School of Medicine and Health Sciences

Permanent URI for this communityhttp://41.89.31.6:4000/handle/123456789/10

Welcome to School of Medicine and Health Sciences,Masters theses and dissertation Sub-community

Browse

Now showing 1 - 20 of 233

Aflatoxin Analysis in Staple Food Cereals and Assessment of Households’ Awareness on its Management in Tharaka-Nithi County, Kenya
(KeMU, 2021-09) Marangu, Victor Mwiti
Aflatoxin is a poisonous substance produced by fungi. Crops infestation is inevitable and numerous evolving nations collectively with Kenya do not regularly test their main foods for aflatoxins contamination. Consumption and sale of mycotoxins infested cereals and grains has the risk of contributing to a diversity of severe medical complications in people. Context-specific information on the aflatoxin occurrence in the County makes it possible to document vulnerable staple crops and the level of toxicity in the County. Measurement of exposure using the factors that influence the choice of the food together with the presence of these harmful mycotoxins can be used to demonstrate how this contamination occurs in food, map the aflatoxin hot spots in the County and inform the choice of the most effective control approaches. However, there is lack of local data on aflatoxin contamination in Tharaka-Nithi County to inform interventions chiefly due to lack of local research, testing facilities, and qualified personnel. The main purposes of the research included: to evaluate the levels of aflatoxin in cereals commonly used as staple foods sourced from households and marketplaces, to evaluate households’ awareness on suitable conditions for storage of foods regarding aflatoxin contamination, and to identify factors contributing to aflatoxin contamination. Samples were collected from Tharaka-South and TharakaNorth Sub-Counties which had three Wards with a total of 24 Sub-Locations. 3 Households per Sub-Location that had some stock of the crops of interest were randomly chosen from the villages in each Sub-Location. Three major open-air markets were also selected based on size for the collection of the samples. During the collection of the samples, observations were done, and a questionnaire used to determine the study respondents’ awareness of aflatoxin contamination and knowledge of the potential causes of contamination. Analysis for aflatoxin levels was conducted using the ELISA Kit. The information collected during household interviews was analyzed using SPSS version 22. The main cereals used as staple foods among households in the County as per the study results included: pearl millet, sorghum, maize, green grams, and cow peas. Overall, aflatoxin contamination in 25.8% of sampled cereals was above the legal threshold of 10ppb Kenyan standards with 17.2% of cereals exceeding the established human tolerance levels of greater than 20ppb. The aflatoxin contamination levels of 44.4% of the market samples was greater than the Kenyan tolerable limits. Based upon the Chi-Square test for association, it was evident that level of aflatoxin was associated with the type of cereals and grains (p-value 0.001, which was less than 0.05 at 95% confidence level). Therefore, cereals and grains levels of contamination differed as they were exposed. Based upon the t-Test for Equality of Means, the difference was not significant (p-value for Maize= 0.89, Sorghum= 0.47 and Pearl Millet=0.64, all of which are greater than 0.05). Thus, there was no difference in mean level of aflatoxin in the cereals and grains in the two study areas. Furthermore, the t-Test for Equality of Means, showed that there was no difference in mean level of aflatoxin in the cereals and grains collected from the markets and households (p-value for Maize=0.294, Sorghum=0.422 and Pearl Millet=0.918, all of which are greater than 0.05). Majority of the farmers (84.7%) were aware of aflatoxin as a dangerous poison found in cereals and grains especially those that are not properly dried to safe moisture content. However, detailed information on the nature, formation, effects, prevention, and control of aflatoxins was scanty and inconsistent. The study provided crucial information on the aflatoxin contamination levels of these major cereals and grains and on households’ knowledge on aflatoxin management. This data will be key in bringing issues to light of the presence of these harmful mycotoxins in staple foods and increase the community’s knowledge and skills on the use of sustainable, low-cost post-harvest management practices to decrease the contamination. This will enhance the well-being of populations in the County and ultimately the national food security.
Assessing Factors Hindering the Effectiveness of The Family Muac Program in Detecting Malnutrition Among Under-Five Years Children in Banisa Sub-County, Mandera County
(KeMU, 2024-09) SAIDA, ROBLE HASSAN
The Family MUAC Program, which involves training mothers and caregivers to use a Mid-Upper Arm Circumference (MUAC) tape to detect signs of malnutrition in children, has shown positive outcomes in terms of improving nutrition surveillance and early detection of malnourished children. In its implementation, there have been challenges which have made the program not successful as it was intended. The study general objective focused on the barriers to effectiveness of family MUAC programs in Banisa sub-county in Mandera County. In this case, the study focused on four objectives which included; assessing mothers’ sociodemographic characteristics, socioeconomic factors, health facility services, and training factors’ influence on nutrition surveillance and early detection of malnutrition among children aged 6-59 months in Banisa sub-county in Mandera County. The early detection and nutritional surveillance amounted to effectiveness of the family MUAC programs. The study was guided by Cognitive Behavioral Theory (CBT) which informed the study variables. The study adopted correlation research design, where the study sought to establish any statistically significant correlations between the independent and the dependent variable, effectiveness of family MUAC program. Target population was 293 mothers from Banisa Sub-County, from where a sample size was established at 236 mothers, but managed to get 209 fully filled questionnaires. This corresponded to 89% response rate which was considered adequate for analysis of the findings. The sample size was through systematic simple random sampling method. The researcher interviewed mothers presenting to the clinic until the sample size was achieved. Data collection was primary and the researcher administered questionnaires and interview guides. Data was analyzed using SPSS version 26. Presentation was on tables, frequencies and percentages. Bivariate analysis was done, having Pearson correlations coefficients and multivariate analysis was done through multiple linear regression, with ANOVA and regression coefficients. The findings of the study showed that there was a positive significant relationship between Socio-economic factors, training factors, health facility, and effectiveness of family MUAC programs (p <.001). Only mothers’ characteristics was not significantly correlated to effectiveness of MUAC programs. The study recommendation and conclusion aimed at training mothers to capacity build on using the family MUAC program, and to know the features and indicators to look for in enhancing nutritional surveillance and early detection of malnutrition among children under five.
An Assessment of Classroom Teaching Strategies Utilized by Nurse Educators on Diploma Nursing Students at Kenya Medical Training College Vihiga Campus
(KeMU, 2019-09) Amtamwa, Mary Obaga
In recent decades, globally, nursing educators have tended to use innovative teaching strategies in the classroom rather than traditional teaching strategies. This is raid advance due to benefits such as increased self-confidence and competency levels. Despite there being ain technology, little is known about the teaching strategies being used by the nurse educators to prepare students for real life practice experience. The goal of the study was to determine the classroom teaching strategies utilized by nurse educators at KMTC- Vihiga. The study utilized descriptive cross sectional research design. The target population comprised of 11 nursing educators and 350 KRCHN nurse students. The study employed the stratified sampling technique for the nursing student respondents. For the nurse educators, purposive sampling technique was used. Data collection tools were two structured questionnaires which were used to obtain information from respondents. This was after pretest showed validity and reliability of the tool. Data was analyzed using quantitative techniques by use of the Statistical package for Social Science Software version 25 for windows and excel version 10. Descriptive and inferential data analysis were used particularly the Analysis of variance and chi square test. The findings obtained show that nurse educators were predominantly using traditional teaching strategy although the innovative teaching was also minimally used. The chi square analysis showed that no association was found between number of years since last qualification and frequency of use of lecture teaching strategy However, there was an association between number of years since last qualification and utilization of storytelling during teaching by nurse educators On further analysis of variance the study found that there was a statistically significant difference in knowledge between age groups as determined by one way Analysis of variance. Similarly there was a significant difference in attitude towards teaching strategies as determined by one way Analysis of analysis of variance. Pearson product moment correlation coefficient was computed to assess the relationship between nurse educator’s knowledge and rating of attitude towards the teaching strategies. There was a significant correlation. This showed that increases in nurse educator attitude were correlated with increase in nurse educators’ knowledge of teaching strategies. The recommendations included, designing of a curriculum which includes innovative teaching strategies for the nurse educators. Nurse educators should utilize the computers and internet for the benefit of students learning.
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.
An Assessment of Factors Influencing Clinical Learning Among Diploma Nursing Students at Moi Teaching and Referral Hospital Eldoret, Kenya
(KeMU, 2025-06) Robert, Salome Nkatha
Clinical learning is a critical component of nursing education worldwide, enabling students to develop practical skills through supervised patient care. Globally and regionally, nursing students face challenges such as inadequate supervision, resource shortages, and a persistent theory-practice gap, particularly in low- and middle-income countries. In Kenya, despite nurses demonstrating strong overall competencies, diploma nursing students often underperform in clinical placements compared to theoretical assessments, highlighting a pressing need for context-specific investigation. This study assessed factors influencing clinical learning among 304 diploma nursing students at Moi Teaching and Referral Hospital (MTRH), Kenya. The objectives were to: (a) identify student-related factors; (b) evaluate training institution-related factors; (c) examine clinical setting-related influences; and (d) explore students’ experiences with the preceptorship model. Using an explanatory sequential mixed-methods design, the study samples 304 nursing students by census sampling to complete questionnaires as well as 24 students participating in a total of 4 Focus Group Discussions (FGD). Quantitative data were analyzed with SPSS version 27 using descriptive statistics, chi-square tests for associations, and multivariate regression to identify predictors of clinical performance (p ≤ 0.05). Qualitative data underwent thematic analysis to enrich understanding of preceptorship experiences. Among the 304 respondents, key quantitative findings included: 37.83% (n=115) strongly disagreed that clinical supervision was adequate (χ²=15.7, p=0.001); 36.51% (n=111) reported ineffective teaching methods (χ²=12.4, p=0.004); and 33.88% (n=103) experienced poor cooperation with clinical staff (χ²=10.8, p=0.013). Anxiety and financial constraints were notable student-related barriers (anxiety χ²=11.5, p=0.009). Regression analysis revealed that training institution-related (β=0.32, p=0.002) and clinical setting-related factors (β=0.28, p=0.005) significantly predicted clinical performance, explaining 12.5% of variance (R²=0.125, F=7.64, p=0.003). Qualitative themes included supportive preceptorship fostering confidence and skills, resource limitations such as PPE shortages, and the persistent theory-practice gap due to inconsistent clinical guidance. In conclusion, inadequate supervision, poor teaching methods, and resource scarcity are significant barriers to effective clinical learning at MTRH. Strengthening supervision, enhancing teaching strategies, and improving clinical resources are essential to bridge the theory-practice gap and improve nursing students’ clinical competence.
Assessment of Factors Influencing Service Delivery at Sub-County Hospitals in Meru County, Kenya
(KeMU, 2020-11) Anampiu, Jason Maingi
Integrated and people-centred health services are critical for realizing universal health care coverage. This can only be achieved through provision of efficient and effective health services. Service delivery is one of the key building blocks of any health system; it is an immediate output of the inputs into the health system, such as the health workforce, procurement and supplies, infrastructure and financing. The rising burden of disease and weak health systems are being compounded by the poor health service delivery. The purpose of the study was to determine factors influencing service delivery at sub-county hospitals in Meru County, Kenya. The objectives of the study was to determine the influence of staff on service delivery in sub-county hospitals in Meru County; to assess the influence of facilities on service delivery in sub-county hospitals in Meru County; to establish the influence of management practices on service delivery in sub-county hospitals in Meru County and to evaluate the influence of Drugs procurement process on service delivery in sub-county hospitals in Meru County. The study adopted a descriptive cross-sectional design. The target population consisted of five officers from each of the twenty three sub-county hospitals which totalled up to one hundred and fifteen. Open and closed ended question were used to collect data. Data was analyzed using Epidata and SPSS version 22.0. Correlation and multi linear regression analysis were respectively used to establish the strength and direction of the relationship between the variables and the extent of independent variable on service delivery while descriptive statistics were used to generate means and standard deviation from the collected data. There was a positive significant relationship between staff, facilities, management practices and drugs procurement (Staff r= 0.892, p=.000; Facilities r= 0.969, p=.000; Management practices r= 0.891, p=.000; and Drugs procurement r=0.930, p=.000.respectively) and service delivery in Meru sub-county hospitals. It is concluded that staff, facilities, management practices and drugs procurement had positive and significant effect on service delivery among Meru sub-county hospitals. This study recommends that management of Meru sub-county hospitals should motivate and have the required number of staff, have adequate and useable facilities, engage in management practices that will add value to hospital operations as well as procure drugs in a timely manner, of the right quality and quantity.
Assessment of health workers perinatal knowledge and practices related to service delivery in Makueni County, Kenya
(KeMU, 2019-09) David, Benard Kasanga
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 Knowledge, Attitude and Practices on Kenya’s Breast Milk Substitutes Act (2012) Among Nurses in Mbagathi and Pumwani Hospitals, Kenya
(KeMU, 2021-09) Nyaboke, Clement
International Code on marketing BMS was developed by the World Health Organization, to protect lactating mothers and healthcare personnel from commercial pressure by BMS manufacturers. Nursing officers are obligated to promote, encourage, protect and acquaint themselves with their obligations in accordance with this Code. The research problem in this study was based on the scarce empirical evidence about the information and knowledge of the recommendations of the International Code on BMS by health workers in Kenya responsible for counseling mothers of new-born babies on breastfeeding. The main objective of this study was to determine the knowledge, attitude and practices of BMS Act among nurses at selected hospitals. The specific objectives were; establish demographic characteristics of nurses in Mbagathi and Pumwani Hospitals, Nairobi County, to assess the knowledge level of Nurses on the Kenya’s Breast Milk Substitute Act; determine the attitude towards Kenya’s Breast Milk Substitute Act and to examine the practices of the Kenya’s Breast Milk Substitute Act among nurses in Mbagathi and Pumwani Hospitals, Nairobi County. This study adopted a cross-sectional descriptive research/study design. Simple random sampling was used to include nurses in the study. Yamane formula was used for the simple random sampling technique method to come out with a sample size of 200 Nurses for study. The study used questionnaire as the primary data collection tool. Descriptive statistics and chi-square tests were used to analyses data with the help of SPSS. The study found that majority (83.9%) of the respondents was Female. Majority (85%) were young being aged under 40 years. Slightly above half (49.7%) were married. All the respondents were trained with majority (65.6%) having acquired a college certificate. Over half (56.5%) of the respondents had more than 6 years of working experience. Majority [168, 90.3%] had a high knowledge on Kenya’s BMS Act. The vast majority [185, 99.5%] of the respondents had a positive attitude towards BMS. Majority [153, 82.3%] of the respondents had good practices in regards to BMS practices. The level of education and nurses’ knowledge were significant (p=0.000) in the study. The study therefore concluded that nurses had high knowledge, positive attitude and good practices regarding their role in EBF promotion and discouraging use of breast milk substitutes in line with the BMS act. The study recommended that; the government and other private organizations should carry out mass education to create awareness on BMS, in order to adopt the recommended infant and young children nutrition practices as postulated by the World Health Organization (2017). Policies and programs should be implemented to support breastfeeding initiatives for the purpose of upscaling exclusive breastfeeding in Kenya.
Assessment of Mentorship Factors Influencing Clinical Competences of Diploma Nursing Students at coast General Teaching and Referral Hospital, Mombasa
(KeMU, 2023-09) Muthui, Milka Ngonya
Nurses work in various health care settings and represent the universal entry access for roughly 90% of healthcare users hence effective graduation of qualified nurses with necessary abilities is a paramount function in the nursing education training (Bvumbwe & Mtshali, 2018). According to Cooley and De Gagne (2016), there is a global scarcity of qualified experienced nurses forcing healthcare administrators to employ recently graduating nurses to fill the gap. Over the last decade, several concerns have arisen concerning newly qualified nurses’ clinical competences and suitability for practice after completing their training. Missen et al. (2016) argue that even at the end of their training, nursing students lack clinical competences and are unable to attain the maximum degree of clinical competence required of them and blame this on the theory practice gap. Training initiatives should prioritize the acquisition of competences through mentorship. In South Africa Mentoring in practical placements is not yet codified as there are no regulatory norms to act as a guide for mentors (Mhlaba, 2011). In Kenya, the student lecturer ratio is beyond the expected limit (MOH, 2012). When student mentorship is lacking or inadequate, institutions risk generating half-baked graduates who may not be able to perform nursing procedures adequately and attend to patients appropriately due to a lack of essential competences required for all practicing nurses. This study sought to assess mentorship factors influencing Clinical Competences of Nursing students at Coast General Teaching and Referral Hospital, Mombasa. The study had four objectives and adopted a descriptive cross-sectional survey. The study population was ninety-five (95) basic diploma students in their 3rd year at KMTC Mombasa. The sample size formula of Yamane, (1967) was employed to arrive at a sample size of 77 students. The researcher collected data by use of online google form questionnaires. The statistical package for social science (SPSS) version 25 was used to conduct the analysis for quantitative data. Inferential data analysis was run using Pearson correlation coefficients. The statistical significance was set at P= 95% (0.05). The students perceived themselves as competent and had acquired average to moderate level competence in communication skills, decision making, teamwork, performance of nursing skills / procedures, problem solving skills and self-confidence [r=0.406, p<0.05]. The mentor’s modeling style helped students integrate the knowledge learnt into practice and had a positive correlation coefficient of [r=0.703, p<0.05]. Findings on mentor-mentee relationship showed that there were poor interpersonal relationships among mentors and mentee [r= 0.956, (p<0.05]. This led to inadequate mentoring and thus poor acquisition of clinical competences. Findings on Institutional factors showed [r= 0.451, (p<0.05]. There was no intentional matching of mentees to mentors and the high number of students per mentor hindered proper development of expected skills, knowledge, and competences as it was difficult to assist them all. The results of this study confirmed that the independent variables (mentor, institutional, and mentor- mentee relationship factors) had a strong statistically significant relationship (p<0.05) on the dependent variable clinical competences. This study therefore recommends the hospital to improve the mentoring environment, by resolving the mentor- mentee relationship challenges. Both institutions to come up with a policy and implement a formal structured mentorship program so that there is a precedent standard that can be followed to have a mentoring action plan where students are intentionally matched to mentors depending on the placement.
Assessment of Nutrition and Dietary Practices Among Patients with Gastrointestinal Symptomatology at Kenyatta National Hospital, Kenya
(KeMU, 2025-10) Ndirangu, Faith Wambui
Gastrointestinal Symptoms (GIS) represents a range of disorders with unclear pathophysiology, presenting symptoms such as abdominal pain, ulcers, cramps, constipation, nausea, and vomiting. The disease is linked to multiple factors, including genetics, environment, infections, immune dysfunction, and altered gut microbiota. The rising incidence of GIS globally—affecting over 6.8 million individuals—is attributed to increased urbanization, industrialization, and consumption of processed foods. Sub-Saharan Africa, despite reporting an increase in GIS cases, has limited published studies on the condition, highlighting the need for localized research. The study investigated the dietary habits, nutritional status, and food choices of patients with GIS attending Kenyatta National Hospital (KNH). This study assessed 200 randomly selected GIS patients diagnosed by 2023. It aimed to determine their socio-demographic characteristics, dietary patterns, the influence of food choices on disease progression, and their nutritional status. Findings indicated that females (57%) were more affected than males, though gender did not show a statistically significant association with GIS (p=0.76). The majority (40%) were aged above 34 years, and most patients (72.5%) lived in urban areas. Socio-economic factors such as marital status, education, and income had significant associations with GIS (p<0.05). Over 45% of respondents were well-educated and self-employed, and 22.4% reported a history of cigarette smoking. Dietary analysis revealed that 87% of respondents used sugar in beverages, and 87.9% preferred home-cooked meals, with only 8.1% eating in hotels. The most common foods reported to trigger GIS included beans (76.6%), spicy foods (14.1%), chapatti (13.8%), soft drinks (5.8%), and oranges (4.1%). Similarly, intolerable foods identified were legumes (28.9%), chapatti (10.4%), milk (5.8%), and oranges (5.2%). Foods that brought relief included cabbage (23.3%), potatoes (10.75%), milk (8.3%), and carrots (6.2%). Nutrient intake assessment showed excessive consumption of macronutrients compared to recommended daily allowances (RDAs): carbohydrates (154%), protein (193%), energy (127%), and fiber (211%). Consequently, 69% of participants were overweight or obese (BMI ≥26.38 kg/m²), though none were morbidly obese or underweight. Regression analysis showed a significant relationship between BMI and calorie intake (p=0.003), while the relationship between BMI and food frequency was not significant (p=0.680), contrary to most prior research. The study recommends that GIS patients regularly consult nutritionists to receive updated dietary guidance, control portion sizes to reduce excess macronutrient intake, and engage in at least 30 minutes of exercise daily. Weight reduction and careful food selection, avoiding foods that aggravate symptoms, are essential. Additionally, the Ministry of Health (MOH) should develop dietary prescriptions for GIS patients and integrate GIS management strategies into national health policy guidelines.
Assessment of Nutritional and Lifestyle Risk Factors Influencing Clinical Remission in Multiple Sclerosis Patients in Nairobi County
(KeMu, 2025-11) GIKUNGA, CYNTHIA WAMBUI
Multiple sclerosis (MS) is a condition identified by acute inflammation in the cerebrospinal axis, that brings about demyelination and nerve dysfunction. This incapacitating condition presents diverse neurological symptoms, including fatigue, compromised mobility, sensory disturbances, and cognitive impairment. This investigation, conducted in Nairobi, aimed to explore the influence of dietary risk factors on disease activity and clinical remission in MS patients, utilizing a mixed-method approach. Nairobi faces distinctive healthcare challenges and comprehending how dietary factors interact with MS outcomes can lead to tailored interventions that enhance the well-being of patients in this environment. The study employed a cross-sectional study design encompassing qualitative and quantitative data collection methods. A total of 150 participants with multiple sclerosis (MS) were studied, with a mean age of 41 years; 58.67% were male and 41.33% female. Most had Relapsing-Remitting MS (80%) and were primarily managed by neurologists (88.67%). Mediterranean (39.33%), low-carb (27.33%), and vegetarian (26%) diets were the most common dietary patterns, with 84% of participants reporting supplement use and 67.33% consuming whole grains daily. A large proportion (88.67%) achieved clinical remission. Statistically significant associations were found between dietary compliance and remission (χ² = 15.495, p = 0.004), with 92% of those reporting “very close” adherence attaining remission. Dietary patterns such as gluten-free (100%), low-carb (95.12%), and vegetarian (92.31%) were significantly associated with higher remission rates (χ² = 8.3824, p = 0.039). Supplement use (OR = 36.05, p < 0.001), avoidance of sugary foods (OR = 209, p < 0.001), and occasional dairy intake (OR = 16.33, p = 0.006) were strongly linked to remission. Logistic regression showed that disease stage (OR = 0.099, p < 0.01) and disease progression markers (OR = 0.301, p < 0.05) negatively influenced remission. While most demographic factors showed no significant effect, poor dietary adherence significantly reduced the odds of remission. Non-dietary factors such as physical activity (χ² = 105.87, p < 0.001), sleep quality (χ² = 18.85, p = 0.001), psychological health (χ² = 19.69, p < 0.001), and environmental triggers (χ² = 15.04, p = 0.001) were significantly associated with clinical remission. High levels of daily physical activity (61.33%) and satisfactory sleep (88%) were common among participants who attained remission. Qualitative findings confirmed that stress, diet, exercise, sleep, and family support jointly influenced symptom control and compliance. Based on the findings, promoting adherence to anti-inflammatory dietary patterns, regular supplement use, and consistent physical activity is crucial for achieving clinical remission among MS patients. Integrating holistic lifestyle interventions including stress reduction, quality sleep, and psychological support can further enhance disease management and symptom control. The findings revealed that adequate dietary diversity, higher protein intake, and regular physical activity were positively associated with clinical remission, whereas sedentary lifestyle and poor dietary habits were significantly linked to relapse or prolonged symptom activity. Socioeconomic factors such as income level and educational status also influenced dietary compliance and overall disease management. The study concludes that nutritional quality and lifestyle practices play a vital role in modulating remission among MS patients. These findings contribute to understanding the behavioral and dietary determinants of remission and underscore the need for comprehensive dietary counseling and lifestyle interventions in MS care programs.
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.
Assessment of Satisfaction with Online Learning Environment among Nursing Students in Kenya Medical Training College (kmtc) Nairobi
(KeMU, 2023-09) Maryline Chebii
In recent years, there has been an increased use of eLearning in medical training colleges, driven by technological advancements, learners' desire for flexibility, and the COVID-19 pandemic. However, there is limited literature on nursing students' satisfaction with the eLearning environment at Kenya Medical Training College (KMTC) in Nairobi. Therefore, this study aimed to assess nursing students' satisfaction with online learning at KMTC Nairobi, focusing on teacher, platform, and user-related variables. A cross- sectional survey was conducted, involving 259 nursing students who were selected proportionately from eligible classes. Data was collected using self-administered semi- structured questionnaires and a Focus Group Discussion guide. Ethical clearance was obtained, and participants were informed of the study objectives before giving consent. The collected data was coded, cleaned, and analysed using SPSS software. The study included 234 questionnaires in the final analysis, achieving a response rate of 91%. The majority of participants were preservice learners (75.6%) in their first year of training (50%). Female students constituted a significant proportion (81.5%) of the sample. The primary online learning platforms used were Zoom and Google Classrooms. The study investigated student characteristics, instructor characteristics, platform characteristics, and institutional support in relation to satisfaction with online learning. The findings revealed that a significant proportion of students faced challenges in accessing a computer (50.2%), reliable internet (65.1%), and a conducive study area (53.2%). Cross-tabulation analysis showed that various student factors, including navigating online platforms (p = 0.026), browsing the internet (p = 0.003), accessing and using a computer (p = 0.003), having reliable internet access (p = 0.01), and being in a conducive environment for online classes (p = 0.01), were significantly associated with high satisfaction with e-learning. Instructor factors associated with high satisfaction included teacher knowledge (p = 0.001), active facilitation on online platforms (p = 0.001), concern for student needs (p = 0.002), and providing prompt feedback (p = 0.001). Platform characteristics significantly influenced satisfaction, with a small percentage of students able to upload work onto the platform (34.5%), hold online discussions easily (35.4%), or receive necessary technical support (39.4%). Students expressed significant satisfaction (p < 0.05) with platforms offering updated materials, flexibility in learning, accessibility to content and sessions, efficient time management, and time-saving benefits. Higher satisfaction levels (p < 0.05) were observed when students could easily upload content, engage in discussions, had clear objectives, encountered logically organized content, experienced seamless communication, and had access to technical support. Institutional support for e-learning was perceived as inadequate, significantly impacting satisfaction levels (p < 0.05), particularly in terms of technical support availability and access to e-learning platforms for all students. The study recommends actions to improve the online learning experience, including ensuring access to computers and reliable internet, enhancing instructor effectiveness, improving platform functionality, and addressing gaps in institutional support. Future studies are also suggested to investigate instructor training needs and interventions for technical skill improvement.
Assessment of the Role of Nurse Educators in Clinical Learning of Undergraduate Nursing Students at Kenyatta National Hospital, Kenya
(KeMU, 2022-10) Otunga, Claire
Clinical learning enables nursing students to implement knowledge transfer fromtheorytopractice. Therefore, it is the role of nurse educators to fulfill this role to facilitate learningingraduate nursing education. This can be achieved when educators conduct effective patient- centered interactions with student nurses. Although their role is stipulated by the relevant bodies, it is not clear to nurse educators. At the study site, the hospital withdrewclinical mentors leaving a huge gap in the role of nurse educators to fulfill. The purpose of this studywas to assess the nurse educators' role in the clinical learning of undergraduate nursingstudents at Kenyatta National Hospital, Kenya. A descriptive cross-sectional study designthat adopted a mixed-method was used. The target population was all nurse educators fromall seven universities. Multiple sampling was used, thus stratified randomsampling, thenpurposive for the eighty-two nurse educators, and convenience sampling for the 3rd-year undergraduate nursing students. Quantitative and qualitative data were collected usinganinternet -administered, semi-structured questionnaire, and an interview guide. In quantitativedata analysis, descriptive statistics were used and Statistical Package of Social Sciences(SPSS) version 24 was employed, then for inferential statistics, Binary Logistic RegressionbyOdds Ratio, the level of significance was set at <0.05. Data was presented in formof tablesand figures. Qualitative data were coded, analyzed thematically, and presented in narratives. Ethical approval, clearance, and permission protocols were observed. Participants' informedconsent was sought and anonymity, and confidentiality were observed. The teachingrole, (90.8%) participated in planning and orientation, and for teaching methods, case study (85.5%, p=0.030) was highly utilized by educators. The educator skills and attributes, evaluation, andenvironment were significant at (p=0.001, p=0.005, p=0.003) respectively thus affectinglearning outcomes. For the supportive role, professional socialization (55.3%, p=0.004), useof the clinical teaching model (89.5%, p=0.008), and supervisory visits 2 weekly p=0.001were significant. In the administrative role, formal and informal orientation was (10.5%, p=0.001) thus essential to clinical learning. Regarding collaborative roles, forums werelessutilized (7.9%, p=0.039), and training of health workers 47.4%, p=0.041) respectively. Inconclusion, the role of nurse educators was significantly affected by the planning, orientation, good interpersonal relationships, clinical teaching methods, and a conducive environment. Professional socialization, availability of educators, use of clinical teaching model, andsupervisory visits were found to improve clinical learning outcomes. None the less clinical orientation, and facilitating transport for students were essential with the use of collaborativeforums. Also, good interpersonal relationships, training of health care workers, and feedbackwere found to be significant. The study recommends the readjustment of policies byuniversities and curriculum review on the clinical roles of nurse educators, especiallyinteaching, administration, support supervision, and models. Also, the formationof collaborations and partnerships at clinical sites by various universities is to be considered.
Assessment of Vitamin A Routine Supplementation and Diet Rich in Vitamin A on Nutrition Status in Under Five Years of Age in Wajir East Sub-County
(KeMU, 2020-11) Abdi, Nuria Ibrahim
The deficiency of Vitamin A increases child vulnerability to stunting whose effects are permanent if not managed early and spilling over into adulthood. The study aimed to measure the outcome of vitamin A routine supplement and diet rich in vitamin A on morbidity and nutrition status (stunting) in under-fives months children in Wajir East Sub-County. The study design was descriptive cross-sectional survey. The target population was children under-fives months and the sample size was 207 however there was a non-response of two making the response rate 99.03% which is still considered valid. Interview schedule was used to gather information from the caretakers and mothers of under-fives children in the study and anthropometric measurement was used to collect data on height/length for age of the target children. The respondent was selected randomly. SPSS (Statistical Package for Social Sciences) was used to evaluate statistics. Permission was obtained from respondents. Research approval, ethical clearance and research permit were granted by Kenya Methodist University and National Council of Science, Technology and Innovation respectively. The routine coverage for under-fives was found to be 51.2%. Study findings also revealed the prevalence of stunting was high at 63.4% among children who did not receive vitamin A supplement as compared to those who were supplemented (36.6%). Further analysis indicated that there was substantial (0.036) association between the supplement and nutritional status of the target group. The study concludes that the outcome of the vitamin A routine supplementation had effect on both occurrence of morbidity and children nutritional status in Wajir east. The study recommends the need for the national, county government and health stakeholders to strategies and put more effort to accelerate and establish platforms that enhance service delivery at the community level such as Baby Friendly Community Initiative through community strategy to address the poor coverage and insufficient doses , and also to improve availability of the vitamin A stocks at the health facility level since it’s one of the factors that is highly influential in supplementation as identified in the study.
Association of Carcinogenic Heavy Metals in Foods, With Colorectal Cancer, In Nyambene, Meru County, Kenya,
(KeMU, 2025-10) Onduso, Brian Moindi
Colorectal cancer is a growing public health concern in Kenya, especially in the Kiegoi sub-location of Nyambene region where incidence rates are rising without clear etiology. This study aimed to quantify arsenic, cadmium, chromium, mercury and lead in staple foods from Kiegoi and explore their association with colorectal cancer incidence in the area. Cross sectional retrospective review of Meru Teaching and Referral Hospital oncology department records from 2018-2024 was conducted which limits the causal inference of heavy metals in colorectal cancer. Samples of beans, arrowroots, potatoes and maize were collected using simple randomized stratified sampling from each of the five agro- ecological zones in Kiegoi. The samples were then digested with nitric v acid, perchloric acid and hydrochloric acid and analyzed by inductively coupled plasma mass spectroscopy (ICP-MS). The overall crude incidence of colorectal cancer in Kiegoi was 1211 per 100,000 of the population. The age specific standardized rate (WHO standard population) was599 per 100,000 of the population. Cadmium levels were significantly below regulatory thresholds (below FAO/WHO limits) in all foods. Mercury and chromium levels exceeded limits in 100 % of the samples; arsenic and lead exceeded levels in 50 %. Multivariate logistics regression identified lead (OR=17.7), mercury (OR=3.5) and arsenic (OR=2.5) as significant predictors for colorectal cancer. Cadmium showed a negative association while chromium’s effect was marginal. Widespread contamination by mercury chromium and lead in staple foods most likely contributes to Nyambene’s colorectal cancer burden. Policy measures should include routine environmental surveillance, soil remediation and targeted public health screening.
Barriers to Effective Communication between Student Nurses and Older - Patients at Chogoria Hospital
(KeMU, 2013-08) Phidelis, Kubende O.
Older adults constitute a majority and 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 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.
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.
Barriers to Implementation of Nursing Process among Nurses Working In Narok County Referral Hospital
(KeMU, 2020-11) Anna, Lekenit Saretin
Globally, nursing process has gained popularity and is utilized in hospitals to offer quality individual nursing care to patients. It is utilized by nurses in clinical setup to offer quality nursing care to patients individually as unique and having special needs. Nursing process non-implementation can lead to poor nursing care to patients in healthcare institutions. This study therefore assessed barriers of nursing process implementation by Narok County Referral Hospital (NCRH) nurses. A descriptive cross sectional study design was used to collect data from 102 conveniently sampled nurses in NCRH. The study instruments used were self-administered questionnaires and key informant interview. SPSS version 20.0 was used to analyze quantitative data and sample characteristics were analyzed using mean and median. Qualitative data was thematically analyzed and presented in tables. Association between the study variables was calculated using chi square at 95% level of significance while statistical significance of results obtained was calculated using p values of 0.05. Approval was sought from relevant authorities. The study findings may be of importance to Health institution managers, policy makers, nurses and patients in terms of improving service delivery, reduction in mortality and morbidity as well as length of stay of patients. The study results showed that female participants were the majority(70.6%). Most participants (71.6%) had attained diploma level of education and among them, 92.2% had received training in nursing process. Majority 95 (93.2%) were observed not to implement nursing process and of those who implemented, only 1 (1%) correctly outlined all the steps, a sign of poor nursing process implementation. NP implementation was of statistical significance with age of nurses (p =0.001) since 18 out of 29 of younger nurses aged 21-30 years were found to actively practice it. This finding showed that younger nurses were found to implement NP more compared to their older counterparts. Work experience (p = 0.015) was also of statistical significance since the study results showed that recently qualified nurses with working experience of 10 yrs and below (p=0.015) had high likelihood of implementing NP at 64.7% in relation to their counterparts who are older in the profession. Those who were between 11-15 years accounted for 26.3% while 29.4% were aged 16 years and above. This finding shows that nurses who are fresh from school practiced what they learnt and try to do the ideal as opposed to their counterparts who have remained in service for many years. On the other hand, institutional factors (p=0.075) had no significant relationship with NP implementation except on the supply of necessary tools (p=0.001) and implementation of NP. Availability of materials was seen to impact positively NP implementation. The interview also revealed less commitment by the hospital administration to supporting nurses in implementation of the NP. Therefore, the study recommends that nursing process mainstreaming interventions such as regular staff refresher courses, mentorship in the hospitals, availability of relevant resources, change of attitude by nurses, hospital managers commitment towards supporting NP activities and nurses, can highly improve NP implementation and prevent the above obstacles
Barriers to Uptake and Utilization of Linda Mama Initiative Among Women of Reproductive Age (15-49 Years) in Kajiado North Sub-County, Kenya
(KeMU, 2024-09) KENDAGOR, LYDIA
Maternal mortality remains a significant concern globally, with substantial improvements observed over the years yet persisting challenges, particularly in resource-constrained regions like Kenya. From 2000 to 2018 according to the World Health Organization (WHO), approximately 295,000 women died during and following pregnancy and childbirth in 2017. Kenya, like many countries in sub-Saharan Africa, faces challenges in reducing maternal mortality rates despite efforts to improve maternal healthcare services. According to the Kenya Demographic and Health Survey (KDHS) 2014 estimates, Kenya's maternal mortality ratio (MMR) was 362 maternal deaths for every 100,000 live births. In Kajiado North Sub-County, Kenya, despite governmental efforts such as the Linda Mama program, aimed at sponsoring maternal care services to alleviate financial burdens on expectant and pregnant women, uptake and utilization of these services remain low. This study, conducted between 2018 and 2020, targeted childbearing mothers aged 15-49 in Kajiado North Sub-County, with a population of 310,696. The study employed inferential statistics, specifically chi-square tests, to reveal significant relationships between socio-demographic factors, health system factors, and the uptake of the Linda Mama Initiative, with p-values less than 0.05. It was found that only 26% of women had registered for the initiative, a figure significantly lower than the national target, despite high levels of knowledge and positive perceptions of the program. The analysis further demonstrated that health system factors, such as infrastructure and support from health workers, had a more substantial impact on the uptake of the initiative compared to socio-demographic factors. Findings indicate that the Linda Mama Initiative program is accessible and straightforward, with easy enrollment processes primarily conducted in health facilities and minimal paperwork requirements. Information dissemination about the initiative is facilitated through various media channels, including social media, radio, television, and community forums like Chief's Baraza. The study underscores the importance of promoting the utilization of Linda Mama initiative services, emphasizing their accessibility, affordability, and critical role in safeguarding the health and well-being of mothers and newborns. The study recommends policymakers to improve infrastructure and possibly increase funding. Implementers should make use of social media for dissemination, expand insurance coverage and involve local leaders for credibility.