KeMU Digital Health Repository

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Welcome to African Digital Health Library community Kenya node. The African Digital Health Library (ADHL), Kenya node, makes available health-related content ranging from theses, dissertations,from the School of Medicine, Kenya Methodist University. ADHL currently operates in 5 Sub Saharan African Countries and is supported by the medical librarians. It is a collaborative effort among medical librarians at major universities in sub-Saharan Africa Kenya, Mali, Nigeria, Zambia and Zimbabwe and is funded by the Office of Global AIDS/US Department of State and the U.S. National Library of Medicine / National Institutes of Health. The Kenyan node is managed through the Kenya Methodist University Library and The University of Nairobi.

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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.
Analysis of factors that influence drugs and substance abuse among secondary school students in Imenti North District.
(KeMU, 2014-06) Mukomunene, Pamela
Drug and substance abuse has continued to be an issue of great concern during the past several years with a great number of people reported as drug abusers in the world and being a serious problem affecting secondary school students. Drug and substance abuse has numerous biological, psychological and social adverse consequences. The menace has been reported as being influenced by different factors which include mass media, availability of drugs, peer pressure, curiosity, and availability of funds, boredom, harsh school rules and poor parenting. The study being carried out is aimed at analyzing the factors that influence drug and substance abuse among secondary school students in lmenti North District. The research objectives for the study were whether peer pressure, mass media, amount of money given to students and availability of drugs influence drug and substance abuse among secondary school students in Imenti North. The target population was composed of 10,663 students from the 43 secondary schools in Miriga Mieru East and West divisions. Questionnaires were prepared and used in the collection of primary data from the deputy principals, teachers and students. Prior to administration, the questionnaires were pilot tested to facilitate validation and assessment of reliability. The data was analyzed manually at the end of which results were displayed using frequency distribution tables, percentages and pie charts. The study concluded that drugs and substance abuse was influenced by different factors. These were categorized into major and minor factors, the major factors included mass media, peer pressure, availability of. Drugs and the amount of pocket money given to the students. The study, therefore, recommends that parents and guardians should avoid giving a lot of pocket money to their children; the government should come up with ways to fight drugs found within the students' reach.
Assessment of factors affecting healthcare waste management system in Machakos County, Kenya
(KeMU, 2019-09) Mwania, Michael Musango
In general, most local authorities in Kenya have been unable to cope up with the segregation, the treatment and methods of waste disposal especially healthcare waste. Health facilities in Machakos County have poor practices when it comes to the segregation of healthcare waste, its treatment & disposal; the general population, the patients, the health workers including waste handlers are exposed to certain risks such as needle stick injuries, a higher risk of infection of HIV/AIDS and hepatitis B&C. This study, therefore, focused on the reinforcement of the service delivery pillar of Health Systems, through addressing aspects of securely managing healthcare waste in medical facilities in Machakos County. The general objective of this study was to ascertain factors affecting the management system of healthcare waste in Machakos County in Kenya. The study was governed by four specific objectives; to determine the process of healthcare waste management, the role of health Managers, human resource factors, and how the implementation of healthcare waste management policy affect the management of wastes in the healthcare facilities in Machakos County. To obtain data for the study, a survey research-based study was used. Stratified random and purposive sampling techniques were used in drawing a sample size of 187 respondents. Questionnaires and interview guides were used in the collection of primary data, whereas existing literature that is related to the current research topic under study was used for the purposes of secondary data. The study findings showed that all the four independent variables healthcare waste management process health manager’s role, human resource factors, and healthcare waste management policy implementation had positively and significantly influence on the management of healthcare waste system. From the findings, the health manager’s role had the strongest positive and significant influence on the management of the healthcare waste system. The study concluded there is an inefficient healthcare waste management process in Machakos county health facilities, Health Managers understands their role in waste management but lack capacity building and enough funding to purchase required healthcare waste management commodities. Main human resource factors were lack of capacity building through continuous medical education on healthcare waste management and enough healthcare waste management commodities hence leading to inefficiencies on waste management. Most Health workers had little or no information on customized healthcare waste management policies and guidelines. The study recommended there a need for training on healthcare waste management to all healthcare staff and waste handlers in line with existing healthcare waste management policies for the healthcare waste management in Machakos County and in Kenya. County governments need to provide adequate budgets to health facilities to enable procurement of adequate healthcare waste management commodities and also adopt safe treatment technologies.
Assessment of health workers perinatal knowledge and practices related to service delivery in Makueni County,Kenya
(KeMU, 2019-09) Benard, Kasanga David
A health system has six interdependent and interrelated pillars: health workforce; service delivery; information; financing; medical products, vaccines and technologies; leadership and governance. This study addressed health workforce pillar in order to strengthen maternal and new born services delivery in Makueni County. Globally, new born (neonatal) mortality remains unacceptably high. Neonatal mortality accounts for 60% of infant mortality rate in Kenya. In Makueni County, 1 in 22 children does not live to his or her first birth day. This unacceptable high mortality is despite existence of cost-effective evidence-based interventions which could reduce up to 70% of current deaths. Review of client complaints in Makueni has revealed gross medical mismanagement raising concerns whether health workers attending to them are knowledgeable. This study assessed perinatal knowledge and practices among health workers in Makueni County. It specifically established prenatal care knowledge and practices, pre-eclampsia knowledge, postnatal care knowledge, home visits and hand hygiene knowledge among health workers in Makueni County. The study was cross sectional in design where 163 health workers selected randomly were interviewed using a structured questionnaire and a checklist used to observe antenatal care consultation practices. Data analysis was done using SPSS v25 and chi-square statistic test used to examine associations within variables. On prenatal care, 89 (54.6%) of health workers were rated as having good knowledge. However, practice did not conform to guidelines since 10 (30.3%) and 23 (69.7%) of mothers didn’t have full history taken and general physical examination done respectively. On pre-eclampsia 78 (49.4 %) had poor knowledge while on use of recommended drugs for pre-eclampsia, 70 (42.9%) had moderate knowledge and 39 (23.9%) poor knowledge. On postnatal care, 132 (80%) had good knowledge on young infant feeding while 35 (21.5%) had poor knowledge on new born care. On management of neonatal infections, 58 (37.4%) had good knowledge while on home visits 80 (48.5%) knew the importance of home visits but 88 (80.4%) did not know the optimal time for the visits. On hand hygiene 127 (77%) of health workers knew the four critical times for washing hands with soap under running water. The study concluded that workers had good knowledge on prenatal care, young infant feeding and hand hygiene. There were critical gaps in knowledge on pre-eclampsia, use of recommended drugs for pre-eclampsia, new born care, management of neonatal infections and home visits. Prenatal care practice did not conform to guidelines. The study recommended refresher courses and continuous medical education in focused antenatal care, management of pre-eclampsia, newborn care, management of neonatal infections and home visits. It also recommended strengthening of supportive supervision to ensure guidelines are available and adhered to in practice.
Assessment of nutrition counseling services offered to diabetic patients and its effect on adherence to therapies and treatment at the Nakuru Provincial General Hospital, Kenya
(KeMU, 2012-06) Karanja, Lucy W
Poor health has been a global issue which has been associated with the impediment of productivity, economic growth and poverty eradication. It has been estimated that 32 percent of the global burdens of disease are caused by dietary complications. All millennium development goals are in one way or the other related to good nutrition intake. Nutritional Counseling has been credited for ensuring that people are aware of their dietary choices hence avoiding nutritional complications. This is more essential to diabetic patients. The purpose of this study was to assess the effectiveness of Counseling services offered to diabetic patients in Nakuru Provincial General Hospital, Kenya. In order to have the study carried out successfully, a descriptive survey was used to assess the effectiveness of nutritional Counseling services. The sample consisted of 283 respondents that included 8 dieticians and 275 diabetic patients. Stratified random sampling where the total population was split into two distinct samples (diabetic patients and dieticians) based on their demographics. After obtaining permission from all relevant authorities, the researcher collected the data in form of responses through structured questionnaires. Expert judgment was used to improve on content and construct validity of the items. The Statistical Package for Social Sciences (SPSS) was used to analyze the data. The study established that there was a significant relationship between the patient’s nutritional knowledge and recovery rate. Majority of the patients were not adhering to the recommended therapy. There was a statistically significant influence of nutritional counselors’ knowledge of diabetic management and diabetics’ recovery rate. There was also a significant relationship between the economic status of patients and adherence to therapy. This study recommends that the government must take an active role in promoting the nutritional counseling services offered in hospitals by employing more dieticians, intensifying awareness campaigns on the recommended diet for the diabetics. Civil society and religious groups must also take an active role by holding workshop and seminars to sensitize the community about the diabetic condition, psychological support and fighting against stigma to the patients. Additionally, dieticians need to be aware of the current recommendations for diabetic patients so as to pass it on to their clients. Male nutritionists/dieticians should also be trained to encourage more male patients to attend counseling sessions. The researcher suggests a further research on the level of stakeholders input in promoting nutritional counseling in hospitals and an assessment on whether patients actually adhere to the diet by doing a 24 hour recall.
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.
Community health information system utility.
(2015-12) Pepela, Wanjala David
A wealth of data is available within the healthcare systems more so at community level. However, lack of effective use of information shared during dialoguing at the community level in Bungoma County posed a great challenge despite efforts by government in recognising community care services as critical level 1 service. Health indices have remained on a worsening trend with service utilisations very low. The purpose of the study was to inform service utilisation, promote use of community health information to improve health outcomes. The main objective was to determine the community health information system utility to improve health outcomes in Bungoma County. The specific objectives were to assess the community units level of use of information processes for improved community health services; to identify the technical tools for sharing information during community dialogue and action days; establish community health information system capacities affecting sharing of available information and determine what organisational factors influence sharing and use of community health information. The study was descriptive cross-sectional design. The study employed a combination of stratified clusters proportionate to population size and applied simple random sampling technique with a proportion of 30% of target population as representative sample. The target population was (N =163) with a sample size of nh =54 community units. A structured interview questionnaire both closed and open-ended was administered to Community Health extension workers and 3 in-depth focus group discussions. Data analysis generated univariate frequencies and interpretation using tables and charts. The expected outcome was utility of health information. Results showed that response rate 44 (81.5%), 35 (79.5%) with knowledge on data management and 39 (88.6%) generated monthly summaries with 34(77.3%) with overall utility of community information using white/chalkboards. 27(60.6%) provided feedback and shared information during dialogue days monthly at 41(93.2%) and 17(38.6%) respectively. Information had inadequate involvement in design 14(32%), unavailability of data tools in 39(89%) and less use of appropriate technologies. 26(59.1%) had knowledge on kind of information required, 27(61.4%) analysed this information while, 42(95.5%) used information for evidence based-decision making. Income generating activities supported by partners in 6(13.6%) of the units. Community formal structures was in 32(72.7%) units and shared information in dialogue 54(100%), 36(81.8%) using "Barazas" while, 31(70.5% through health promotion and education. Majority 40 (90.7 %) were empowered through support supervision using standard procedures and checklists. Regression analysis using ANOVAa showed that results were moderately correlated with utility of community information with correlation Coefficientsa 0.017 at 13 0.538b, while Pearson Chi-Square Tests compared with use of information with linear association of 0.910 had a likelihood ratio of Fisher's Exact Test of 0.658 thus, result moderately significant. In conclusion knowledge was above average; information was regularly shared through community dialogues; while design, technical tools and empowerment of communities were weak and inadequate and finally the system was well structured though not resourced and uncoordinated. It was recommended that both National and County governments to emphasize on regular feedback to promote information utility; adequately provide technical capacities and mentorships;
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.
(KeMU, 2019-09) Nango, Wilbert Otieno
Most referral health facilities are faced with challenges ranging from congestion of patients at these health facilities, limited resources both human and material to deal with the voluminous clients, slow rate of service delivery due to high numbers as a result of the by-passing tendencies. Self-referrals normally results in compromised quality of medical care provided to the patients. The problems mentioned above affects most of the high level health facilities which are traditionally meant to be referral health facilities. The study conducted in the month of August 2017 therefore aimed to find out the determinants of a functional referral system in two level 5 health facilities; Jaramogi Oginga Odinga Referral Hospital (JOOTRH) and Kisumu County Referral Hospital (KCH). The objectives of the study were to; examine the extent to which the primary health care centres characteristics, patients’ characteristics, receiving health facility characteristics and proximity to a health facility influence a functional referral system. A cross sectional study was conducted using a qualitative approach to data collection. Three hundred and thirty eight patients were systemically selected to participate in the study. Data was collected using an individual questionnaire through one on one interview between the dates 14th- 22nd August 2017. The collected data were coded and analyzed using the SPSS 25.0 Computer program. The qualitative data collected were analyzed quantitatively using the descriptive statistics and linear regression models. The results indicates that there was a positive and significant influence of the primary health facility characteristics (r=.474**, p<0.001) and receiving facility characteristics (r=.475**, p<0.001) on a functional referral system at the two high level facilities. There was also a negative but significant influence of proximity to health facility (r=- 0.137**, p=0.017) on a functional referral system at the two level 5 facilities. On patients characteristics, a significant interaction was found on gender χ2 (1) = 4.64, p= 0.031, education level χ2(2) = 20.37, p<0.001 and Marital status χ2(2) = 8.78, p= 0.012 with a functional referral system. Conclusion – Factors influencing functional referral system are primary health centre characteristics, patients’ characteristics, proximity to a health facility and referral health facility characteristics. It is therefore recommended that the County government of Kisumu should improve the supply of drugs and quality of service delivery at the primary health facilities to attract more patients seeking primary care services, specialists movement especially to the lower level health facilities need to be reinforced by the Ministry of Health to boost the citizen’s confidence in quality of care at these facilities, more sensitization strategies need to be put in place to educate both the patients and health care providers on the recommended referral practices that should be upheld to improve efficiency and effectiveness of service delivery.
Determinants of 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).
Determinants of availability of tracer essential medicines in public health facilities in Nyeri County, Kenya
(KeMU, 2016-07) Kawira, Micheni Stella
The goal of the health system is to improve health and health equity in ways that are responsive, financially fair and make the most efficient use of the available resources. This is supported by six Health Systems Strengthening (HSS) pillars of medicines, vaccines and technologies, human resource, financing, leadership and governance, service delivery and health information systems. A well-functioning health care system ensures equitable access to medicines, vaccines and technologies which results in overall HSS. Tracer essential medicines are supposed to be 100% available at all times to treat the common ailments in a region. Despite the large number of patients that visit public health facilities, the inadequacy of trained pharmaceutical personnel, inefficiencies of the supply chain system and inadequate funding, no study has been carried out to ascertain the availability of tracer essential medicines in these facilities. The objectives of the study were to determine the stocking level of tracer essential medicines, to establish human resource factors affecting availability of tracer essential medicines, to find out the supply chain factors affecting availability of tracer essential medicines and to assess the organizational factors affecting availability of tracer essential medicines. A cross sectional study design with a mixed method approach was used. A questionnaire was used to collect data on the human resource factors and supply chain factors affecting availability of tracer essential medicines. A Focus Group Discussion (FGD) guide was also conducted with seven respondents comprising of six sub County public health nurses and the County pharmacist. The sample population comprised of 17 public health facilities and 30 pharmacy personnel. The response rate was 25 (83.3%). The average stocking level in tier three facilities was 94% while that in tier two facilities was 63.75%. The overall mean percentage stocking level of the 20 tracer essential medicines in all the facilities was 72.65%. Human resource factors that affected availability were unavailability of Standard Operating Procedures (SOPs), inadequate training of pharmacy personnel and pharmacy personnel not aware of tracer medicines. There was a significant relationship between availability of tracer essential medicines and pharmacy personnel awareness of tracer list (r=0.850), pharmacy personnel receiving training in commodity management (r=0.834), availability of SOPs (r=0.817) and designation of pharmacy personnel (r=0.746). The supply chain factors that affected availability of tracer essential medicines were long lead times, unavailability at Kenya Medical Supplies Agency (KEMSA), long ordering and delivery schedules and incorrect quantification. The organizational factors that affected availability were inadequate supportive supervision, inadequate financing and absence of Revolving Drug Funds (RDFs) within the facilities. The study concluded that the stocking level of tracer essential medicines in Nyeri County was below the World Health Organization recommendation of 100%. In addition, human resource factors, supply chain factors and organizational factors affected availability. The researcher recommends that a community pharmacy with subsidized medicines prices be introduced in the facilities; the County should facilitate training of all pharmacy personnel on commodity management, all facilities should have buffer stocks to cover at least two months as they await new stocks and the County should provide supportive supervision to the facilities.