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Item Improving Health Systems: Influence of Technical Capacities of Community Health Volunteers on Use of Community Health Information Systems in Kenya(International Journal of Computer Applications (0975 – 8887), 2018-07) Mambo, Susan Njoki; Odhiambo-Otieno, George W.; Ochieng’- Otieno, George; Tenermbergen, Wanja MwauraWHO identified six key pillars of an effective health system namely: leadership and governance; service delivery; health workforce; health information systems; medical products, vaccines and technologies and healthcare financing. This study focused on Community-based Health Management Information System (CbHMIS) of health information pillar. A Community-based Health Management Information System (CbHMIS) is a type of health information system based in the rural community and informal settlements of urban areas. CbHMIS’s main objective among others is to produce relevant and quality information to support decision making on public health issues at the community level. The importance of effective information use is still a key impediment to achievement of goals at level one of health care delivery. According to a situation analysis on the state of Community Health Services in year 2014, the functionality of CbHMIS was said to be at 64% which came down considerably to 55% in year 2015 documented by USAID, and that access to quality data was not guaranteed through the current CbHMIS.Lack of technical capacities among the CHVs is a serious gap in achievement of information use in Kenya.This study aimed at establishing the factors influencing technical capacities of community health volunteers on use of CbHMIS in Kenya.Other objectives of this study were: To establish the influence of System Availability on CbHMIS use; to find out effects of availability of skills to CHVs on CbHMIS use, To assess the influence of personnel knowledge on CbHMIS use, To identify competencies of CHVs that influence CbHMIS use. The selected counties were Kiambu, Kajiado and Nairobi which gave a rural, urban and peri-urban representation respectively of the country. This was a crosssectional analytical study design, with both quantitative and qualitative data collection methods. The target population was 156 active Community Units (CUs) from the 3 counties where a total sample of 122CUs (50 in Kiambu; 26 from Kajiado and 46 from Nairobi CUs) was derived using Mugenda and Mugenda formula of populations less than 10,000. Multistage sampling was used to identify the CUs; Systematic random sampling was used to identify total of 366 respondents 3Community Health Volunteers (CHVs) were purposively sampled form each CU to make a total of 366 (150 in Kiambu; 78 from Kajiado and 138 from Nairobi. A total of 6 KIIs (two from each county) and 3 FGDs (one from each county) were conducted for qualitative data. Interviewer administered questionnaires were used to collect quantitative data, observation checklist was also used. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level. Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. Use of Cb-HMIS stood at 56.6%. Slightly above half 51% of respondents agreed to having technical skills on CbHMIS, However a KII noted that “….We have challenges in training all our CHVs and refresher trainings due to funding so you will find some have been partially trained….”.There was statistical significant differences between group means (F(2,363) = 32.47,p = .000). (X1) explains 28.6% of the total variations in the use of CbHMIS (R 2 =.286). This implies that the use of CBHMIS by Community Units (CU) improves significantly when the CU personnel have better technical capacitiesItem Assessing the influence of process interventions of community health volunteers on use of community based health management information systems in selected counties, Kenya.(International Journal of Scientific and Research Publications,, 2018-08) Mambo, Susan. N.; Odhiambo-Otieno, George W.; Ochieng’-Otieno, George; Mwaura – Tenambergen, WanjaThe World Health Organization (WHO) identified information as one of the six key pillars of an effective health system. In this context, the need to strengthen community health information has been felt globally. African countries have faced the greatest challenges in collecting, analyzing, evaluating and interpreting indicator data to guide evidence based policymaking. The generation of health information starts at the community level through the Community-Based health information system (CbHMIS) (Kaburu, Kaburi, & Okero, 2016). At the community level, this source of information is complete in coverage and in planning and action-oriented (Odhiambo-Otieno, 2005). High health threats characterized by low levels of life expectancy, deteriorating healthcare facilities, high disease incidences, high levels of infant mortality (73/1000) and maternal mortality (488/100,000) specifically on communicable diseases are currently facing Kenya (Flora, Margaret, & Dan, 2017). The importance of effective information use is still a key impediment to these problems, hence affecting greatly the health care service delivery at all levels, and the worst level in its information use is level 1 – the community. In Kenya, According to a situation analysis on the state of Community Health Services in year 2014, the functionality of CbHIS was said to be at 64% which came down considerably to 55% in year 2015 documented by USAID, and that access to quality data was not guaranteed through the current CbHMIS. Some known and assumed barriers include: lack of proper processes, lack of physical access, lack of awareness of what is available; lack of relevance of available information (i.e. not meeting peoples' needs in terms of scope, style or format); lack of time and incentives to access information; and lack of interpretation skills (Flora et al., 2017). Processes forms an integral part of performance (Aqil et al., 2009). In Kenya, the Kenyan Health Information System has had several weaknesses which include weak linkages, data sharing, inadequate feedback, and lack of an operational CBHMIS manual, among others. The purpose of the study was to assess the influence of process interventions of the CHVs on CBHIS use in Kiambu, Kajiado and Nairobi Counties, Kenya. The study objectives were to 1. examine the influence community units assesments on CbHMIS use; 2. Assess the influence of feedback on CbHMIS use; 3. Assess dialogue and action days influence on CbHMIS use; 4. Determine the influence of reporting channels on CbHMIs use. A cross-sectional analytical study design was adopted, utilizing both quantitative and qualitative approaches. The target population was 156 active CUs from the 3 counties, from whence a total sample of 122 CUswasderived. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. One Focus Group Discussion with the members of the community health committees and two Key Informant Interviews (KIIs) were conducted in each of the three counties. The respondents in the KIIs were County Community Strategy Coordinators and Subcounty Community Strategy Officers. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level and results were presented in form of graphs, frequency tables, figures, and narration. Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Majority were Females 72.4% n=265; majority attained secondary level education 42.6% (n=156); Non-formal occupation stood at 84.7% (n=310); Use of CBHMIS stood at 56.6% (n=207). Process interventions, 36% of the respondents agreed that the Sub-county team and CU leadership are quick to act on the feedback of our MIS reports. Process interventions (X4) explains 67.4% of total variation in CbHMIS use. (R2 = .674). Attention should be given to reporting channels by ensuring that CUs are technologically enabled to be reporting in a timely manner The study recommends that CUs should be provided with enabling technology and further capacity development in technical, computer and electronic reporting skillsItem Factors influencing demand for healthcare insurance:A study of jua kali workers in Nairobi(IJPP, 2013-01) Nalebeson, Mugubi Robert N.; Odhiambo-Otieno, George W.Health systems are a means to achieving better health outcomes for all. However, where patients depend largely on out of pocket (OOP) payments to access health services, there is often lack of care for those who cannot afford. This study aimed at establishing the fac¬tors influencing the demand for health insurance among Jua Kali workers in Nairobi. This was a cross-sectional research study involving mixed approach (simple random, purposive sampling, qualitative and quantitative methods) involving 130 Jua Kali workers from Associations/Cooperatives and 258 Jua Kali workers from non-organized groups; key informants from NHIF and the Department of Micro and Small Enterprise Department and was. The study was conducted between January to March 2012 within Pumwani Division in Nairobi County. Findings indicated that 113 (29.1%); 21.1% members of Jua Kali association and 11.8% individualJua Kali workers out of 388 were enrolled in NHIF while 262 (67.5%) were not enrolled in NHIF. Inadequate Knowledge of NHIF benefit and the KShs. 480 upfront NHIF premium payment were the main contributing factors to non-enrolment of262 (67.5%) of Jua Kali workers. 42.3 % individual Jua Kali and 6.1 % members of association with a monthly income less than KShs. 9,000 did not enrol in NHIF. To enhance more enrolment of Jua Kali workers, the study recommends that NHIF should design strategies that target the younger, low income and Jua Kali workers with low level of education with key information on health insurance benefits and the benefits of enrollment in NHIF , establish satellite pay¬ment offices within Jua Kali working zones to bring services closer to them, apply KShs. 160 per month instead of KShs. 480 and enhance networking and engage Jua Kali association as strategic partners for the purpose of motivating Jua Kali workers enrollment.Item Factors Influencing the Utilization of Zidovudine and Nevirapine among HIV Positive Perinatal Women at Pumwani Maternity Hospital in Nairobi, Kenya.(IJPP, 2014-01) Imbaya, Christopher L.; Odhiambo-Otieno, George W.; Okello-Agina, B.M.Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) is a key strategy aimed at protecting babies from being infected with HIV by their mothers. Treatment with combination rather than single Antiretroviral (ARV) drugs has been found to be more effective in PMTCT. The objectives of this study were: 1. to determine the rates of utilization of single drug and combinations of Zidovudine (AZT) and Nevirapine (NVP) for PMTCT and 2. To determine the factors that influence the choice of treatment among HIV positive perinatal women at Pumwani Maternity Hospital (PMH) in Nairobi, Kenya. This was a cross-sectional descriptive study. The study site was Pumwani Maternity Hospital, which is a public health facility on the eastern suburbs of Nairobi County. A total of 326 post natalHIV Positive women were sampled and administered with questionnaires either at the Postnatal Clinic (PNC) or postnatal ward in Pumwani Maternity Hospital. Among the 326 HIV positive women, 299(91.7%) acknowledged having been given ARV's for PMTCT where 160(53.5%) and 139(46.5%) of them were given single and combination drug treatments respectively. Single dose NVP was used by 132(44.1 %) of the women while AZT alone was prescribed in 28(9.4%) of the women. The other 139 (46.5%) of the women received a combination of NVP and AZT. The frequency of Antenatal Clinic (ANC) visits was significantly related to the number of ARV's dispensed (p=0.001). Late ANC attendance and health problems were given as reasons why AZT was not dispensed while the main reason that was cited for NVP not being used was the lack of its availability. More than half of the HIV positive women delivering at PMH received single drug PMTCT. Availing combination PMTCT therapy should be enhanced. Success could be realized by encouraging frequent ANC attendance, availing alternative ARV treatment options and addressing health conditions that contribute to the use of monotherapy.Item Factors that Contribute to Non-Adherence to Antiretroviral Therapy among HIV and AIDS Patients in Central Province, Kenya(IJPP, 2013-01) Nyambura, Anthony Wanjohi; Odhiambo-Otieno, George W.; Otieno, Michael F.Adherence concerns have been one reason expressed by opponents of antiretroviral therapy in developing countries or resource poor settings. The objective of the study was to determine factors contributing to non-adherence to Anti-retroviral therapy among HIV and AIDS patients. This was a Cross sectional, descriptive study carried out in Provincial General Hospital Nyeri, Karatina and Thika District Hospitals. The participants included 300 interviewees, 15 Key Informant Interviews (KIIs) and 3 Focus Group Discussions (FGDs) with 8 members each. In regards to the results, the Odds ratio was used to test for association between variables and level of significance. Results also showed that the prevalence of adherence to ART was 7 4%. Risk factors associated with non-adherence were: age (p<0.039 OR=l.287 95% CI 1.013-1.634), occupation (p<0.0001 OR=l.675 95% CI 1.449-1.937), food (p<0.002 OR=0.419 95% CI 0.242-0.726), level of education (p<0.023 OR=0.593 95% CI 0.378-0.930), and stigma (p<0.002 OR=2.456 95% CI 1.375-4.389). 23% of those who lacked community support were found to be suffering from stigma and did not adhere to Antiretroviral Therapy (ART). Through the FGDs the study revealed that co-treatment of HIV and other diseases like tuberculosis, diabetes, epilepsy and mental illness remains a major challenge. 66% of Key Informants reported pediatric ARV drugs formulations were inappropriate, unpalatable and inadequate, dependence on care givers and the laboratories were ill-equipped in terms of facilities, reagents and personnel. In conclusion, the level of adherence (74%) was sub optimal (less than 95% which is the acceptable) but comparable to that of other developing countries. Taking ARV drugs without eating any food made patients suffer from side effects thus making them avoid the medication. Stigma, discrimination, lack of family and community support were huge obstacles to ART adherence. Co-treatment of HIV and other infections remain a major challenge. Shortage of appropriate pediatric formulations, unpalatability of some ARV drugs and dependence on care givers contributed to pediatric ART non-adherence. Health facilities with functioning laboratory, adequate personnel and stock of ARV drugs enhanced ART adherence.