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Item Influence of bystander activation on pre-hospital emergency care response time: systematic review(Emergency Care Journal, 2023-07) Musyoka, Felistus Ndanu; Tenambergen, Wanja; Mapesa, Job; Ndolo, Abdushakur; Agot, George; China, Joy; Koyio, Lucina; Ngunu, Carol; Mulonzi, Martin; Njeri, VeronicaThis article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emer- gency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We fol- lowed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emer- gency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analy- sis included forty-six relevant studies meeting the inclusion crite- ria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopul- monary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC sys- tems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.Item Effectiveness of Bystander Knowledge through Community-Based Training on Responsiveness of Prehospital Emergency Care in Nairobi County, Kenya(Journal of Health, Medicine and Nursing, 2025-07) Musyoka, Felistus Ndanu; Tenambergen, Wanja; Mapesa, JobPurpose: Most of the emergencies occur outside heath care setting and prehospital emergency care is vital in reducing preventable deaths and disabilities. In Nairobi, emergency response remains fragmented, and bystander involvement is limited due to low knowledge and training. To assess the effect of bystander Knowledge through community-based training on responsiveness of pre-hospital emergency care. Methodology: This quasi-experimental pre-post intervention in Mama Lucy Kibaki Hospital's catchment area trained 128 Community Health Promoters (CHPs) to educate 64,000 households on emergency notification and response. Baseline and end-line data collected via questionnaires were analyzed using SPSS v26.0. Findings: Training bystanders dramatically improved their emergency response knowledge and efficiency. Knowledge scores significantly increased (p=0.001), with notable gains in knowing the emergency number (55% to 83%), saving the tollfree number (16% to 73%), and recognizing 1508 (4% to 48%)— all p<0.0001. The percentage of individuals knowing what to do in an emergency rose from 85% to 94% (p<0.001), and the mean knowledge score increased from 6.39 to 7.30 (p<0.001). Improvements were observed across all demographic groups. Post-secondary educated respondents showed the strongest gains (+13.7 percentage points to 96.5%, p<0.001). Males experienced greater improvement (+14.4 points to 93.7%) than females (+9 points to 82.2%). The training was most effective for interior residents (achieving 100% knowledge) and those near major roads (+21.3 points to 78.9%, p<0.001). Casual labourers demonstrated the largest gains (+40.9 points to 90.9%). Workingage participants, specifically those aged ≤30 and 31-40 years, also showed significant knowledge increases (+11.4 and +10.9 points, respectively). These knowledge gains led to faster emergency responses, with 87% of reports occurring within 0-5 minutes postintervention, compared to 0% at baseline. Delays exceeding 15 minutes plummeted from 80.4% to 4.1% (p<0.001). The strongest predictors of knowledge were post-secondary education (OR=5.64, p<0.001) and interior residence (OR=7.32, p<0.001). Casual labourers showed reduced odds of knowledge (OR=0.24, p=0.017), while respondents aged 31-40 years had 74% higher odds (OR=1.74, p=0.039). Gender, most employment statuses, and age >50 years did not significantly affect knowledge Unique Contribution to Theory, Practice and Policy: Community-based training significantly improves bystander knowledge and emergency response times, offering a vital solution for strengthening pre-hospital emergency systems in Low- and Middle-Income Countries (LMICs). This highlights the critical need for diverse bystander training strategies. The study recommends; developing a specialized pre-hospital emergency care training model for the elderly. Conducting further research on how marital status influences knowledge acquisition from training. Revising the WHO Emergency Care System Framework (ECSF) to explicitly incorporate bystander training.Item Influence of Health Referral Systems on Adolescent Sexual and Reproductive Health Service Utilization in Kajiado County, Kenya(Journal of Health, Medicine and Nursing, 2025-01) Aluda, Wilfrida Kadenyi; Mapesa, Job; Njoroge, KeziaAdolescent Sexual and Reproductive Health (ASRH) in Kajiado County, Kenya, is hindered by early marriages, cultural practices, and limited healthcare access. The pastoralist communities face unique challenges, increasing risks like unintended pregnancies and maternal mortality. Despite efforts to improve access, gaps in ASRH service utilization persist. This study examines the influence of referral systems on ASRH service use among adolescent girls in Kajiado County. Methodology: A mixed-method design assessed the influence of referral systems on ASRH utilization among adolescent girls in Kajiado County. Data collection took place from December 2023 to March 2024. Quantitative data from 422 girls were analyzed using SPSS version 26, while qualitative data from 5 FGDs, 15 IDIs, and 15 KIIs were analyzed thematically using NVivo. Findings: Only 15.8% of adolescents used ASRH referral systems. Trust (78.6%), confidentiality (74.2%), and accurate information (71.5%) were key facilitators. Married adolescents were 32.1% less likely to utilize referrals (p < 0.05), and those with primary education were 45.3% less likely (p < 0.01). Positive outcomes included 83.4% reporting improved ASRH knowledge and 79.2% better contraceptive access. Barriers included communication gaps (62.7%) and limited provider awareness. Unique Contribution to Theory, Practice and Policy: The study identifies barriers such as poor communication, limited provider awareness, and socio-demographic disparities hindering ASRH service utilization. Positive outcomes, including improved knowledge and contraceptive access, suggest the potential of effective referral systems. Strengthening trust, confidentiality, and targeting vulnerable groups is crucial for improving ASRH referral pathways. Limitations included the small sample size and limited geographic scope. Keywords: Sexual and Reproductive Health, Adolescent Girls, Health Systems Approach, Service Utilization, Health Systems Management, Public HealthItem Awareness and Utilization of Sexual and Reproductive Health Services among Adolescent Girls in Kajiado County, Kenya(Global Journal of Health Sciences,, 2025-01) Aluda, Wilfrida Kadenyi; Mapesa, Job; Njoroge, KeziaPurpose: Adolescent Sexual and Reproductive Health (ASRH) is a global concern, with over 1.2 billion adolescents at risk due to limited access to essential health services. In Kenya, high rates of unintended pregnancies and STIs among adolescents highlight the need for effective sexual health education. In Kajiado County, cultural barriers limit ASRH service access, leaving many girls unaware of available resources. Methodology: A mixed-method design examined the impact of referral systems on ASRH service utilization among adolescent girls in Kajiado County. Quantitative data were collected from 422 girls through structured questionnaires, while qualitative data came from FGDs, IDIs and KIIs. Quantitative analysis used SPSS version 26 and qualitative data underwent thematic analysis. Findings: While 78% of participants showed general SRH awareness, only 45% were knowledgeable about contraception and 38% about STIs. Unintended pregnancies were common (65%), with just 30% aware of preventive options. Peer influence (60%) and schools (50%) were primary information sources; however, stigma (55%) and inadequate outreach (62%) were significant barriers to access. Statistical analysis confirmed these barriers were associated with lower SRH knowledge levels (Fisher's exact test: < 0.05). Unique Contribution to Theory, Practice and Policy: Despite increasing SRH awareness among adolescent girls in Kajiado County, significant knowledge gaps persist, particularly in contraceptive use and STI prevention. Recommendations include educational initiatives on SRH, greater parental involvement and enhanced outreach programs. Future research should explore community-based and digital strategies to improve SRH knowledge and service use among rural adolescents.Item Determinants of Effective Child Immunization Delivery: A Study of Community Health Units in Informal Settlements in Nairobi County, Kenya(Journal of Service Science and Management,, 2024) Chepkorir, Lenah; Tenambergen, Wanja; Mapesa, JobThe effectiveness of Community Health Units (CHU) in delivering child im- munization services is a critical component of public health in urban informal settlements. In Nairobi County, CHU are tasked with ensuring that all chil- dren receive necessary immunizations. However, the effectiveness of these units is influenced by several factors, including the Accountability System and Human Resource Management practices. Despite the implementation of CHU, a significant proportion of children in these informal settlements re- main unimmunized. Previous studies have not sufficiently explored how the clarity of accountability systems and adherence to human resource practices impact the effectiveness of CHU in delivering child immunization services. This gap necessitates an in-depth examination to enhance the performance of CHU in such vulnerable populations. We aimed to examine the influence of the accountability system and Human Resource Management practices on the effectiveness of CHU in delivering child immunization services in urban in- formal settlements in Nairobi County, Kenya. The study adopted a cross-sec- tional descriptive design, utilizing an interpretivist research philosophy to ex- plore the depth of the relationship between the independent variables (Ac- countability System and Human Resource Management) and the dependent variable (effectiveness of CHU delivery of child immunization services). A sample of 354 Community Health Workers was selected from 449 fully func- tional CHU in the informal settlements using stratified simple random sam- pling. Data was collected via a structured questionnaire and analyzed using descriptive statistics and binary logistic regression to determine the relationship between variables using SPSS version 26. The findings revealed that a clear accountability system significantly increased the effectiveness of CHU in de- livering child immunization services, with an odds ratio of 0.140. Similarly, ad- herence to standard human resource practices significantly improved CHU performance, with an odds ratio of 0.207. The logistic regression model indi- cated that 43.1% of the variance in CHU effectiveness could be explained by the independent variables. The results underscored the importance of clear communication channels, community involvement in monitoring and evalua- tion, and consistent support supervision as vital elements in enhancing CHU performance. We conclude that strengthening accountability systems and ad- hering to standard human resource practices are essential for improving the delivery of child immunization services by CHU in informal settlements. These results imply that policymakers and health administrators should prioritize these factors to achieve full immunization coverage and improve public health outcomes in underserved urban areas.Item Barriers and Facilitators of Postnatal Care Utilization under the Linda Mama Program in Kajiado County, Kenya(Journal of Medicine, Nursing and Public Health,, 2024-08) Nyaga, Daisy Catherine Wawira,; Mapesa, Job; Muchina, EmilyPurpose: To identify determinants and barriers to postnatal care utilization among mothers in Kajiado County, Kenya, within the framework of the Linda Mama program. Methodology: The study used a cross-sectional study and was conducted in Kajiado County. The study’s population was 137 mothers in Ongata Rongai, 87 mothers in Kitengela, 139 mothers in Kajiado & Loitoktok. Data was collected from the mothers through a structured questionnaire, which was interviewer-administered. The key informants' interviews also had a guide. Descriptive statistics and correlation analysis were conducted. Tables, figures, and narratives were used to present the findings. Results: The majority of participants (77%) were aged 19-30 years, and 90% were married. The level of awareness of the free PNC services provided by the Linda Mama program was low, with only 4% of mothers being aware and a mere 1% utilizing these services. Employment status significantly influenced PNC utilization, with 67% of mothers being unemployed. Conclusions and Recommendations: The study identified critical barriers to PNC utilization, including low awareness, misconceptions about costs, financial constraints, and logistical challenges. Despite the availability of free maternal health services, misconceptions about costs and accessibility hinder effective utilization. The study recommends that enhancing awareness, recruiting additional Community Health Promoters (CHPs) for mobile PNC services, and encouraging the acquisition of necessary identification documents could improve PNC uptake. Improved community outreach and education about the NHIF Linda Mama program are essential to address these barriers.Item Evaluation of the determinants of uptake of oral rehydration salts with zinc in the management of childhood diarrhea in Kakamega County(International Journal of Community Medicine and Public Health Muhande IK et al. Int J Community Med Public Health. 2024 Oct;1, 2024-10) MUHANDE, KHAYERI IRENE; Mapesa, Job; Ouna, BenardBackground: Diarrhea remains a significant public health concern, contributing to high child mortality, particularly in Sub-Saharan Africa and South Asia. Approximately 1.5 million cases of childhood diarrhea are reported annually in Kenya, with a prevalence of 16%. Despite the availability of affordable interventions like oral rehydration salts (ORS) and zinc supplementation, their utilization remains suboptimal in Kakamega County, where child mortality is 45 per 1,000. The combined impact of ORS and zinc in reducing childhood diarrhea and its consequences has not been adequately studied in Kakamega County. This study aims to assess the utilization of ORS and zinc in diarrhea management in Kakamega County. Methods: We utilized a cross-sectional design to evaluate current practices and outcomes in managing diarrhea among children under five years old. A random sampling approach was applied to ensure a representative sample. Key variables assessed included the frequency of diarrhea episodes, the use of ORS and zinc, and nutritional status. Statistical analyses, including Chi-square tests and descriptive methods, were used to examine the relationships between the variables in SPSS version 26. Results: Of the 246 children surveyed, 47.4% were under 10 months old. The study found that 26.8% of children had not received rotavirus vaccinations, and diarrhea was significantly (p<0.05) associated with poor nutritional outcomes. ORS had strong support (69.4%), but zinc supplementation showed moderate support (54.3%). Conclusions: The study highlights the need for increased uptake of ORS and zinc supplementation, as well as enhanced vaccination coverage to prevent diarrhea-related deaths and malnutrition in Kakamega CountyItem Clinical and Socio-Demographic Predictors of Psychosocial Distress in Women with Breast Cancer in Nairobi, Kenya(International Journal of Professional Practice (IJPP), 2023) Muriithi, Wanjiru; Kaaria, Zipporah; Mapesa, JobResearch shows that 25%–50% of breast cancer patients worldwide experience distress, with Africa reporting 71% and Kenya 34-50% distress cases. This study investigated clinical and socio- demographic predictors of breast cancer patients' psychosocial distress. Poor quality of life outcomes, reduced adherence to treatment, and inferior clinical and psychosocial functioning are all associated with psychosocial distress. This study adopted an exploratory, sequential cross- sectional design. The study targeted 763, 18–70-year-old female breast cancer patients. Breast cancer patients, nurses, lay navigator, and oncologists were enlisted through opportunity sampling technique for collection of both the qualitative and the quantitative data. Interviews, focus group discussions, and questionnaires were used to collect data. Using a total score of >11, with NCCN cut-off mark of >4 for clinically significant distress; and >7 for severe distress, psychosocial distress was screened using distress thermometer and problem checklist. Notably, income and stage of diagnosis emerged as significant predictors of psychosocial distress, clinical anxiety, and depression. Income predicted severe distress (OR = 5.5, p = 0.001), anxiety (OR = 2.8, p = 0.004), depression (OR = 4.7, p = 0.001), and early diagnosis had an inverse relationship with distress (OR = 0.3, p = 0.006) and depression (OR = 0.5, p = 0.049). Still, testimonials showed that young women had more emotional distress, while elderly women had more physiological distress. Marriage provided two insurance policies. The study emphasises understanding of emotional and psychological distress factors, identifying patients who need extra help, and using psychotherapy and social interventions to alleviate suffering, enhance resilience, and improve treatment outcomesItem Determinants of Demand for Community Differentiated Service Delivery among People Living with HIV in Kakamega County(International Journal of Professional Practice (IJPP), 2023) Owiti, Winnie Sarah; Njoroge, Kezia; Mapesa, JobCommunity differentiated service delivery model (CDSD) is community level health system strengthening intervention that addresses barriers to accessing health services. Increased number of stable people living with human immunodeficiency virus (PLHIV) has prompted more emphasis to promoting CDSD model utilization as a significant policy to improve health outcomes and meet the international commitment to make health services accessible. However, key health systems policy makers have put more emphasis on improving physical access rather than its patterns of utilization. This study seeks to understand demand for CDSD model and its determinants among PLHIV in order to device appropriate strategies that will encourage better utilization. The objectives were to assess CDSD model of choice, and factors that determine its demand among PLHIV. A quantitative design was conducted in Kakamega County, Kenya. Systematic random sampling was used to select 402 participants from facilities with high number of stable patients. A pretested interview schedule, and structured questionnaire was used to collect data using an open data kit app. Non parametric test was used to determine determinants for demand for CDSD model. A total of 402 (depicting a response rate of 100%) participants took part in the study. The tests revealed 66 % (264) of participants prefers the family model, 25 % (100) community anti-retroviral treatment groups, 8% (30) community drug distribution points, and 2% (8) community pharmacies. Determinants of demand were awareness 76% (307), acceptability 44% (176), service availability 78% (314), and service cost 78% (315). The findings indicate that the model of choice is the family model. Determinants for demand that affect utilization of the model include awareness, service availability and cost of the services. Policy makers in the ministry of health need to use these key determinants of demand to estimate its impact on health service delivery and health outcomes.Item Evaluating Quality of Services in Community Differentiated Service Delivery Model. A case of Kakamega county(African Journal of Health Sciences, 2023-12) Owiti, Winnie Sarah; Njoroge, Kezia; Mapesa, JobThe provision of high-quality services is a prerequisite for the successful implementation of community-differentiated service delivery. The service quality influences the clients' satisfaction, perceived value trust in the model and eventual utilization. Evaluating the quality of services in community differentiated service delivery will inform policymakers of existing quality gaps and in turn, this will assist in formulating strategies that will improve service quality and increase utilization. METHODOLOGY This was a cross-sectional study conducted in Kakamega County between September and December 2021 involving 402 participants. using purposive sampling, clients already established on ART were selected and data was collected through a structured questionnaire. Descriptive and inferential statistics were used to analyze data using SPSS version 25. RESULTS The results on dimensions of service quality established a high mean score (4.27) related to client literacy and a low score (2.64) on the package of services. There was a moderate positive relationship between client literacy and package of services (0.641) and a strong positive relationship between package of services and competence of the service provider (0.894). On the package of services (79.9%) of participants reported that ART refill and referral services were available, (12.7%) adherence and psychosocial support, 11.7% and 5% viral load sample collection. Regarding quality, the Freidman test ranged from client literacy (7.84), cost of services (7.79), accessibility (5.71), competence of the provider (4/06) and comprehensive package (2.54). CONCLUSION The study established a service quality gap in the package of services and the competence of the provider. The package of service provided is not comprehensive enough to address the needs of the clients. RECOMMENDATION Policymakers and leaders should re-distribute resources to allow for the training of providers using the differentiated service delivery manual 2023. The dimensions of quality can be reorganized to prioritize the appropriate package of services followed by the competence of lay health providers and lastly client literacy.