School of Medicine and Health Sciences
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Item Determinants of Willingness to Renew National Hospital Insurance Fund among National Scheme Members in Kajiado County, Kenya(KeMU, 2022-10) Saikwo, Sisimwo KennethUnder the WHO’s systems strengthening building blocks, Health financing is key to achieving universal health coverage (UHC). However, progress to achieve equity, quality and financial protection is slow especially in Africa. Kenya is rolling-out national health insurance scheme through NHIF towards achieving UHC. However, evidence shows that uptake of NHIF is low and that voluntary membership is marked by high attrition rates. This survey sought to establish the factors connected with willingness to renew the NHIF among Supa cover members in Kajiado County. The study used mixed methods cross sectional survey to establish the causal factors of willingness to renew their NHIF covers among national scheme members. Respondents were selected through purposive sampling with stratification. Quantitative data was collected through researcher-administered questionnaires rated on a 5-point Likert scale while qualitative data was collected using key informant interview (KII) guides. The study was approved by KeMU Scientific Ethical Research Committee (SERC and a research license to conduct the research was authorized by the national commission for science, technology and innovation (NACOSTI). Data was entered in Microsoft Excel 2016, exported to SPSS version 26 for analysis. Descriptive statistics were reported using median and interquartile ranges. Binary logistic regression was used to establish the significant determinants associated with the willingness to renew the insurance covers. P-values of less than 0.05 were considered statistically significant. Overall, respondents showed high willingness to renew NHIF (median 3.86, IQR 0.75). At the multivariate logistic regression, the study findings showed that controlling for all factors, marital status, household size, household income per month, awareness of NHIF fund services, service providers and adverse selection on willingness to renew were significant determinants of willingness to renew the insurance cover (p<0.05). In conclusion, the study found that the key determinants of willingness to renew NHIF among residents of this region include; awareness of NHIF services, Service provider factors and adverse selection. Others are marital status, household size and household income. NHIF should increase the community’s awareness on the health insurance risk-benefits through member education and improve access to high-grade health services in the accredited institutions to enhance renewal of cover by members.Item Determinants of Adherence and Retention in Care of Hiv Positive Adolescents in Murang’a County Hospital, Kenya(2020-10) Peter, Kabugua NdunguThe burden of HIV amongst teenagers in Kenya is increasing, yet the adolescence period can be a window of maximum prevention, testing, and treatment HIV. The prevalence of HIV among adolescents (10-19 years) was 0.9% in 2018. Adherence to medication and retention in care is important in improving clinical outcomes and quality of care. Disaggregated data particularly for the adolescent age group is a challenge in Murang’a County. The study aimed at determining the factors associated with retention and adherence in care for HIV positive adolescents attending Murang’a HIV Comprehensive Care Center (CCC). A descriptive cross sectional study was carried out at Murang’a County Comprehensive Care Center involving 93 purposively sampled adolescents. 2 key informants were conveniently sampled. Retrospective Retention data of the preceding 12 months (Nov 2018-Nov 2019) was collected from the hospital records. Data was collected using a questionnaire, FGD and key informant guides. Data was analyzed using SPSS, both descriptive and inferential statistical techniques were used i.e chi square and cox to regression analysis, time to event data was used to analyses survival of adolescents in care. Qualitative data was manipulated manually through thematic analysis. In the preceding 12 months, the number of adolescents enrolled in care was 350. 250 (71%) were retained in care and 100 exited in that period. The average period till exit was 3.463 years. Transfer to other facilities, deaths and loss of follow up resulted to exit. The median survival time was 3.00 years. Retention had a significant association with adherence at (p=0.043). The results showed that 91(98%) of the respondents were adhering to HIV management. Increasing level of education improved adherence and retention to care. From the FGD, disclosure, family and hospital support system, reduced waiting time, health education and counselling were contributed to good retention and adherence. Stigma, fatigue from medication and peer pressure were cited obstacles. The study recommends development of cost-effective, scalable, and sustainable evidence based strategies to strengthen adolescent retention in care and adherence to ART. HIV data reporting systems on adolescents should be improved more so adolescent specific data should be disaggregated. Continuous strengthening of health education through operation triple zero (OTZ) and counselling is important for improvement and maintenance retention to HIV care. There is need for continuous HIV/AIDS awareness in the community to reduce some of the barriers like stigma and discrimination to HIV care. There is also the need for continuous improvement and adjustment of HIV/AIDS care service to meet the needs of adolescents to maintain good retention and adherence. Further research on challenges facing transition from paediatric to adolescent care is recommended.