MST-Department of Health Management & Informatics

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Factors Influencing Newcastle Disease Vaccine Biotechnology Adoption by Small-holder Poultry Farmers in Kathiani and Central Divisions of Machakos District, Kenya
(2005-08) Muswali, A.G.
Agricultural biotechnology, of which poultry vaccine production is an integral component, is believed to hold great potential for contributing significantly to household food security particularly among the small-holder farmers in developing countries such as Kenya. In view of this, developing countries are adopting agricultural biotechnology and Kenya has so far embraced various aspects of this technology including tissue culture planting materials and use of vaccines against livestock/poultry diseases. This descriptive cross-sectional study therefore sought to investigate the factors influencing adoption of the Newcastle disease vaccine, a product of agricultural biotechnology, in Kathiani and Central Divisions of Machakos district where the vaccine was introduced by the Kenya Agricultural Research Institute (KARl) in 1998. A sample size of 150 poultry farmers, most of them small-holder farmers, was determined. The two study areas of Kathiani and Central divisions of Machakos District were selected purposively because KARl, the sponsor of this study, needed data from these divisions for future biotechnology programming. Systematic sampling methodology was then used to identify households in each of the five locations of the two divisions from which respondents were selected and interviewed through interviewer-administered questionnaire. The study established that Newcastle disease (NCD) vaccine adoption was poor since the majority (147; 98%) of small-holder farmers interviewed could not afford it each time they wanted to vaccinate their birds. Similarly, due to limited awareness regarding the importance of vaccine use, many (123; 82%) small-holder farmers interviewed did not know of its availability in the study areas. This, in turn, resulted in the vaccine's poor adoption rates by the said farmers. The difference between the levels of awareness and unawareness of the vaccine among respondents was significant (l d f 1 = 61.440; P< 0.001). Only 3 (2 %) of the respondents who knew about the vaccine used it. The difference between these respondents and those who did not use it (147; 98%) was also statistically significant (l d f 1=138.240; P < 0.001). The study established that there were no distribution arrangements of the vaccine in the study area to specifically address the needs of the small-holder poultry farmers. This too, contributed to poor adoption of the vaccine by the farmers. In conclusion, unaffordability, low awareness levels as well as lack of distribution strategies for NCD vaccine contributed to its poor adoption levels in the study area. Therefore, the biotechnology intervention (NCD vaccine) may not have contributed to significant increase in household poultry production in the area. There is need to address the reported factors such as low awareness, unaffordability and lack of distribution strategies of NCDV that are constraining NCD vaccine biotechnology adoption by small-holder poultry farmers in order for the technology to contribute to household poultry production in the study area. A rise in poultry production would in turn contribute to household food security through increased consumption of chickens as well as proceeds from the sale of birds, thus increasing family incomes.
Cost -Effectiveness of Spinal and General Anaesthesia in the Surgical Treatment of Benign Prostatic Hyperplasia in Hospitals in Nakuru Municipality, Kenya. /1
(Kenyatta University, 2008-05) Macai., John N.
Anaesthesia has been cited as one of the medical practices that escalate the cost of expenditure on healthcare. In view of this, spinal anaesthesia has been proposed as a method that can lower surgical costs. However, medics in Kenya are yet to fully embrace spinal anaesthesia. The reasons for the low usage rates of the spinal anaesthesia are not well known. This study compared the cost-effectiveness of spinel! anaesthesia and general anaesthesia. It also sought to establish the factors that explain the low utilization rates of spinal anaesthesia among medics in Ken; a. 1\ survey approach was adopted in this study. The population for this study was drawn from three randomly chosen hospitals within Nakuru Municipality. Patients operated for Benign Prostatic Hyperplasia (BPH) within the period Ist January 2003 and 31q December 2006 in the three hospitals formed the sampling frame for this study. Seventy-three such patients were identified and formed the study sample. The data for this study was collected by way of document analysis. A coding scheme was developed to gather secondary data. A focus group discussion was conducted to a sample of surgeons, anaesthetists and hospital administrators/proprietors in order to collect their perceptions on spinal and general anaesthesia. An anaesthetic complication index was then developed. This is an ordinal scale that measures the degree of post operative complications after surgery. It has three levels beginning with three for the absence of any complication, two for one complication and one for multiple complications. The higher the score the less the post operative complications a patient has. The research instruments for this study were pre-tested on a Iew patients and medical staff in Naivasha Sub-District Hospital. These research tools were used to gather data by the researcher with the help of two trained research assistants. Data was coded and analysed using the statistical software package SPSS Version 13. Student's t tests were used to compare data on the cost effectiveness of spinal anaesthesia and general anaesthesia. Finally, a ratio of the net costs to the net health outcomes of both spinal and general anaesthesia was calculated. Patients in this stud) had an average of 71.19 years. The average cost of anaesthetic drugs for general anaesthesia was Kshs. 2206.30, while that for spinal anaesthesia was Kshs. 1548.60. The differences in these costs were statistically significant (t == 3.87. df == 71: p == 0.000). Patients operated under spinal anaesthesia had a mean of 2.47 011 the anaesthesia complication index, while those operated under general anaesthesia had a lower mean of 2.03. The lower complication index score obtained in general anaesthesia implies that patients had relatively 1110re post operative complications. The differences in the complication index were statistically significant at 95% confidence level (t == 2.40, df == 69: p == 0.019). The incremental cost effectiveness or this study was calculated as -1494. Adopting spinal anaesthesia ill the treatment of BPI-! results is a reduction in costs and aversion of anaesthetic complications. Medics in Nakuru have favourable knowledge, skills and attitudes towards spinal anaesthesia. Factors that explain this are the least costs, aversion of complications and the ease of performing spinal anaesthesia. However. their usage of this technique was very low. Lack of spinal kits and the tradition of using general anaesthesia explain this low usage rates. Availing spinal kits and sensitizing medics on benefits or spinal anaesthesia might help in the uptake of spinal anaesthesia where indicated.
Cost -Effectiveness of Spinal and General Anaesthesia in the Surgical Treatment of Benign Prostatic Hyperplasia in Hospitals in Nakuru Municipality, Kenya. /1
(Kenyatta University, 2008-05) Macai., John N.
Anaesthesia has been cited as one of the medical practices that escalate the cost of expenditure on healthcare. In view of this, spinal anaesthesia has been proposed as a method that can lower surgical costs. However, medics in Kenya are yet to fully embrace spinal anaesthesia. The reasons for the low usage rates of the spinal anaesthesia are not well known. This study compared the cost-effectiveness of spinel! anaesthesia and general anaesthesia. It also sought to establish the factors that explain the low utilization rates of spinal anaesthesia among medics in Ken; a. 1\ survey approach was adopted in this study. The population for this study was drawn from three randomly chosen hospitals within Nakuru Municipality. Patients operated for Benign Prostatic Hyperplasia (BPH) within the period Ist January 2003 and 31q December 2006 in the three hospitals formed the sampling frame for this study. Seventy-three such patients were identified and formed the study sample. The data for this study was collected by way of document analysis. A coding scheme was developed to gather secondary data. A focus group discussion was conducted to a sample of surgeons, anaesthetists and hospital administrators/proprietors in order to collect their perceptions on spinal and general anaesthesia. An anaesthetic complication index was then developed. This is an ordinal scale that measures the degree of post operative complications after surgery. It has three levels beginning with three for the absence of any complication, two for one complication and one for multiple complications. The higher the score the less the post operative complications a patient has. The research instruments for this study were pre-tested on a Iew patients and medical staff in Naivasha Sub-District Hospital. These research tools were used to gather data by the researcher with the help of two trained research assistants. Data was coded and analysed using the statistical software package SPSS Version 13. Student's t tests were used to compare data on the cost effectiveness of spinal anaesthesia and general anaesthesia. Finally, a ratio of the net costs to the net health outcomes of both spinal and general anaesthesia was calculated. Patients in this stud) had an average of 71.19 years. The average cost of anaesthetic drugs for general anaesthesia was Kshs. 2206.30, while that for spinal anaesthesia was Kshs. 1548.60. The differences in these costs were statistically significant (t == 3.87. df == 71: p == 0.000). Patients operated under spinal anaesthesia had a mean of 2.47 011 the anaesthesia complication index, while those operated under general anaesthesia had a lower mean of 2.03. The lower complication index score obtained in general anaesthesia implies that patients had relatively 1110re post operative complications. The differences in the complication index were statistically significant at 95% confidence level (t == 2.40, df == 69: p == 0.019). The incremental cost effectiveness or this study was calculated as -1494. Adopting spinal anaesthesia ill the treatment of BPI-! results is a reduction in costs and aversion of anaesthetic complications. Medics in Nakuru have favourable knowledge, skills and attitudes towards spinal anaesthesia. Factors that explain this are the least costs, aversion of complications and the ease of performing spinal anaesthesia. However. their usage of this technique was very low. Lack of spinal kits and the tradition of using general anaesthesia explain this low usage rates. Availing spinal kits and sensitizing medics on benefits or spinal anaesthesia might help in the uptake of spinal anaesthesia where indicated.
Factors Associated with Default from Treatment among Tuberculosis Patients in Nairobi Province, Kenya
(2009-05) Muture, B.N.
Tuberculosis is caused mainly by Mycobacterium tuberculosis.' It affects all tissues and organs except hair teeth and nails. Over 2 billion people were estimated to be infected with the tubercle bacilli in 2005. The immune system is able to contain the bacillus. Only 10% of infections progress to clinical disease. Over 90% of global TB cases and deaths occur in the developing countries. The WHO estimates an incidence of 207,311 new cases in Kenya and 44,576 tuberculosis related deaths annually. Kenya is ranked io" among countries with high tuberculosis burden. Tuberculosis treatment requires use of combination of drugs for 6-8 months. Adherence is vital for successful cure and prevention of drug resistance and treatment failure. In the year 2005, 7.6% of patients defaulted from treatment nationally. The high default rate in the country impedes the achievement of the global target to successfully treat 85% of detected TB cases. Treatment adherence is a complex issue and improving treatment outcomes for tuberculosis requires a full understanding of the factors that prevent people from taking medicines correctly and those that help them complete their treatment. Determination of predictive factors for default was thus justified for early interventions and for policy and strategy formulation to address non-compliance of TB treatment. Default from treatment enhances risk of developing multi-drug resistant tuberculosis, lowers treatment success rates and increases cost of treatment. The objective of this study was to determine factors associated with default from tuberculosis treatment in Nairobi. A Case-Control study was used. Defaulters formed the case and the successfully treated the control group. Secondary data from conveniently sampled treatment facilities was used. Further, cases and controls were traced and interviewed using a structured questionnaire. The response variable was default outcome. Independent variables included drug side-effects, knowledge on TB, access to health care, stigmatization, HIV co-infection and demographic and socioeconomic factors among others. Data was analyzed using SPSS and Epi Info statistical software. Descriptive statistics and analyses of contingency tables to determine association were used. Chi-Square, Fishers exact tests and confidence intervals were used to establish significance. Multivariate logistic regression modeling of associated factors and Kaplan-Meier method to determine probability of staying in treatment over time were employed. Results revealed a 16.7% prevalence of treatment default in Nairobi. Default occurred most frequently during the initial three months of treatment. Among defaulters who were AFB smear positive at initiation of treatment, 47.7% defaulted before conversion was confirmed. Major reasons for default included ignorance, traveling, feeling better, side effects, opting for herbal medication, alcohol use, inadequate food, poor facility factors and stigma. Factors independently associated with default included HIV co-infection (OR 1.56, P
Determinants of Under-five Mortality in Kisumu North District, Kisumu County, Kenya
(2013-10-17) Akobi, William Kala
Addressing child mortality and under-five mortality (USM) has continuously been a global challenge. The world summit for children in 1990 called for a worldwide reduction in child mortality to reduce USM to below 70 deaths per thousand live births or one third reduction. Nations and organizations have continued to invest much resources and effort to promote child health. In Sub-Saharan Africa investments in health systems and interventions necessary to achieve these marks has been elusive. Despite this, maternal and child mortality and morbidities remain high. The purpose of this study was to identify the determinants of USM in Kisumu North District of Kisumu County. The specific objectives were: to examine the levels and trends of USM in Kisumu North District; to identify the determinants-of the U5M in Kisumu North District; and, to assess the influence of KAP on USM in Kisumu North District. The study design was a descriptive cross-sectional in nature targeting women of reproductive age (IS-49) living in Kisumu North District for at least six months. Data was collected using both quantitative and qualitative approaches involving structured questionnaires, key informant interviews and focus group discussion with chiefs, health workers and household heads in the district. A randomly selected sample of 265 women participated in the interviewer administered questionnaire. Data was analyzed using SPSS version 16. Chi square statistics was used to assess the association between background factors and USM at 9S% confidence interval and a p-value of O.OS.Qualitative data were analyzed thematically. Finding showed that slightly more than half (S6.3%) of the respondents were aged below 30 years and 43.7% of the respondents were aged more than 30 years. Majority (8S.9%) of the respondents were married. Most (36.9%) of the respondents had completed primary education, and only 3.1% of the respondents had post primary education. Majority (8S%) of the respondents reported to have lost a child below five years old. The USM (S2.S%) was higher among those aged below 30 years as compared to those below 30 years 47.S% (pvalue= 0.006). Level of education was a significantly association with USM (p-value = 0.007). Sign of use of latrine was also significant associated with USM (p-value ~ 0.012). The presence of latrine was significantly associated with USM (p-value = 0.03). Occupation, source of water, whether water is treated, type of dwelling place, place of delivery, immunization status of the child and whether the child had been sick in the last two weeks were not significantly associated with USM. KAP factors that were significant associated with USM included staff of the facilities being friendly (p-value = 0.01, children die due to poverty (p-value = 0.02), child with fever should be taken to the health facility without delay (p-value=O.O1), children die because they are bewitched (p-value = 0.01), a child with fever should not be given injection (p-value = 0.01), immunization makes children sick (p-value = 0.01), children should not be given drugs bought from the shops (p-value = 0.01). The findings of this study indicate that the USM is very high in Kisumu North District and is associated with socio-demographic, environmental and KAP determinants. There is need to address health factors that contribute to high mortality rates in this district, and putting in place a well defined system targeting improved socio-economic empowerment of women aged IS-49, improved enrollment of women in school, a defined health system to enable early identification and timely care to children and their mothers.
Barriers to early diagnosis of invasive cervical cancer among patients receiving treatment at Kenyatta National Hospital, Nairobi Kenya
(2014) Korir, Anne Rugutt
Although cancer still remains a major health problem, early diagnosis and improved therapeutic interventions of cervical cancer in developed countries are quite different from what is observed in the developing countries; Kenya included. In resource constrained environments, limited access to oncology facilities, coupled with the stigma associated with cancer has much influence on the disease reporting and management. While the biological factors associated with early diagnosis and proper management have been documented, there is need to clearly define the role of individual, social, cultural and economic factors as determinants of early diagnosis of cervical cancer. The main objective of the study was to determine the barriers to early diagnosis among cervical cancer patients. Kenyatta National Hospital was chosen because it is the only national referral hospital in Kenya with radiotherapy machine used in treatment of cancer patients. Given that the cost of treatment is lower than the private hospitals, it attracts a large number of patients as referrals from the forty seven counties in the country. This was a descriptive survey using researcher-administered structured questionnaires to obtain data from a sample of 320 cervical cancer patients in Kenyatta National Hospital‟s radiotherapy clinic and among in-patients. To corroborate the findings from the patients, key informant schedule was administered to 30 healthcare personnel who interact closely with these patients to seek their views on reasons for late diagnosis. The data was analyzed using SPSS version 16.1 and presented in frequencies, graphs and tables. Chi square was used to test association among variables and significance level was set at 0.05. Individual patient‟s attitudes of the disease and health seeking behaviour were analyzed and correlated with the measurable outcomes which include; time lapse to disease diagnosis, age, socio-economic status, cultural factors, health facility-related factors and reaction time by health personnel. The findings have been correlated with time of onset of disease to diagnosis and treatment. The findings of this study established that general lack of knowledge on cervical cancer (75.3%) was significantly associated with late diagnosis (Chi-square=9.27 (1, N= 320; p=0.0023). A preponderance 266 (83.1%) had no knowledge on screening tests prior to diagnosis while only 54 (16.9%) were aware of Pap smear test. Similarly education level (² = 20.62 (3, N=316, P<.0001) was significantly association with late diagnosis of cervical cancer. Logistic regression analyses showed that higher education attainment was associated with 0.58 lower odds of late diagnosis of cervical cancer. Other social factors like age at diagnosis, locality, marital status and religion did not show any significant association with either early or late diagnosis.This study recommends that well organized cancer awareness and screening programmes be established while considering aspects of accessibility and affordability. Strengthening healthcare and referral systems, as well as continuing education of existing healthcare providers is recommended.
Prostate Cancer Awareness, Knowledge, Perception on Self-vulnerability and Uptake of Screening among Men in Nairobi County, Kenya
(2014-02-19) Wanyagah, Paul; Were, T.; Okello-Agina, Bonventure Michael
Prostate cancer is the number one cancer afflicting men in Africa and a leading cancer killer among Kenyan men. Although there is scarcity of information on the disease in African men, higher awareness with concomitant low levels on knowledge, attitudes and perception of self-risk to the disease were established among urban men in West Africa. In addition, uptake of prostate cancer screening by African men has remained extremely low despite the fact that early screening and detection is the most effective intervention tool for the disease. A lack of awareness and knowledge and poor perception on prostate cancer and prostate cancer screening, and a low uptake of screening appear to promote the increasing burden of the cancer. Most of the reports on prostate cancer from Kenya have largely been hospital-based hence little is known about prostate cancer in the community. Although prostate cancer is the leading cancer in Nairobi, awareness, knowledge and perceptions of the cancer including uptake of screening remains undetermined among men from the Nairobi community. As such, this house-hold cross-sectional descriptive study was conducted among men (n=581) of age 30-73 years to evaluate the awareness and knowledge levels; perception of prostate cancer self-vulnerability and uptake of prostate cancer screening in Nairobi County. Data was collected using structured questionnaires and summarised using descriptive statistics and presented in tables and graphs. Statistical analyses for associations between knowledge levels, perception of self-vulnerability to prostate cancer, uptake of prostate cancer screening and socio-demographic characteristics were performed using the chi-square tests followed by Spearman’s correlation tests and binary logistic regression modeling. Results of this study show high prostate cancer awareness (84.6%). The frequency of respondents with good knowledge on prostate cancer was low at 52.3%. The frequency of good perception on self-vulnerability to prostate cancer was 58.0%. Respondents with poor knowledge on prostate cancer were older relative to those with good knowledge (P=0.001) and the knowledge levels on prostate cancer were positively correlated with perception of prostate cancer self-vulnerability (r=0.144; P=0.001). Binary logistic regression analyses revealed that good knowledge of prostate cancer was associated with university [OR, 18.741; 95% CI, 6.878-51.064; P<0.0001]; diploma [OR, 9.332; 95% CI, 3.752-23.213; P<0.0001]; and secondary education [OR, 4.078; 95% CI, 1.650-10.075; P=0.002]. Similarly, good perception of self-vulnerability to prostate cancer was associated with university [OR, 2.405; 95% CI, 1.121-5.162; P=0.024]; diploma [OR, 3.394; 95% CI, 1.699-6.780; P=0.001]; and secondary [OR, 1.832; 95% CI, 0.932-3.603; P=0.079] education. Only 4.1% of the respondents had ever been screened for prostate cancer. Consistent with the low uptake of prostate cancer screening, only 48.2% of the respondents were aware of prostate cancer screening; 7.1% of the respondents knew about the methods of prostate cancer screening; and 45.8% of the respondents knew about the frequency of prostate cancer screening. Moreover, proportions of respondents with good perception about self-vulnerability to prostate cancer were higher than those reporting ever being tested (79.2%) against those that had never been tested (57.1%) for prostate cancer (P=0.032). Of importance, 91.4% of the respondents were willing to take up prostate cancer screening and 97.2% of the respondents were willing to know more about prostate cancer screening. The results of this study demonstrate higher awareness but low knowledge levels on prostate cancer that are accompanied by low perceptions on self-vulnerability to the cancer, low uptake of prostate cancer screening that parallel poor knowledge and perceptions on prostate cancer self-vulnerability and uptake of screening. Thus, public health health intervention targeting information dissemination on prostate cancer; behavioural change on risk perceptions; and uptake of early screening of prostate cancer can halt the increasing burden of the disease.
Determinants of Self Directed Referral amongst Patients Seeking Health Services at Kenyatta National Hospital, Nairobi, Kenya
(2014-02-24) Mahinda, Faith Wambui; Otieno, George Ochieng; Karama, Mohamed
Kenyatta National Hospital (KNH) is found at the apex of the referral system of health care. Ideally, patients seen at KNH are supposed to have sought care from lower levels of health care in the referral system first before seeking health services at KNH. Referral can assume two forms: Self and Non-self. Self referral refers to the scenario where a patient bypasses lower health care levels and visits KNH as his first point of entry while non self-referral refers to the referral done by a health care practitioner from a lower level of health care where the patient is sent to KNH with a referral note. The main objective of this study was to identify determinants (individual and institutional) of self directed referral of patients seeking health services at KNH. 404 respondents participated in the study; sample size was determined using the 10% Gay principle (Mugenda and Mugenda). The researcher conducted a cross sectional, descriptive study using both qualitative and quantitative data collection methods to examine patterns of patient self-referral at KNH according to social-economic status, education level and their perception of quality of care offered in lower levels of healthcare as well as the level of awareness of referral procedures. Descriptive and inferential statistics were analyzed using Statistical Package for Social Sciences (SPSS) while Chi square test and Logistic Regression was used to derive relationships that may exist between the dependent and independent variables; results were significant at a p value <0.05 . The findings of the study indicate that only 27.7% of patients seeking health services at the hospital self refer to KNH. Amongst the patients who self refer to KNH, ailments related to surgical complications (28.6%) were found to be the most common health problems. No statistically significant association was found between individual factors and self directed referral. Institutional factors that were found to influence patients‘ decision to have KNH as their hospital of choice were: location of the hospital, availability of medicines, quality of care, clear kept surroundings and affordable deposits. The health problems that cause patients to seek health services from KNH call for high level diagnostic health care which is often unavailable in lower levels of healthcare. It may be useful to introduce reversed referral within the Kenyan health care system where consultant doctors from KNH visit lower level health facilities and see patients on site. This would go a long way in reducing the number of patients who travel from far in search of quality health service at KNH and at the same time help to decongest the hospital.
Determinants of Utilization of Routine Data for Decision MAKING IN Health Facilities in Kitui County, Kenya
(2014-02-26) Karijo, Eddah Kanini
Effective management of today’s health systems depends on critical use of data and information for the effective policy-making, planning, monitoring of services and making decisions. Following the decentralization of health, the district health management information systems (DHMIS) was established to support the districts in utilizing the generated data for the decisions made in health facility. However, data use has been limited and faced with inadequacy hence vital health decisions often relying on political opportunism, donor demand and infrequently repeated national studies which are insensitive to changes occurring over shorter timescale. This study was designed to identify for determinants of utilization of the routine data for decision making by the health care providers in health facilities in Kitui County in Kenya. This was a descriptive cross sectional study that adopted quantitative and qualitative research paradigms. Purposive sampling was used to select the district hospital, being the only one serving the eleven districts in the county. Multi stage cluster sampling to sample the health facilities in the districts and simple random sampling to select the respondents in the health facilities. The 110 participants completed a self-administered questionnaire. Key informant interviews, focused group discussions, observation and analysis of documents in health facilities were also applied. Recordings were transcribed and key concepts identified. Questionnaire results were edited, coded, tabulated and analyzed using the SPSS 16. Chi-square test was applied to determine the relationship between independent and dependent variables. The results showed that among the respondents 70% were females and 40% males. Majority, 64% had diploma level of education. Nurses/ midwifes were the majority, making up 81% of the workforce. Overall extent of data utilization was 66% not using data and 34% use the routine generated data. The following actors influence utilization of routine data: frequency of meetings held (𝑥2=42.036, df=1, p=0.001), data storage and analyzing methods (𝑥2= 30.582, df=1, p=0.001), continuous professional training (𝑥2= 49.782, df=1, p=0.0001). Organization of the district health system influenced routine data utilization through the frequency of support supervision (𝑥2=30.000, df=1, p=0.001), issues assessed during supervision (𝑥2=49.164, df=2, p=0.002) and feedback report from the supervisors (𝑥2=5.236, df=1, p=0.022). In conclusions the study demonstrates limited utilization of routine data to make decisions for health facility management and recommends the need for the government to build capacity for data utilization through on job training and strengthening the curriculum in health training institutions in data related areas. The ministry of health should standardize the parallel reporting levels and unify the reporting tools and finally ensure the districts have structured meetings, support supervision and feedback to the health care providers.
Effectiveness of partner notification in the management of sexually transmitted infections in Nairobi
(2014-03-11) Nyanchera, Wakasiaka Sabina
Partner notification is the health activity in which sexual partners of individuals with a Sexually Transmitted Infection are notified, counseled about exposure risks and offered services. Brown et al., 1970 has shown that notification has been a strategy for controlling these diseases for many years. The aim of the study was to assess partner notification practices among STI patients and Health Care Providers in Nairobi. A cross sectional descriptive study was carried out in16 city council clinics over a period of 16 weeks. Four hundred and seven STI patients were recruited in the study. Respondents were asked standardized questions about presenting STI complaint, symptomatic period and the number of sex partners. The patients were then counseled and offered a referral slip for all partners. The results show most of the patients were index patients 84%, primary 15.5%, and secondary 0.5%. Notably, there were no tertiary patients seen. The main barrier to notification was fear of quarrels and violence from the partners. Respondents were not sure on how partner's notification can be improved, 37.8%. There was no difference between patients issued with referral cards and those without P< 0.108. However, patients with multiple sex partners referred fewer partners 17.9% compared with those who had one partner 82.1 %), P<0.00045. Partner notification is an essential tool in prevention and control of STIs. It is difficult for people to notify unless they are well informed about their diagnosis mode of transmission and the need to treat partner. This calls for urgent formulation and implementation of a tracking system that will help trace difficult cases. Future studies should focus on re-infection rates among referred patients.
Influenza virus subtypes in wild birds within selected sites along the major migratory fly-ways in Kenya
(2014-05-02) Konongoi, SamsonLimbaso
Human influenza pandemics are rare but recurring events that have periodically affected humanity since ancient times. They are associated with a rapid surge, experienced globally, in the number of cases of respiratory illness and death. Three pandemics occurred during the previous century; the Spanish flu in 1918, the Asian flu in 1957 and the Hong Kong flu in 1968. The world is at risk of another pandemic. For almost two years, health experts have been monitoring a new and severe influenza virus, the highly pathogenic H5Nl strain. Since mid- 2003, this virus has caused the largest and most severe outbreaks of highly pathogenic disease ever recorded in poultry. The current H5Nl strain is a fastmutating and is found in multiple bird species. It is both epizootic and panzootic. Since 1~97, studies of H5Nl indicate that these viruses continue to evolve, with changes in antigenicity and internal gene structure with an expanded host range in avian species and the ability to infect other animal species with enhanced pathogenicity and increased environmental stability. Kenya is a part of the migratory bird fly-way from Europe and Western Asia. Surveillance along the flyway is essential to identify possible HPAI infection and the nature of infection in order to be able to predict possible spillover into human populations. Due to limited data on circulating Influenza strains in wild birds in Kenya, the study was initiated to determine what subtypes of avian influenza viruses are harbored by wild birds in four migration seasons between October 2005 to June 2009. Specimens were collected in 13 sites from 3,618 birds representing 150 species with majority of the specimens being collected from sandpipers, plovers and ducks. The specimens were screened for influenza A by real-time Reverse Transcriptase Polymerase Chain Reaction. All positive Influenza A specimens were further screened for the H5 subtype.Influenza A virus was detected in 1.68% (61/3618) of the all birds representing 23 different species. Of the 61 Influenza A virus positives 21 (34%) were from resident birds, 21 (34%) from paleartic migrants and 19 (32%) from intra African migrants. All the positives were detected during the migration period between October to April. Chi-square was used to determine if there was a significant difference in the number of positive samples in each of the 4 years and among the various categories of birds based on their migration patterns. This variation in prevalence was significant among the four year migration seasons. No highly pathogenic avian influenza viruses were detected during the study period. However, 1 low pathogenic avian influenza virus (LPAI) H12N2 and 4 LPAI H5 subtypes whose neuraminidase subtype was not established were detected in 4 bird species representing both resident and migratory species sampled in 3 sites. The findings demonstrate the potential for wild birds as reservoirs and disseminators of HPAI viruses to areas that may be free from the viruses. The study has given animal and public health experts a baseline of influenza virus activity in wild birds. The study should be strengthened and maintained to continuously monitor influenza virus subtypes circulating in wild birds. In addition to screening for H5 subtypes, other subtypes like the H7 should also be screened for as they are known to cause outbreaks in poultry and have been associated with disease in humans.
Assessing the Level of Readiness for Computerized Health Management Information System Among Nurses in Kenyatta National Hospital, Nairobi, Kenya
(2014-08-18) Mucheneh, Olive Mirai
Healthcare Organizations are now in the process of implementing computerized health management health information system (CHMIS) with a hope that they will improve on safety, efficiency and effectiveness of patient healthcare (Ammenwerth, 2004). More specifically, due to advances of technologies, the adoption of CHMIS is growing rapidly. CHMIS are believed to offer significant benefits in improving patient health care delivery (Thompson, 2005). Health care Organizations implement CHMIS, without knowing whether, nurses will be willing to adopt such systems. If nurses reject the new technologies, CHMIS implementation will not succeed, resulting to poor health care and wastage of resources. The main objective of this study was to assess the level of readiness for CHMIS among nurses in Kenyatta National Hospital (KNH). The specific objectives were to assess the level of readiness for CHMIS, to determine the influence of demographic characteristics influencing readiness for CHMIS, to determine the institutional characteristics influencing readiness for CHMIS, determine the influence of information technology (IT) skills on readiness for CHMIS. The research problem was studied with cross sectional descriptive design using both quantitative and qualitative techniques. The study was conducted at KNH with a sample of 313. The study used a self-administered questionnaire for the respondents, focus group and key informant interview guides for focus group discussion and key informant interviews. Standard package for social sciences (SPSS) version 19.0 was used for analysis. Descriptive and inferential statistics were computed. Results were presented in tables and in narration. The mean for level of readiness was 3.5 which was low. The study found that 110 (35%) were ready for CHMIS, while 203(65%) were not ready. The study showed a significant relationship between designation and readiness for CHMIS among nurses in KNH x2 (1) = 12.26, p = 0.000). However, there was no significant relationship between gender x 2 (1) = 0.01, p = 0.91; age x2 (2) = 3.87, p = 0.14; level of education x 2(1) =0.15, p =0.70; highest qualification x2 (1) = 3.34, p = 0.07; work experience x 2 (1) = 3.67, p = 0.05 and readiness for CHMIS among nurses. The study further showed a significant relationship between overall institutional characteristics x2 (1) = 41.69, p= 0.000 and readiness for CHMIS among nurses. The study showed a significant relationship between IT skills and readiness for CHMIS x2 (1) = 7.613, p = 0.006. Results from focus group discussion and key informant interviews indicated that the hospital has not trained nurses in IT, the top management has not communicated the IT strategy to nurses, and awareness and participation among nurses was lacking. System champions were also lacking among nurses as well as technical support. Further, KNH lacked sufficient infrastructure for CHMIS and the hospital has not carried any technology assessment to find out whether nurses were ready for CHMIS or not. The hospital information communication technology (ICT) master plan was still on draft. Based on these findings, the study recommends that; the top hospital management should fully assess nurses level of readiness and other requirements prior to implementing CHMIS, provide IT training to nurses, identify system champions among nurses, provide sufficient infrastructure for CHMIS implementation, and finalize the ICT master plan for possible implementation. The study recommended that future research could investigate which new constructs such as high innovativeness, low insecurity and discomfort could add to the explained levels of technology readiness (TR).
Determinants of access to healthcare among the elderly.the case of Kibera informal settlement, Nairobi County, Kenya
(2014-08-28) Wairiuko, Judy Wanjiru
Access to Health care by the elderly can be defined as the ability of the aged to get the required medical care from the health service providers when they need it. It’s a comprehensive measurement of access to health care that requires a systematic assessment of physical, financial and socio-psychological access to services. These are further defined into three basic indicators: availability, affordability and acceptability. The proportion of the elderly is increasing rapidly in Kenya. This comes up with health problems like hypertension, diabetes, cancers among others. Which can be delayed if good health care is accessed; whether the healthcare is prepared to take care of the elderly has not been extensively investigated in Kibera urban informal settlement, Nairobi County, Kenya. This was a descriptive cross-sectional study targeting both elderly men and women aged 60 years and over, in Kibera informal settlement of Kenya, to identify factors influencing access to healthcare by the elderly. Data collection tools employing both qualitative and quantitative parameters were used in the study. A multistage sampling approach was used. Kibera urban informal settlement was purposively selected while the sub-locations Gatweekera, Kianda and laini-saba were randomly selected. Probability proportionate to size sampling of the elderly was done and systematic sampling was done to identify the respondents. Data was obtained from a total of 399 elderly using interviewer administered questionnaire. Key informant interviews on health facility managers were used to provide additional information. Data was analysed by SPSS and presented using tables, graphs and cross tabulations, while association between variables was assessed using Chi-square statistics and Odds Ratio. Thematic analysis was done on qualitative data. Findings showed that access to healthcare was at 40.4 %. Marital status (χ2=8.321, df=2, p=0.016), type of house (χ2=7.069, df=2 p=0.029), education (χ2=12.521, df=3 p=0.006) was statistical significant in relation to access to health care services by elderly. The odds of access increased with those who lived in permanent houses (OR: 30.699, 95% CI 1.827-515.927 P<0.017) when compared against those who lived in temporary houses. Services of CHWs was significant (χ2=9.092,df=2,p=0.011) in relation to access. Satisfaction of health care services (χ2=257.326,df=4,p<0.001) was significantly associated with access. Availability of equipment (χ2=48.871, df=2 p<0.001) and availability of drugs (χ2=39.031, df=2 p<0.001) were significantly associated with access to healthcare. The study showed need to address access to health care factors that contribute to elderly not accessing health care. Findings in this study will be used by policy makers to develop a policy on elderly person’s welfare, ensure that there are elderly friendly services in all primary health care facilities, with trained health personnel on geriatric health, and basic drugs and medical equipments for non communicable diseases.
Compliance with the Provisions of Section 126 of The Public Health Act (Cap 242) By Public Food Places in Bungoma County, Kenya
(Kenyatta University, 2015) Ogweno, C.
The public food industry in Bungoma has been experiencing numerous challenges in their quest to comply with the Public Health Act (CAP 242), especially section 126. Consequently, the study sought to establish the extent of compliance with the provisions of Section 126 of the Public Health Act (Cap 242) by public food places in Bungoma County, Kenya. The government has channeled few resources towards enforcement of public health laws in the county regardless of the high levels of court fines and summons issued to proprietors within public food places. Studies determining compliance with public health laws, especially section 126 among public food places have either not been conducted or inaccessible. One of the objectives of the study was to establish the extent of compliance with the provisions of section 126 of the Public Health Act by public food places in Bungoma County, Kenya. The second objective was to establish the factors influencing the public food places proprietors’ ability to comply with Section 126 of the Public Health Act. The last objective was to establish the association among socio-demographic characteristics, public food places characteristics, practices and compliance levels. The study took a cross-sectional survey conducted across public food places in Bungoma County. A representative sample was obtained using the fisher et al (1991) approach. The total number of public food places as per the records in the Bungoma County offices is 639. However, the respondents chosen for the study was 149 after the sampling process. The respondents were obtained using a formulated eligibility criterion (exclusion and inclusion). Data was collected using inspection checklists, structured questionnaires, interviews and focus group discussions. A database that facilitated the analysis process was then created using SPSS. However, the analysis process used stata software. The association between hotel characteristics and compliance were considered significant when the p value was equal or less than 0.001. The results on compliance out of a possible score of 5 based on likert scale was certificate of fitness (3.1), wells, tanks and cisterns (2.9), stoves, cooking apparatus and chimney (2.1), construction, repair of dilapidated buildings and escape routes for occupants (2.2) and erection of movable objects, excavations and projections (2.3). The mean compliance for sewerage system was (2.2), removal of refuse on an hourly basis was (2.6), regulating sanitary conveniences was (2.1), ventilation and dimension of rooms was (2.9) and lighting was (2.9). An independent t-test indicated that on average, there indeed was a statistically significant difference in the mean compliance level between male and females with female gender being less compliant than the male gender (p=0.0001). A one-way anova test also revealed that those with less education (primary level) were less compliant as compared to their counterparts who schooled up-to secondary and college/university (F=13.9, p=0.0001). Other factors studied included revenue, relationship with law enforcers during inspection and awareness. The factors showed a statistically significant relationship with compliance based on chi-square results (p<0.005). However, bribery did not show a positive relationship with compliance. The study recommends that the county government should adapt cooperative enforcement (co-regulation) to enhance compliance. Health literacy is an important approach that increases the understanding of the law among proprietors in the county through enhancing familiarity.
Disaster Preparedness Among Members of Staff at Kenyatta National Hospital, Nairobi County, Kenya
(Kenyatta University, 2015) Kiongo, J. G.
Over the world, hospitals have suffered severe damage as a result of natural and anthropogenic disasters leading to the partial or total collapse of the structures and interruption of the health services urgently needed by the victims of the event. During the disaster strike, hospitals are confronted with a large number of casualties exceeding their capacity to cope. Despite the situation, many governments have paid less attention to disaster preparedness in health facilities. Hospitals from various parts of the world possess limited capital and staff time to spend on conducting comprehensive disaster response drills, emergency planning and preparedness. The main objective of this study was to find out whether members of staff at Kenyatta National Hospital are prepared for disasters. The study also looked into structures that the Kenyatta National Hospital has put in place to mitigate for disaster. This was a cross sectional descriptive study. Data collected in this study was both quantitative and qualitative. Data was collected using self -administered questionnaire containing both closed and open ended questions. The study involved 361 respondents sampled from 4646 being the total population of members of staff at Kenyatta National Hospital. The respondents were stratified according to departments of the hospital and then randomly selected based on the required sample size. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 16.2 and Microsoft office excel. The study established that terrorist attack is the leading potential threat followed by fire. Most members of staff of KNH were aware of the existence of a disaster management committee and the existence of a disaster plan in the hospital. Majority of the respondents felt that firefighting equipments and evacuation plans are inadequate. The results have been presented in tables and charts. Chi square was used to determine association and difference between responses. Terrorist attack and fire were identified as the main potential threats with 84% and 81% of the respondent identifying them as potential disasters respectively. The study found out that 58% of the respondents had no training on disaster management. Majority of the respondents indicated that there was no adequate infrastructure to manage disaster with 62.3 % indicating there was inadequate fire fighting equipments. The findings showed a significant association between age and disaster preparedness (Χ2=13.202, df=9, p=0.002); training on disaster management and disaster preparedness (Χ2 =34.738, df=3, p=0.001); years of experience and disaster preparedness (Χ2=13.202, df=12, p=0.007); level of awareness and disaster preparedness (Χ2=8.477, df=1, p=0.004). The study will assist KNH and other health facilities in formulating policies on disaster preparedness. The study recommends that Kenyatta national Hospital improves on the training of staff on disaster management in order to respond to emergencies effectively and efficiently.
Cost and Quality of Healthcare Services Provided to Urban Refugees Through in-House and Outsourced Health Facilities in Nairobi, Kenya
(Kenyatta University, 2015) Kamau, E. N.
More than half of the world’s refugees reside in non-camp settings, In Nairobi, approximately 55,000 refugees had been registered with United Nations High Commission for Refugees by end of 2012 (UNHCR, 2013).In recent years the UNHCR has documented a trend towards a growing number of refugees and asylum seekers residing in urban areas. Refugees in urban areas often face numerous problems limiting them from accessing the already overstretched government health services. Most urban refugees do not have a reliable source of income and hence cannot afford to pay for healthcare services. In Nairobi, healthcare for urban refugees is provided using donor funds through two main models: In-house health facility set up to provide healthcare services exclusively for urban refugees and through outsourcing from mainly existing faith based health facilities where refugees are treated and the costs passed to humanitarian organizations for settlement. Despite the increasing humanitarian crisis in Africa, there is shrinking humanitarian resources hence overstretching the already limited donor funds. There is need therefore to use the available donor funds in the most cost efficient way and ensure quality healthcare services. The main objective of this study is to determine and compare the cost and quality of healthcare services between in-house and outsourcing healthcare among urban refuges in Nairobi Kenya. The study employed a descriptive cross sectional design. Purposive sampling method was used to select the two facilities. Structured questionnaires were administered as exit interviews on refugee patients who were treated at the two facilities with the selected five common illnesses. The quality data was analysed using SPSS version 20 and cost data using excel 2007. The direct medical cost was at an average of Kshs 130.1per patient at the in-house facility and Kshs 588.02 per patient at the outsourced facility. The overhead costs were at an average of Kshs 800 pp and Kshs 349 pp respectively. Total average cost was Kshs 930.1per patient at in-house and kshs 937.02 per patient at outsourced facility. The quality of care indicators, clinician’s understanding of patients problems was statistically significant (χ2(1) =7.635, p=.006) patients being allowed to ask questions about their health was significant (χ2(1)=38.019,p=.000), patient being examined physically was statistically significant (χ2(1) =126.95,p=.000), drugs well utilized was also significant at( χ2(1)=36.837, p=.000).Laboratory utilization was higher at the outsourced facility compared to the in-house facility was significant (χ2(1)=23.214,p=.000). Comparing the cost at the two facilities, the direct medical cost was significantly different with in-house being the cheaper model (t-test=27.639, df 302.290 and p=.000) however with additional overhead costs, there was no significant difference in cost (t-test=-.346,df 302.290and p=0.729).Comparing quality of care, the results was subjected to a quality index measure. The in-house facility scored 87.53% while the outsourced facility scored 73.99% hence there was better quality of care at in-house facility compared to the outsourced centre. The study therefore recommends that the in-house model looks for ways of reducing their overhead costs (rent and salaries) since the direct average cost was significantly lower, with lower overhead costs, then the total average costs would be lower. The facility should also increase laboratory utilization (evidence based practices) since it scored high on all other quality measures apart from laboratory utilization.
Migration of Human Resources for Health at Kenyatta National Hospital, Nairobi County, Kenya.
(Kenyatta University, 2015-01-19) Obura, Brendah N.
The importance of health workers to the effective functioning of healthcare systems is widely recognized. Shortages of health workers constitute a significant barrier to achieving health-related Millennium Development Goals (MDGs) and expanding health interventions in developing countries. In Kenya, internal migration of workers, from rural areas to urban areas, is just as serious a problem as international migration. Shortages in the health workforce are aggravated by the unequal distribution of health workers as a result of economic, social, professional and security factors that all sustain a steady internal migration of health personnel from rural to urban areas, from the public to the private sector, and out of the health profession itself. This research was undertaken at Kenyatta National Hospital. The main objective of this study was to establish determinants of migration of human resource for health at KNH. The research was a cross sectional descriptive design study conducted in the month of March, 2012. A sample size of 360 was determined using Fisher et al method of 2003.Data was collected using questionnaires with open and close ended questions. Key informant interviews were held with the various heads of departments to gain deeper insight into causes of migration. A strict inclusion criterion was followed to select respondents. Data was analyzed using SPSS version 12.0.1 and presented in figures and tables. Chi-square test was applied to determine the relationship between independent and dependent variables. The results showed that majority of the respondents 37% were aged between 30 to 39. This means that KNH employs regularly, an indicator of growth or turnover of staff. The following factors influenced the migration of HRH: Marital status (x2 =6.082, df=4, p=0.001), divorcees and those separated were associated with migration: Years of service (χ2=10.010, df =3, p=0.001): Socio-economic factors especially on income and job description (χ2 =30.45, df= 8, p= 0.000): Management of KNH (χ2 =19.696, df=4, p=0.000) influenced migration of HRH among other factors. The study revealed that majority (67%) of HRH was happy with their current job and have attained the necessary skills to perform specific duties assigned to them. In conclusion, the study recommends that KNH put in place policies to retain health workers. A number of non-financial incentives are highly valued: improved working conditions; training and supervision; and good working conditions, communications, health care and educational opportunities
Patient satisfaction at comprehensive care centers (ccc) points-of-care in level 5 public health facilities in Kenya
(Kenyatta University, 2015-08) Oyoo, Otieno Titus
Quality of care in government public facilities is important for ehnancing patients satisfaction and hence retention of patients in care especially in cases where treatment is life long such as HIV/AIDS. The Kenya Quality Model (KQM) was developed to improve quality and patients satisfaction with care in public hospitals. The purpose of this study was to assess patients‟ satisfaction with HIV/AIDS services at the level 5 comprehensive care centres (CCC). The specific objectives included profiling of patients satisfaction, determine the relationship between patients satisfaction with quality of service; determine the influence of patient reported outcomes on the quality perceptions; determine the influence of patients‟ biomarkers on satisfaction; and, determine the influence of sociodemographic factors on satisfaction with services at the CCC in level 5 public health facilities in Kenya. This was a cross sectional study conducted in three level 5 public health facilities, namely; Machakos, Rift Valley Provincial Hospital-Nakuru and Oginga Odinga Teaching and Referral Hospital-Kisumu. Three hundred and ninety (390) patients were interviewed using a questionnaire that consistent of three sections:- socio-demographics characterisitics; service quality (SERVQUAL) and Patient Reported Outcome (PRO). Secondary data on biomarkers were retrieved from patients‟ records. Data analysis was done using SPSS. The study findings showed that the average service score gap for all patients was -0.42, indicating that the expectations were higher than perceptions. There was a positive relationship (r = 0.699, or 69.9 %) between the service quality and patients satisfaction. There was no significant relation between PROs and patients‟ satisfaction (r=0.055). Biomarkers and socio-demographic factors (e.g. gender, age and education levels) of patients had no significant influence on patients satisfaction (χ2=7.788, p=0.454 and χ2=2.552, p= 0.279, respectively). In conclusion, there is a fairly strong relationship between quality of health care services provided and patient satisfaction at level 5 public health facilities, and that there is need for patient opinions in health service provision as a policy matter, now and in future. There is need for patient satisfaction studies to be carried out regularly; facilities enhance their capacities for Cd4++ and Cd8++ cell counts through robust and regular budgetary allocation. There is also need for similar studies for all other KEPH levels, i.e. KEPH levels 2, 3, 4 and 6. The facts brought out through such deliberate initiatives would help health system managers to prudently manage by properly allocating resources where they are required and improve patient satisfaction with health service provision in the public health facilities.
Technical efficiency in public hospitals in Kenya
(Kenyatta University, 2015-11) Rithaa, Koome Gilbert
The World Health Organization called attention to the importance of efficiency in all functions of a health system for the ultimate achievement of the goals of health improvement, stewardship, responsiveness and fairness in financing. Although, efficiency improvement should be seen as a strategy for mobilizing domestic resources and utilizing the available resources without waste to achieve the desired health sector goals, it is not usually the case especially in low income countries like Kenya despite health facilities receiving over 75% of the total recurrent budget from Government allocation. Over the past years, there has been little health outcome improvement despite significant increase in budgetary allocation to the health sector especially the health facilities. Therefore, quantifying the current level of efficiency in the hospitals is an accepted strategy in dealing with inefficiencies and enhancing the scarce resource optimization. The general objective of this study was to assess the technical efficiency in public hospitals in Kenya. The study used an analytical and descriptive study design employing econometric techniques for data analysis. Simple random sampling was used to select a study sample of 30 level 4 hospitals in Kenya. A cross sectional model was used to analyze secondary data collected from District Health Information System using Data Envelopment Analysis to determine efficiency levels while interval regression was used to establish determinants of inefficiency. Results indicated that 50% of the hospitals were Constant Returns to Scale technically efficient with a mean efficiency score of 80.6% while 66.6% of the hospitals were Variable Returns to Scale technically efficient with a mean efficiency score of 92.7%. In terms of Scale Efficiency, 50% of the hospitals were scale efficient with a mean efficiency score of 86.8% score. There was a constant return to scale in 50% of the hospitals, increasing returns to scale in 40% of the hospitals and decreasing returns to scale in 10% of the hospitals. The mean level of technical inefficiency was 21.9%. The total inputs slacks in the inefficient hospitals were 122 beds and 454 staff which represented an input slack of 7.3% for the beds and 22.1 % for the staff. All the inefficient hospitals required a 27.6% increase in total outpatient visits which translated to an additional 217, 547 outpatient visits. A total of 5,006 discharges were required which was a 9.2% increase in total discharges. Further, all the inefficient hospitals required to augment their operations capacity with a sum of 1,596 operations which represented a 31.3% increase in total operations for them to be technically efficient. Interval regression analysis results showed that outpatient to inpatients visits ratio, bed occupancy ratio, inpatient discharges to death ratio, National Health Insurance Fund bed days to bed days of those not enrolled in National Health Insurance Fund, gross death rate influence technical inefficiency levels. In conclusion, a substantial proportion of public hospitals were technically inefficient due to inappropriate production sizes occasioned by use of excess production inputs to produce sub-optimal outputs. Therefore, there is need for effective policy and managerial interventions for dealing with the existing production slacks and factors influencing inefficiency in the hospitals.
Clinicians User Satisfaction with Paper-Based Patient Information System in Kenyatta National Hospital and Mbagathi County Hospital, Nairobi, Kenya
(Kenyatta University, 2016) Kimani, Alice Wanjiku
User satisfaction with paper-based information system is a subjective evaluation of the various individual, organizational, and societal consequences of information systems use. Despite the widespread use, the need to identify the extent to which clinicians are satisfied with the patient information systems in health institutions is still necessary. The purpose of this study was therefore to investigate the clinicians' (doctors, dentists and clinical officers) user satisfaction with paper-based patient information systems in Kenyatta National Hospital (KNH) and Mbagathi County Hospital (MCH).The specific objectives were: To determine the proportion of clinicians who were satisfied, to determine the influence of user characteristics, to determine the organizational characteristics that influenced satisfaction and to determine the influence of information quality to clinician’s satisfaction. This was a cross sectional descriptive study. The two hospitals were purposively selected. The study employed stratified random sampling. Probability proportionate to size sampling of the clinicians was done and simple random sampling was done to identify the respondents. Data collection tools employing both quantitative and qualitative parameters were used in this study. Questionnaire was pretested in Mathari Hospital and thereafter refined accordingly. Data was obtained from 190 clinicians using self-administered questionnaires, FODs and KT interviews to provide in-depth information. Data was analyzed by SPSS Version 16.0 and the results of the findings presented in form of figures and tables while association between variables was assessed using chi square statistics. The findings showed that clinician's satisfaction was at 15.3%. Age (x2=42.079, df=3, p=.OOO), years worked (X2=41.973, df=4, p=.OOO), education (X2=4.518, df=I, p=0.034), designation (X2=23.385, df=3, p=.OOO) was statistically significant to clinicians user satisfaction. Overall organizational characteristics (X2=6.409, df=l, p=.Oll) and information quality dimensions (p< .01) was statistically- significant in relation to clinician's user satisfaction. The study therefore showed need to address factors that contribute to very low clinicians' satisfaction level with paper based patient information systems. Findings of this study will be used by policy makers to develop policy on information systems to ensure that clinicians' requirements are met.

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