Browsing by Author "Otieno,George"

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    Evaluation of Large-Scale Implementation of Obstetric Point of Care Ultrasound in Eight Counties in Kenya Using RE-AIM Framework
    (Springer Nature, 2025-08) Githemo,Grace; Wanyoro,Anthony; Masika,Jacob; Onsongo,Lister; Bett,Sarah; Githuku,Stephen; Gachuiri,Grace; Walker,Dilys; Santos, Nicole; Ghosh,Rakesh; Otieno,George
    Abstract Background Obstetric Point-of-Care Ultrasound (O-POCUS) holds promise for strengthening maternal health services particularly in low- and middle-income countries (LMICs). However, its widespread use is hindered by limited provider training and resource constraints within health facilities. To address this gap, a large-scale O-POCUS program was implemented across eight counties of Kenya whereby 468 healthcare providers (HCPs) from 224 facilities were trained in five basic O-POCUS parameters. This study evaluated the reach, effectiveness, adoption, implementation, and maintenance of this program using the RE-AIM framework. Methods For this cross-sectional evaluation study, trained research staff conducted surveys and in-depth interviews with HCPs, stakeholders, and antenatal and postnatal care clients for one week from a random sample of about half of these facilities (n=114) six months after O-POCUS introduction. A total of 249 HCPs, 2,292 antenatal and 1,704 postnatal clients were surveyed, and 96 HCPs/stakeholders and 114 clients were interviewed. Data were analyzed using descriptive and thematic methods and mapped onto the RE-AIM framework to assess program implementation. Results The findings revealed that O-POCUS was implemented across all 114 health facilities and 1937 (49%) of surveyed clients received a scan (reach). Over 80% of trained HCPs reported moderate to high confidence in performing key obstetric assessments, and 72% reported that O-POCUS influenced clinical decision-making including referrals (effectiveness). 41% of HCPs conducted more than 20 scans per month and 89% of the clients reported that they were likely to recommend O-POCUS to others (adoption). Lack of resources such as gel and paper towels were identified as major challenges (implementation), while 60% of HCPs reported the need for further training and mentorship (maintenance). Conclusion These findings demonstrate successful large-scale implementation of O-POCUS in Kenya and provide valuable insights for policymakers and healthcare organizations seeking to implement similar O-POCUS programs in resource-limited settings. Continuous strengthening through mentorship, supportive supervision and resource provision is recommended for sustained success of O-POCUS in improving maternal healthcare.
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    Utilization of Cervical Cancer Screening Services among Women Aged 18 to 59 Years in Laikipia East Sub-County, Kenya
    (African Journal of Health Sciences, 2024-01) Njoroge,Lily N.; Mudhune, Godfrey H.; Otieno,George; Wanjau, Grace; Yoos,Alison
    INTRODUCTION Cervical cancer, a preventable disease, continues to be the leading cause of death resulting from cancers in Kenya. Despite free cervical cancer screening services in all government hospitals in Laikipia County, the screening uptake remains low at 19% compared to the WHO target of 70%. Hence, understanding the barriers and facilitators is important in informing targeted interventions. MATERIALS AND METHODS A mixed-method cross-sectional study was done in Laikipia East Sub-County, Kenya, between July and August 2022. The participants were women aged between 18 to 59 years. Data was collected on demographic factors and cervical cancer screening utilization. Also, qualitative data was collected using 5 FGDs and 6 KIIs to get more insights. Chi-square tests and odds ratios were calculated using STATA version 15 to assess associations and determine the level of significance. RESULTS Out of the 272 participants, 32.4% (n=88) had ever screened for cervical cancer. The logistic regression analysis indicates that as women age, their likelihood of undergoing screening increases, particularly for those aged 50-59, who show a tenfold higher likelihood of screening [ OR 10.40 (3.20-33.82), p-value <0.001]. Conversely, unemployment is associated with a reduced likelihood of screening [OR 0.42 (0.18-0.99), p-value 0.047] while individuals earning 50-200 USD per month exhibit an increased likelihood [OR 2.25 (1.30-3.87) p-value 0.004]. However, religion, marital status, and education level factors do not show a significant association with the utilization of cervical cancer screening as indicated by p-values of 0.735, 0.069, and 0.765, respectively. CONCLUSION AND RECOMMENDATIONS Laikipia county government offers free cervical cancer screening in all government-run facilities but many, especially those aged 25-49, lack awareness. It is vital to boost awareness through community education on cervical cancer causes and prevention, emphasizing screening as preventive. Affordable treatment is also crucial for community reassurance post-diagnosis.