and desk review. Quantitative data was analysed using Statistical Package for Social Sciences (SPSS), while data from desk review was analysed through a process of data reduction, organization and interpretation. Pearson's chi-square test was used to determine the significant differences (p
Barriers to Effective Communication between Student Nurses and Older- Patient at Chogoria Hospital
(KeMU, 2013-08) Kubende, Phidelis .O
Older adults constitute a majority and a growing proportion of people who receive nursing care in Kenya. It's projected that by 2050; there will be a 470% increase in the number of older persons, representing 10% of the Kenyan population. This projected increase calls for action by the government because it's likely to pose a challenge to the health care system if tomorrow's nurses are not adequately equipped to communicate effectively with this generation. Though they are living longer, 80% of them have at least two chronic conditions known to cause communication problems. However, research findings indicate that the quality of nurse-older person communication has been and continues to be poor. Barriers to effective communication between student nurses and older patients are increasing their length of stay and resource use, eroding the quality of nursing care. The purpose of this descriptive research study was to examine the barriers to effective communication, determine how students and older patients perceive their communication and explore ways of improving communication between student nurses and older patients. This is relevant as today's Nursing students are tomorrow's registered nurses and the manner in which they currently communicate with older persons may indicate how they will interact with them in future. Simple random sampling technique was used to select a total sample size of 172 (patients n=84 and student nurses n=88) participants from Chogoria Hospital and Nursing Training School. Data was collected from the subjects using a questionnaire for both students and patients. Data was analyzed using statistical package for social sciences (SPSS) software version 17.0. The respondents acknowledged that there were barriers to effective communication. Fifty-four (64.3%) of the patients and 84 (95%) of the students asserted that age-related changes affected communication, 66 (78.6%) of the patients and 76 (87.4%) of the students believed that there was the need for additional information. It was found out that Eighty-three (98.8%) of the patients and 76 (87.4%) of the students thought that attachment of the students to qualified Registered Nurses would boost communication. These results expand our understanding of the barriers to effective communication between Nursing students and older patients. These insights will be used in training to reinforce a positive attitude of student nurses with regards to effective communication with older patients, improving the quality of nursing care. In subsequent research, these findings will be used to study faculty members' attitudes towards older patients since their attitudes have been found in studies to affect their students' attitudes.
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.
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.
Community based health insurance and utilization of health services.The case of Tanykina community health insurance plan, Nandi County, Kenya.
(2016-07) Terer, Erick Kiprotich
Health financing mechanisms aims to achieve universal coverage for all and protection against the financial burden during illness. Community Based Health Insurance is one of the alternative sources of health financing especially in the rural and informal sectors. Tanykina Community Health Plan (TCHP) is a community based health insurance targeting the rural population and dairy farmers of Nandi North Sub County of Nandi County. Despite the wide coverage of the program, there is still low health care utilization in the sub-county. Using the Health Belief Model as the theoretical framework, the study purpose was to evaluate the clients and community perception of the services offered by Tanykina Community Health Plan and the influence they have on the utilization of health services by clients. The specific objectives were to evaluate the clients and community perceptions on the services offered by TCHP, to review the respondents' characteristics that determine the utilization of health services and to review the health provider factors that affect the utilization of health services by the clients of TCHP. This was a cross-sectional study design. Data was collected in March 2015 on a sample of 336 patients attending health facilities that offer services to clients of TCHP and the community at large. Systematic random sampling technique was used to determine the study sample. Data was collected using a structured interviewer administered questionnaire and analyzed by STATA version 10. Statistical tests were employed at 0.05 level of significant. Qualitative data was analyzed based on thematic framework to support the quantitative results. A total of 336 patients participated in the study of which 169(50.2%) were enrolled members of TCHP while 167(49.8%) were none members. Of all the respondents 183(54 %) were female and 163(48.5%) had attained at least secondary level of education. The enrolled members had the majority 94(55.6 %) being female and 91(53%) having attained college level of education compared to 82(49%) of the none-members. The average age of all the respondents was 41years. The level of education was highly correlated with increased healthcare utilization (p=0.069) though this was not statistically significant. Increased level of satisfaction correlated positively with increased used of outpatient services and this was statistically significant (p=0.05). The perceived availability of information was however no statistically significantly associated with increased utilization of health services in either outpatient department (p=0.112) or inpatient department (p=0.939). The increased level of perceived acceptance was highly associated with increased utilization of inpatient services (p=0.04). Being male increased the level of perceived acceptance by 10 % compared to the female counterparts. With regard to in-patient health services an additional increase in the level of education of the insured members and the duration of membership significantly increases the utilization of these services by 0.19 and 0.89 respectively. However, the duration of membership was statistically significant (p=0.008) in influencing the level of in-patient utilization. I recommend managers of community based health insurance to continuously evaluate the perceptions that the members have in order to improve utilization of health services. There is need to regularly monitor community based health insurance with respect to client satisfaction to enable prompt action by managers to act to increase the effectiveness of these schemes in achieving universal coverage.
Comparative Study of Professional Competences of Graduates of Innovative and Conventional Medical Schools in Kenya: A Case of Graduates of Moi and Nairobi Universities
(IJPP, 2011-09) Kimeu, Anastasiah; Mengech, Harun arap K.; Kangethe, Simon
A population of 280 intern doctors was randomly sampled using Gay's (1992) sample estimate of 20%. An increase of 10% in the sample accounted for non-response. The desired random sample size was therefore 84 intern doctors. A purposively selected sample of 47 supervisors from a population of 140, which included medical doctors and nursing officer in charges, was also assessed. A total of 54 (63% questionnaires) from graduates were returned with 26 of these from graduates of school of medicine- Moi university, while 28 were returned from University of Nairobi. A total of 47 (100%) questionnaires were returned from supervisors. The graduates from the conventional school rated themselves 82% on the excellent category in the knowledge of scientific foundation of medicine while the graduates from innovative school ratings were 89% on the same category. On further analysis of the results, there was no significant difference between the graduates. The ratings of supervisors on graduates from conventional school (56%) and those from innovative school (53%) on this competence showed no significant difference either. The majority of graduates of the two schools considered themselves highly competent in clinical skills (76% IMS; and 79% CMS). However, there was no significant difference between the ratings of proportion of graduates from the two schools. The findings on supervisors ratings (70%, 30% IMS; and 70%, 30% CMS) of graduates showed no significant difference. The graduates from the two medical schools do not differ at all as perceived by their supervisors on the seven global competences. However, there seems to be significant differences in the way graduates perceive themselves with regard to six competences as shown in the study. The author notes that these differences may be due to limitation of the self assessment method used in the study, which does not always provide for objective information as was the case in graduates' ratings. However, this limitation applied equally to respondents of the two universities, the differences between the graduates from the two schools of medicine can be indicative of the effects resulting from the different curricula used.
Comparative study on quality of life among married and non- married women living with HIV/ AIDS
(IJPP, 2010-09) Luhahi, Yema
Human immunodeficiency virus (HIV) infection is a serious health problem among married and non-married women. It has become a health problem for women of all ages. Antiretroviral therapies introduced in the mid 1990s have allowed many women with HIV infection to live long~ before progressing to AIDS, and to have longer survival time following an AIDS diagnosis. Then the issue of quality 0£.life becomes important for these women. The progression of HIV disease most often results in a decreasing quality of life. While examining quality of life among women living with HIV/AIDS, limited attention has been paid to study addressing the issue of whether there is a difference in the levels of quality of life between married and non-married women living, with HIV/AIDS. This study will assess and compare the levels of quality of life in married and non-married women living with HIV/AIDS. Random systematic sampling of 114 women living with HIV/ AIDS who participated in the study were-administered well structured questionnaires by the palliative care nurses. Quality of life was evaluated using World Health Organization's Quality of Life HIV short form (WHOQOL HIV BREF) instrument. The data reported in this study suggest that there is no significance difference with regard to quality of life between married and non-married women. The independent t test revealed that the levels of quality of life differed significantly in the married and the non-married respondents, t (112) = -2.64; p value =.01. But controlling the effect of the covariates in both groups, the result revealed that there was no significant difference in the levels of quality of life in non-married and married women, t (1J2) = -1.4, p value = .17. The apparent difference (t (112) = -2.64; p value =.01) in the levels of quality of life was found to be due to covariates variables.
A Comparison between Self and Clinician-collected Vaginal Swabs for Detection of Bacterial Vaginosis among Women in Kisumu, Kenya
(IJPP, 2011-06) Mwangi, JN; Kisia, A; Bukusi, EA; Wamae, CN
Two tests are available for diagnosis of bacterial Vaginosis (BV), Amsel and Nugent. The latter is considered more sensitive. Laboratory diagnosis for BV requires a vaginal swab specimen. In developing countries, vaginal swabs are only collected by trained health clinicians and use of speculum, examination couch and expensive equipment like autoclave is necessary. In contrast, women in developed countries have a choice of either collecting self swab or allowing a trained health clinician to collect the vaginal swab. This study sought to evaluate the validity and reliability of self collected vaginal swabs for diagnosis of BV by comparing with clinician collected ones. Ten beaches were identified based on convenience along Lake Victoria in Kisumu County from which 105 women volunteers were enrolled. Three vaginal swabs were collected from each woman. The first two swabs were self collected while the third one was collected by a qualified clinician. Smears were prepared, read and interpreted by Nugent method while demographic and clinical data were obtained by use of structured questionnaires and pelvic examination forms respectively. There was high agreement (validity) between the clinician collected and the first self collected swab, Kappa score of K=0.952 (p<0.001). The reliability of the clinician and the second self collected swab had a Kappa score of K=0.905 (p<0.001). The self collected vaginal swabs (SCVS) were found to be valid and reliable for use in diagnosis of bacterial vaginosis.
Design, implementation and operation of health management information system at Kenyatta national hospital.
(2016-07) Omambia, Salim Matagi
Embracing modern technology is one among very many ways of improving efficiency and reducing costs within Health care organizations. While the integration of information and health services potential benefits cannot be disputed, there are many challenges which affect its adoption, in fact, majority of organizations have abandoned their newly acquired system only to go back to their old manual system. This study sought to review the design, implementation and operation of Health Management Information System (HMIS) in Kenyatta National Hospital (KNH) Nairobi County. Specific objectives were a) to determine the design criteria phase of HMIS at KNH, b) to assess the implementation of HMIS at KNH, and c) to evaluate the operation of HMIS at KNH. This was a descriptive cross-sectional study. The study sample was 263 respondents who filled a structured questionnaire and 40 key informant interviewees. Data collected from the field was analyzed through the use of univariate and bivariate statistics. The study revealed that in the design phase, there was significant stakeholder involvement and this manifested through definition and identification of the KNH's HMIS, clear understanding of the purpose and process in the design requirements and thus an indication that the design criteria was observed during the HMIS implementation. In the implementation phase, the fmdings indicated that while the other attributes had a significance, gender did not have a significant association with HMIS implementation p=0.901. The fmdings indicated that the level of management and duration of employment were significantly associated with HMIS implementation at KNH. In the operation phase, respondents said the benefits of electronic HMIS were improved efficiency and reduced workload. More than half (53.1%) of health workers felt that the electronic HMIS in KNH had achieved its objectives which will lead to effective utilization of HMIS and better healthcare service delivery. Overall KNH had successfully implemented HMIS. In recommendation KNH in collaboration with the MOH need to come up with a standardized policy for implementing interventions, improve the current infrastructure, and develop a plan for monitoring and evaluation of the HMIS.
Determinants of a functional refferral system in Kisumu County,Kenya. Patient perspective.
(Global Journal of Health Sciences, 2019) Nango, Wilbert Otieno; Mwangi, Eunice Muthoni; Oluoch, Musa
Purpose: Most referral health facilities are faced with challenges ranging from congestion of patients at these health facilities, strained/ limited resources (both human and material) to deal with the voluminous patients, slow rate of service delivery to the patients which normally results in compromised quality of medical care provided to the patients. The study therefore aimed to find out the determinants of a functional referral system in two high level health facilities; Jaramogi Oginga Odinga Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCH). Methodology: A cross sectional study was conducted using a quantitative approach to data collection. Three hundred and thirty eight out-patient clients were systemically selected to participate in the study. Data was collected using Individual questionnaire. The collected quantitative data were coded and analyzed using the SPSS 25.0 Computer program. The quantitative data were then analyzed using the descriptive statistics and logistic regression models. Results: The research findings revealed that there is a positive significant correlation between primary health facility characteristics (r = 0.474**; P<0.000).It also revealed that there is a positive significant correlation between receiving facility characteristics (r = 0.475**; P<0.000) to a functional referral system. Further Multivariate analysis also revealed a significant association between referral health facility characteristics and a functional referral system, (β3 = .425, P =.000).The results further revealed that there was a negative significant association between receiving health facility characteristics and a functional referral system, (β4 =.-0.156, P < .000). Unique Contribution to Theory, Practice and Policy: The County government of Kisumu should supply adequate drugs and equipment’s to attract more patients seeking medical care services to the primary level facilities. Quality of services offered and general cleanliness at the primary health facilities should also be improved to boost patient’s confidence in them. Key Words: Functional Referral System, health facilities; Jaramogi Oginga Odinga Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCH).
Diagnostic Accuracy of Malaria Microscopy in the Highlands of Central Kenya: Implications for Proper Treatment
(IJPP, 2013-06) Batra, Neale S.; Ndege, Peter K.; Kaburu, Mercy; Clauw, Daniel J.; Wilson, Mark L.
Over-diagnosis of malaria is a problem in many African countries and appears to be occur¬ring in the highlands of central Kenya. Blood-smear microscopy, the standard technique for malaria diagnosis in this area, relies heavily on technician skill. Hence, Rapid Diagnostic Tests (RDTs) are increasingly considered the gold standard for diagnosis, but are often not available in resource-constrained settings. We compared the results of microscopy and RDTs performed on finger-prick blood samples from 250 patients referred to laboratory malaria testing at one private and two government health facilities in/near Meru, Kenya. Across the three sites, 97 .1%-100% of microscopy-diagnosed Plasmodium-positive samples were found negative by RDT. Of the three study sites, the government district hospital had the highest microscopy-based positive rate (27.3% as compared to 5.9% and 9.3% in the other two set¬tings). These results indicate alarming levels of inaccurate malaria diagnosis in the Meru re¬gion. Many factors may play a role in this phenomenon, and it is likely that a "systems level" approach is necessary to remedy this problem.
Evaluation of Factors Contributing to Medication Errors among Nurses Working at Mbagathi District Hospital.
(KeMU, 2015-06) Koech, Jane Jebet
Kenya healthcare policies provide that patient's dignity be observed by ensuring medical safety practices are observed. In this case, medication errors are a concern for both healthcare professionals as well as patients. The main aim of this study was to evaluate factors contributing to medication safety practices among nurses working at Mbagathi District Hospital. To achieve this objective, the study investigated types of medication errors committed by nurses, established actual factors contributing to occurrence of medication errors, among nurses and finally established the barriers to reporting of medication errors among nurses working at Mbagathi District Hospital. The study adopted descriptive design study where data was collected from 121 nurses working in medical, surgical, paediatric, maternity and outpatients using structured self-administered questionnaires after a pilot study showed validity and reliability of the research instrument. Basically, to ensure that the sample was representative, respondents were stratified in to 6 strata to ensure all departments are represented and simple random was used to select the wards and participants. The data collected was cleaned and analysis was done using scientific package for social scientist (SPSS) version 20. Descriptive statistics such as means, standard deviations and frequency distribution were used to analyse the data while inferential statistics such as Chi-Square, Person Correlation, ANOVA and Regression analysis were used to tests relationships between independent variables and dependent variables. The results indicated that there exist a statistically significant positive relationship between errors made during drug administration and such errors occurred as a result of environmental factors human factors, system factors and failure to reporting previous errors. Result indicated an error rate per as 6.2. Meaning for every six patients seeking health care one patient suffers a medication error. Nurses perceive that most important barriers of reporting medication errors were fear of punishment, fear of being reprimand and fear of lawsuit. There was complacency in ensuring medication safety practices are adhered, this was further contributed by human, environmental and system factors. There was gap between medication made by nurses and reporting of those medication errors, hence the need by hospital management to put in place measures to promote medication safety practices among nurses. The study concludes that medical safety practices are not well adhered at Mbagathi District hospital and thus hospital management need to deal with all barriers that limit error reporting through creating proper communication channel for relaying information.
Evaluation of the Effectiveness of Nursing Process Training In Improving the Quality of Nursing Care at Machakos Level Five Hospital.
(KeMU, 2015-05) Burje, Sarah Marrey
Improvement of patient care in any hospital depends primarily on the quality of nursing care. The nurses using the phases of the nursing process can enhance the nursing care of the patient; this is because the nursing process is a systematic way of providing nursing care step by step without missing the required details. The nurse's use the phases of the nursing process which enables them to identify the specific health needs of the patient. Thus, nurses being the professionals who spend 24 hours with the patient have a lot to do for the patient, hence they needed to be trained on the phases of the nursing process to enable them to provide systematic quality nursing care. The purpose of the study was to find out the effectiveness of nursing process training in improving the quality of care in Machakos level 5 hospital. Specifically the study sought to ascertain whether training improved nurse's knowledge and the application of nursing process in the provision of nursing care. The study was done within a period of two months in Machakos level 5 hospital, in Kenya. A cross-sectional descriptive study quantitative research, making use of an exploratory and descriptive design was adopted, utilizing a structured questionnaire and an observation checklist for data collection. The nurses (n=136) employed at Machakos Level 5 Hospital served as the respondents and five wards were visited to review nursing documentation. The data was analyzed using statistical package for social sciences (SPSS) version 20.The findings of the study were; the regression analysis revealed that Assessment, diagnosis, planning, implementation and evaluation influence 76.7% (adjusted R square = 0.767) of nursing care quality at Machakos level five hospital. The nurses had undergone nursing process training (n=133; 98%), there was a lack of knowledge in understanding and applying the concepts of the nursing process, especially in formulating the nursing diagnosis. 5 wards were visited to review nursing documentation. The results were despite the nursing process training (n=-73; 60%) of the wards were not implementing all the 5 phases of the nursing process. AssessMent phaSe was dime in all wards (n=5; .100%),' but the other phases Were not done in (n=3; :60%) of the wards. Most of the respondents had adequate knowledge of the nursing process, but they lacked practical skills. The BScN nurses who have intense basic nursing process training and have expertise in nursing process formed (n=5; 4%) of nursing staff in the hospital. Hence the quality of nursing care of patients at Machakos level 5 Hospital did not improve as a result of nursing process training. Recommendations were made for continuation of nursing process trainings to include more of practical's in order to enhance the effective implementation of the nursing process to improve the quality of nursing care of patients at Machakos level 5 Hospital.
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.
Factors influencing Healthcare Waste Management System in Machakos County, Kenya
(Health Systems Management Journal, 2019-07) Mwania, Michael Musango; Oluoch, Musa; Kimemia, Fredrick
Machakos County health facilities have poor healthcare waste segregation, treatment and disposal practices; patients, health workers including waste handlers and the general population are exposed to risks of needle stick injuries and infection of HIV/AIDS and Hepatitis B&C. All population is exposed to risks associated with furans, dioxins and heavy metals released to the environment through open and crude burning of healthcare waste. World Health Organization recommends supporting and strengthening a health system based on six health system building blocks that includes quality service delivery. The study focused on strengthening the service delivery pillar of health systems in which good health services are expressed as both personal and non-personal quality care, through addressing aspects of safe healthcare waste management (HCWM) herein viewed as non-personal services that directly or indirectly affect patient, health workers and the general population health. The purpose of this study was to determine factors affecting HCWM system in Machakos County. Specific objectives were to determine the healthcare waste management process, health Managers role, human resource factors, and how healthcare waste management policy implementation affect HCWM system in health facilities in Machakos County. Methods: We used survey research design. A sample size of 120 respondents was drawn using both stratified random and purposive sampling techniques. Data was collected using questionnaires and an interview guide. Results: The findings showed that the role of health managers (β2 = .436, P < .001), human resource factors (β3 = .065, P < .002), and healthcare waste management policy implementation (β4 = .275, P < .001) influenced management of healthcare waste system. Conclusions: Health managers’ role had the strongest positive and significant influence on HCWM. Recommendations: i) adoption of safe technologies for treatment and disposal of healthcare waste, ii) refresher trainings on HCWM to all healthcare staff on existing HCWM policies in Kenya, iii) provision of adequate budget to procure enough HCWM commodities, iv) provision of adequate personal protective equipment to all health staff, and v) vaccination of health staff against Hepatitis B.
Factors Influencing Rational Drug Use in Public Hospitals among Doctors and Pharmacists in Meru County
(International Journal of professional practice (IJPP), 2019-05) Wahome, Dennis Mwiti; Mwangi, Eunice Muthoni; Mutwiri, Titus
Rational use of medicines requires that patients receives affordable, right drug and dose for the adequate period of time. Irrational drug use is influenced by lack of essential drugs, lack of training and weak implementation of policies. The purpose of this study was to assess the factors that influence rational drug use among doctors and pharmacists in public hospitals in Meru County. Specific objectives were to examine how staff awareness on policy guidelines, management practices, product selection and inventory management influence rational drug use. A cross-sectional research design was adopted for this study. The sample size was 102 doctors and pharmacists in the public hospitals in Meru County. A Likert based questionnaire was used to collect data. There was a significant relationship between staff awareness (r=.232, p<0.05) and inventory management (r=.324, p<0.05) on rational drug use. 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 (p<0.05) shows that there was correlation between the predictors variables and the dependent variable RDU. The study recommends the following to the Hospital Management Team i) to offer training on rational drug use, ii) offer support supervision and appraisals iii) Constitute active Drugs and Therapeutics Committees iv) to form procurement committee with all stakeholders to strengthen inventory management.
Factors influencing scaling up quality of referral processes in Kenya.
(KeMU, 2016-06) Chika, Agnes Akinyi
Scaling-up quality referral processes strengthens the health system. Referral refers to any process in which healthcare providers at lower levels of the health system seek the assistance of providers who are better equipped or specially trained to guide them in managing or to take over responsibility for a particular episode of a clinical condition in a patient. Quality in health care falls under Service delivery, which is one of the six key health system strengthening building blocks. The main objective of the study was to find out the factors influencing the scaling up quality of referral processes at Kenyatta National Hospital and the specific objectives of the study were to; establish how the management of referrals can scale up the quality of referral processes at Kenyatta National Hospital, determine how the pre-referral communication processes scale-up the quality of referral processes, and establish how referral staff can scale up quality of referral process. The Research design was a descriptive cross-sectional and retrospective study, data was collected using a questionnaire and check list. A check list was used and 384 referrals entered, a total of 100 self-administered questionnaires were completed by staffs working at Kenyatta National Hospital and returned. Data analysis was done using SPSS version 21 and presented in tables, bar graphs and pie charts, reliability was done to establish regression co-efficient at (95%) confidence interval. The findings revealed that majority of the respondents 80(79.8%) indicated the referring institutions do not understand the referral policy, guidelines and Standard Operating Procedures, 12(13.5%) showing that they know and 6(6.7%) indicating that they don't know, majority of patients, 75(75%) came with referral letters which were incomplete, 13(13.7%) lab results and 12(12%) coming with X-ray results. The findings indicates that 51(56%) of the referred patients came with nurse, 40(44%) relative with none being escorted by doctor. According to the findings 63(67%) of the referring hospitals did not call prior to referring the patient, only 31(33%) called before transferring the patient to KNH. In conclusion, the findings showed that there was significance relationship between referral policy and staff knowledge on referrals at P< 0.05 with chi square test of 0.004. Scaling up the referral processes ensures quality of referral services. The study recommends that the management of Kenyatta National Hospital needs to ensure that dissemination, sensitazation and awareness of the referral policy, guidelines and SOPs is done for the staffs both in the referring and receiving hospitals, referral tools, forms and registers be distributed at all levels of the health system for standardised information in the referral letters, laboratory and radiological investigations. Employ adequate human resource in the hospital.