MST-Department of Environmental Health

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    Prevalence and pattern of significant refractive errors in high school students in Meru municipality
    (2013-04-04) Njeru, Samuel N.
    Uncorrected refractive errors are an important cause of visual impairment in many. Visually disabling refractive error affects a significant proportion of both genders of the global population. Lack of practitioners is the main reason for high rates of visual problem due to uncorrected refractive errors. In developing countries, it is difficult to provide refractive services mainly due to lack of sufficient data on these errors. The proportion of school children who are visually impaired due to refractive errors can be used to assess the level at which the development of refractive services for schools can be established in a country or region. The main objective of this study was to investigate prevalence, pattern and some of the factors for continued presence of uncorrected significant refractive errors (SRE) among high school students in Meru Municipality, Meru Central District of Eastern Province, Kenya. This was a cross-sectional study that was conducted in two selected secondary schools. Stratified random sampling technique was used to select the study population. Data was collected through structured questionnaires and physical examination of the study subjects who met the eligibility criteria. Chi square test of independence was used to determine the relationship between variables such as prevalence, pattern, refractive status, health seeking behaviour and their association with the sex of the study subjects. The number of students who participated in the study was 164 with boys and girls having equal representation. The participants were between 13 to 18 years old, with a mean of 15.4 years. The study showed that the overall prevalence of SRE was 8.5% (n=164). Sex specific prevalence indicated no significant difference between the two sexes c2 = 1. 24, d.f =1 p> 0.05). The pattern of SRE revealed that myopia was the leading cause of decreased visual acuity, contributing 6.7% of all the students who underwent the screening process. All boys with SIZE were myopic, compared to 66.6% for girls. However, there was no significant difference between them (c2 =2.05, d.f =1 p>0.005). Astigmatism was second with 1.1% prevalence and lastly, hypermetropia with 0.6%. The study has shown poor health seeking behaviour by students, with 78.6 % (n=14) having not sought correction of their visual problem. About 7.1% of students with SIZE had spectacle correction with correct power of lenses while 14.2% (n=14) had spectacles with wrong lens power. The main reason for students with SRE not wearing glasses was inaccessibility to refractive services, with 52.6% of them having never been examined for their refractive state. SRE among students was also associated with family history of wearing spectacles. In conclusion, SRE among high school students in Meru Municipality require attention, with myopia being the main problem. Screening programmes for refractive services through primary health care can offer a reasonable solution to the problem and is therefore highly recommended. Multisectoral approach between stakeholders in the ministries of Health and Education can yield meaningful output in alleviating the situation.
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    Determinants of Utilization of Youth Friendly Reproductive Health Services among School and College Youth in Thika west district, Kiambu county, Kenya
    (2013-08-14) Akinyi, Obonyo Perez
    This study was on Determinants of Utilization of Youth friendly Reproductive Health services (YFRHS) among school and college youth in Thika West District of Kiambu County, Kenya. The reproductive and sexual health of the youth remains a relatively new and sensitive area mainly due to restrictive norms and policies guiding the services. Sex and sexuality among the young people have remained a sacred area and few structures were in place to address it. After International Conference on Population and Development in 1994 countries started implementing adolescent reproductive health issues. The Government of Kenya together with partners in an attempt to address the reproductive health challenges came up with the Adolescent Reproductive Health and Development Policy (ARH&D) in 2003 whose guidelines were finalized in July 2005 and released for use by service providers. Despite these guidelines, the access and utilization of YFRHS among the school youth are dependent on many factors which include demographic, economic, school, socio-cultural and health system factors. The study examined how those factors determined or affected the utilization patterns of YFRHS by the youth. The study further explored ways of mitigating or addressing the barriers to scale up utilization of those services. The study used both quantitative and qualitative approaches to collect data. The study utilized survey research adapting descriptive cross sectional design and semi-structured questionnaire to interview 390 school and college youth in Thika West District from 9th January 2012 to 17thFebruary 2012.The key informants were mainly nurses who were working at the reproductive health service delivery area at the time of study and were interviewed using an interview guide. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) Version 18.0.Descriptive statistics and chi-square tests were performed to determine significant associations. The study established that sex, age, level of education, type of school and youth’s awareness about existence of reproductive health facility and services offered were significantly associated with utilization at p<0.05 while religion and parental employment status had association only to a few services. Ethnicity had no association to utilization of all YFRHS, p>0.05. Long queues, unfavorable working hours, mixing out of school youth and the school going youth and lack of money negatively affected utilization of YFRHS. Parents and teachers‟ involvement in passing RH information was found to be low as majority of the youth reported that they got information of these services from friends. The study concluded that the utilization of reproductive health services among the school and college youth was low largely due to unfriendliness of the reproductive health facilities to the youth and lack of awareness of RH services. In view of the findings, this study recommends need for the Government through the Ministry of Health and partners in health service provision to increase the number of YFRHS and ensure that the recommendations of Adolescent Health Policy guidelines are implemented fully with good evaluation strategies in place. Rigorous awareness drives to sensitize the youth about the available RHS through rigorous health education and increased involvement of both parents/guardians and teachers to scale up utilization are also recommended.
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    Uptake of HPV vaccine and screening for cervical Precancerous lesions among attendees of MCH clinic At Thika level 5 hospitals, Kiambu County
    (Kenyatta University, 2014) Mugwe, Jane
    Cervical malignancy is a disease of public health importance. It is one health condition that, in its prevalence and outcome clearly depicts the disparity between the health care systems of developed and developing countries. About 80% of the morbidities and mortalities resulting from cervical cancer occur in developing countries. This is further compounded by the fact that 75% of patients in developing countries present with advanced stage disease when only palliative treatment is possible. High risk human papilloma virus serotypes are implicated in the development of cervical intraepithelial neoplasm and cervical cancer. Sexual behavior has been identified as the major risk factor for cervical cancer. Although largely preventable, cervical cancer remains a common worldwide malignancy. Globally 500,000 new cancers occur annually. Screening and immunization have been documented to greatly reduce cervical cancer in most developed countries but those strategies are poorly implemented in developing countries. The objective of this study was to assess the factors influencing uptake of HPV vaccine and screening for cervical cancer. This was a cross sectional study of maternal child health clinic attendees, between February and mid June 2011 at Thika level 5 hospital. By simple random sampling technique 290 mothers were interviewed after observing the necessary ethical requirements. Data analysis was done by predictive analytical software and presented in frequency tables, percentages and means. Inferential statistics was done using chi-square to test for association among research variables,• statistical significant was calculated at 5% level of significance and 95% confidence interval. The results of the study showed that less than half of the respondents (40.3%) had knowledge on the causes of cervical cancer. While majority (79%) of the respondents stated that cervical cancer was a very serious disease, only 24 (8.3%) of the total respondents (290) had been screened. Although 39(13.4%) had heard about a vaccine to protect against infection with human papilloma virus (HPV), none of the respondents had been vaccinated. Educational level was positively correlated with knowledge of cervical cancer, (X2 =14.949,df=3, p=0.002). Higher education attainment led to the delay in sexual debut. More than half of the respondents (63%) were at an increased risk of developing cervical cancer. This study recommends integration of HPV vaccine with Kenya National Immunization Vaccine programme and education curriculum to be modified to include diseases of public health importance such as cervical cancer at all I' • levels of education,
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    Determination of the Prevalence of Bovine Cryptosporidiosis and aflatoxin M1 among urban small holder dairy households in Dagoretti Division, Nairobi Kenya.
    (2014-05-05) M'Ibui, Gervase Miriti
    Cryptosporidium is a coccidian parasite belonging to the phylum apicomplexa. It causes human and animal cryptosporidiosis a disease characterized by severe gastroenteritis and watery diarrhea. The disease occurs after ingestion of Cryptosporidium oocysts, shed in human or animal feces. The prevalence of bovine cryptosporidiosis was investigated alongside that of aflatoxin Ml in milk. Aflatoxin Ml is a major metabolite of Aflatoxin Bland is found in milk of animals that have consumed feed contaminated with aflatoxins. Aflatoxins are potent toxic carcinogenic, mutagenic and immunosuppressive agents harmful to the health of the people. The prevalence and knowledge of bovine cryptosporidiosis and detection of Aflatoxin Ml (AFMl) were studied between smallholder dairy and non-dairy farming households in Dagoretti Division Nairobi Kenya, between January and June 2005. The purpose of the study was to establish the prevalence of the two hazards in order to enable the small holder dairy producers, traders, consumers and policy makers to adopt mitigation strategies to the problem. Three hundred (300) and 150 dairy and non-dairy households respectively, were randomly selected for the cross sectional study and mapped using GPS for future follow-up. Focus group discussions and household questionnaire administration were used to collect qualitative data. Cryptosporidium oocysts were identified using Ziehl Nelsen method, while Aflatoxin Ml in milk was determined using aflatoxin kit purchased from Charm Sciences which is a rapid receptor lateral flow assay that detects Aflatoxin Ml at 500ppt USA action level. In the study, three hundred and ninety six (396) milk samples comprising 260 and 136 from dairy and non dairy households respectively were analyzed for AFM1. For identification of Cryptosporidium oocysts, 278 adult cattle and 150 calves' pooled fecal samples were microscopically examined using Ziehl Nelsen method. Of the calf fecal samples, 11.3% (17/150) were positive for Cryptosporidium oocysts, while 12 %( 33/278) of the adult fecal samples were also positive for the same. There were 50 positive samples from 286 households where at least one fecal specimen was taken giving an apparent prevalence rate of 17%. A household was considered positive for bovine cryptosporidiosis if Cryptosporidium oocysts were found in at least one pooled sample (adult, calf or both) from that household. Positive status for households were associated with numbers of animals, feeding the cattle with water from the household well, and cementing the cattle shed floor (p<0.05). More dairy respondents, 20% (55/280) were aware of the disease cryptosporidiosis than their non-dairy neighbors, 4% (5/132). However, knowledge on transmission and symptoms of the disease was low for both groups. The prevalence of Aflatoxin Ml in the tested households was 45% (178/396). The prevalence of Aflatoxin Ml in the farming households was 43% as compared to 49% in the non-farming households. Nevertheless, this difference was not statistically significant I.P= 0.35]. Although there was a 17% prevalence rate of cryptosporidiosis, it does not constitute a human health risk unless Cryptospofidium parvum is present. The AFMl prevalence of 45% exceeds the WHO/F AO tolerance limit for milk. It points to an underlying problem that requires the action by policy makers. Awareness on the two hazards was low, and needs to be created. Further" research is needed to identify the Cryptosporidium genotypes, and quantify AFMl in milk in order to provide further information for guided health education and policy formulation.
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    Assessment of Knowledge, Attitude and use of Insecticide-Treated Nets Among Students in Boarding Secondary Schools in Igembe District, Kenya
    (2014-08-18) Kinyua, Daniel M.
    Malaria is a major public health problem causing immeasurable human suffering in many countries particularly in the sub-Saharan Africa, which account for about 90% of malaria cases in the world. Many people live in countries with high risk of contracting malaria and 300-500 million cases of malaria are estimated to occur annually. Malaria is transmitted to people of all ages and an estimate of 80% of human-mosquito transmission comes from over-fives with young adolescents forming the peak age group. Over the years malaria has emerged as serious threat to poverty reduction and a contributor to poor socio-economic development. In Kenya, malaria remains the leading cause of morbidity and mortality followed by AIDS and TB. Efforts to control malaria are being challenged by emergence of drug and insecticide resistance among other factors. Hence, there is a need to focus on interventions which prevent human contact with the mosquito vector such as the use of ITNs. However, studies have shown that ITN is an effective tool for malaria control. Although, a lot of campaign is being made to promote the use of ITNs WHO has reported low usage of ITNs among students in boarding secondary schools in Ghana, Nigeria, Sudan and Kenya, even in malaria endemic areas. The primary beneficiaries of the donor-driven free distribution of ITNs have been pregnant women and children below five years. Thus failing to target older children, it means malaria transmission is likely to continue. The objective of this study was to access the students’ knowledge on malaria transmission and the use of ITNs for malaria prevention among students in boarding secondary schools. This study was a descriptive cross-section survey and it was carried out in randomly selected boarding secondary schools in Igembe district, Meru County, Kenya. The study focused only on boarders who are admitted or resident of the area for at least one month because naturally acquired malaria has an incubation period of 12-28 days. Three hundred and eighty four students were randomly selected from 5170 learners in ten schools out of 37 secondary schools in Igembe district. Pre-tested, structured self- administered questionnaires, observation checklist and interview guide to guide focused group discussion was used to collect information on demographic characteristics, knowledge, use of ITNs and reasons for non-use of ITNs. Only respondents willing to participate in the study were recruited. Data was analyzed using SPSS. Chi-square test was used to compare differences in proportions between groups. Most respondents 303(79%) were aware that mosquitoes transmit malaria but only a few could identify the causative agent of malaria. Respondents reporting ITN use experienced significantly less episodes of malaria [8(16.6%)] relative to those reporting non-use of ITNs [205(61%)]. This was statistically significant (p = 0.003). Cost [172(44.7%)] and availability [81(21.2%] were the main reasons cited 13 by most students for non-use of ITNs. Therefore, to protect our youth in boarding secondary schools from malaria attack, ITNs usage should be incorporated into the school health service. The result of this study was used to make recommendations to scale up ITNs usage among the students in boarding secondary schools. This would lead to reduced malaria morbidity and mortality and increase malaria prevention awareness among the students in boarding secondary schools.
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    Sexual Violence against Adolescent Girls in Mixed -Day Secondary Schools in Limuru Sub-County, Kiambu County, Kenya
    (Kenyatta University, 2015-06) Kimani, Eunice W.
    Sexual violence against adolescent girls (SVAG) is a global concern due to its adverse effects on the overall health of these girls. In Kenya, cases of sexual violence in this age group are reported to be at 33%. The study explored sexual violence among adolescent girls (15-19 years) in the nine (9) mixed day secondary schools of Limuru Sub-county, Kiambu County, Kenya. The broad objective of the study was: to assess the status of SVAG in mixed day school in Limuru Sub-county, Kiambu County. The specific objectives were: To establish the proportion of adolescent girls in mixed day schools in Limuru Sub-county affected by SVAG, to determine the perpetrators of SVAG in mixed day schools in Limuru Sub-county, to determine the factors that increase vulnerability of adolescent girls in mixed day schools in Limuru Sub-county to sexual violence, and to determine the factors that affect disclosure levels on sexual violence matters among adolescent girls in mixed day schools in Limuru Sub-county. The study was cross sectional in nature and collected qualitative and quantitative data. The research instruments that were employed in gathering data included self-administered questionnaires with the 301 sampled girls. The number of girls sampled in every school was proportionate to the number of adolescent girls in that school. Systematic sampling was then used to select the individual girls to participate in every school. Girls who were aged 15-19 years, who were in any mixed day secondary school in Limuru Sub-county, those that had been in the school for three terms and those who consented to participate in the study were illegible. Those who were excluded were girls who failed to consent to participate in the study as well as those who were absent from school during sampling. Three Focus Group Discussions (FGDs) were conducted; one in each educational zone of the Sub-county to enrich the data collected using the questionnaires. Key informant interviews were conducted with two officials in the Children’s Sub-county office, two medical officers, as well as with two police officers stationed in Limuru Sub-county and two school heads selected at random. 32.6% of the respondents were affected by SVAG. Of these cases, 85% had experienced forced touching, 51% had experienced attempted sex and 15% had experienced forced sex. In all the three forms of SVAG, male perpetrators constituted more than 96%. Boyfriends (32%) were the commonest perpetrators of sexual violence. About 49% of the perpetrators were reported to have been under the influence of psychoactive substances when committing the sexual violence. Most of the SVAG (40%) was done in the perpetrator’s home. Factors that showed a significant association with vulnerability to SVAG were: alcohol use (OR=3.4 p=0.001), forced sex at debut (OR=62.4 p=0.000) and family connectedness (p=0.001 OR=10.6). Social economic status and age of adolescent girl did not show any significant association with vulnerability to SVAG. Disclosure levels were low: forced sex (7%), attempted sex (12%) and forced touch (15%). Factors that showed significant association with disclosure levels were: level of knowledge on sexual violence (OR=1.8 p=0.03), level of knowledge on service availability (OR=7.9 p=0.01) and family connectedness (OR=2.29 p=0.02). Age of the girl did not show any significant association with disclosure levels.
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    Newborn care practices among postnatal mothers in Garissa County, Kenya.
    (Kenyatta University, 2015-11) Kumola, Annastacia Mutono
    Every year, four million infants die within their first month of life, representing nearly 40 per-cents of all deaths of children under age 5 globally. In Kenya, neonatal mortality is 31 per 1000 live births with neonates contributing 42% of the under-five mortality while in North Eastern province (which hosts Garissa County the area of study) under-five mortality was 33 per 1000 with neonatal mortality contributing to 60% of infant mortality in the region. Delivery by a skilled birth attendant has remained low at 32% in this region with only 17% of births occurring in a health facility. Therefore understanding newborn care practices in the home environment where most newborns are born is essential in order to develop appropriate approaches for reducing neonatal mortality. The aim of this study was therefore to establish the newborn care practices (thermal care, cord care and breastfeeding) in the community among post-natal mothers in Garissa County, Kenya. A cross-sectional study design was used to evaluate newborn care practices in seven community units. Data was collected from 421 respondents from a randomly selected sample of postnatal mothers who had delivered in the past one year preceeding the study period in the community of study. Data was collected through semi-structured questionnaires, key informant interviews and focused group discussions. Data was analyzed using STATA. Chi-square and logistic regression were to test for association between the various explanatory factors and the newborn care practices. A total of 421 respondents were interviewed. The mean age of the respondents was 24 (SD 5) years with majority 70% between 20-29years. Majority of the respondents were married 97% (407). Most of the respondents, 51% (212) had no formal education. Newborn care practices were identified as poor in 14% of the respondents for all three practices, more specifically, 66% of the respondents had poor breastfeeding practices, 57% had poor cord care practices and 45% had poor thermal care practices. The following factors were significantly associated with poor newborn care practices: The logistic regression analysis revealed that, across all three newborn practices timing of the first ANC visit (P value <0.001) and place of delivery (P value < 0.001) had significant influence on newborn care practices. The significant predictors of cord care practice were marital status (P value= 0.025) and timing of first ANC visit P value <0.001. Religion (P value<0.001) and Maternal occupation (P value=0.002) were significantly associated with thermal care practice. Breastfeeding was found to be influenced by religion (P value <0.001), maternal occupation (P value <0.001), attendance of ANC (P value <0.001) and paternal occupation (P value=0.005). Newborn care is still largely poor with health facility delivery, ANC attendance and early timing of ANC visit as the main predictors of good newborn care. Results from FGD and KII revealed that harmful practices such as application of cow dung on the stump, immediate bathing of the newborn and introduction of pre-lacteals meals were still being practiced. This was driven by traditional beliefs. This study recommends need advocacy to mothers to deliver at health facilities and seek antenatal care early as this will promote good newborn care practices. The study recommends further research on assessing newborn care practices at among the health care providers at facility level.
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    Prevalence and risk factors for trachoma infection among children aged 1-9 years old in Oldonyonyokie Location, Magadi Division, Kajiado County, Kenya
    (Kenyatta University, 2016-05) Nyamwaro, Christine Moraa
    Trachoma is one of the water-related infectious diseases that affects the eyes and manifests itself in impoverished, rural areas with little access to clean safe water and proper sanitation that disproportionately afflicts women and children in poor communities. It is a bacterial disease caused by Chlamydia trachomatis that is highly infectious and can spread through an infected person’s hands or clothing or transmitted by flies that have been in contact with discharge or nose of an infected person. The disease remains the principal cause of preventable blindness and the second leading cause of blindness globally. The current recommended surgery for trichiasis, antibiotics for active disease, facial cleanliness, and environmental change to reduce transmission (SAFE) strategy targets all key elements believed to be necessary for a short- and long-term intervention program. Even with the interventions on the ground, the prevalence of trachoma is still high. The study investigated the prevalence and risk factors for trachoma infections among children aged 1-9 years old in Oldonyonyokie Location, Magadi Division, Kajiado County. Specifically the study sought to examine the prevalence of trachoma, assess socio-demographic factors influencing trachoma prevalence, identify water, sanitation and hygiene related factors influencing prevalence of trachoma, determine whether the practice of keeping of animals affect trachoma prevalence and assess the health seeking behaviors of care givers of children affected by trachoma. The study was a cross-sectional descriptive survey that employed both quantitative and qualitative approaches. Kajiado County was purposively sampled using multi stage cluster sampling methods in the first stage; secondly Oldonyonyokie location was randomly selected. Thirdly snow ball sampling was used to select households with children aged 1-9 years old, guided by Community Health Workers (CHWs). Data was collected using interviewer administered structured questionnaires, focus group discussions (FGDs) and In-Depth Interviews (IDIs). Quantitative data was entered and analyzed using SPSS version 20, which was triangulated using qualitative data. Qualitative data was transcribed and analyzed by content analysis and presented verbatim. The results indicated that prevalence of trachoma is high (18.6%) in Oldonyonyokie, Magadi. Although this was lower than the greater Kajiado County, the prevalence was still an issue of public health concern. The main socio-demographic characteristic found to influence the prevalence of trachoma were the levels of formal education. Majority of the respondents had poor hygiene practices mainly manifested by poor latrine coverage of 11.6%, and hand washing (28.1%) after toilet use. Majority of the households kept cattle (50.9%), goats (82.6%) and sheep (57.4%) in the households, hence increasing the risk of transmission of trachoma The results further indicated that majority of households’ health seeking behaviors was poor – with only 23.1% of respondents visiting health centers after having watery eyes. The study recommends that the Ministry of Health, at County and National levels, should come up with effective, tailor-made and sustainable ways of curbing the trachoma infections. There should be concerted efforts to promote the understanding of Trachoma prevention and management in affected communities. This could be undertaken through localized Behavior Change Communication (BCC) using Information, Education and communication (IEC) materials. There should also be special programmes aimed at improving the negative hygiene practices in the communities. Traditional practices such keeping animals in the houses should be addressed so that the community is trained on behavior change.
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    Safety of Workers in Slaughterhouses and Meat Processing Plants in Nairobi City County, Kenya
    (Kenyatta University, 2018) Makori, Charles Motari
    Slaughterhouses and meat processing plants are known to potentially pose significant threats to worker’s safety and health due to the hazardous conditions involving animals, tools and dangerous machines used in the meat industry.The main objective of this study was to investigate the safety of workers in slaughterhouses and meat processing plants in Nairobi City County. The specific objectives were to determine the level of compliance of various categories of slaughterhouses and processing plants to Occupational Safety and Health Act, 2007, establish the types of injuries experienced and the associated risk factors and the management of these injuries in these facilities. Descriptive cross sectional study design was used. Quantitative data was collected from the facilities using structured questionnaires while focused group discussions, key informant interviews and observational checklist were used to collect qualitative information. A total of 347 respondents were included in this study from 30 facilities. The data was analyzed using the Statistical Package for Social Scientists (SPSS) version 18 and relations between independent and dependent variables determined by use of Chi-Square. Frequency tables, percentages and charts were used to present the results. The study established that socio-demographic factors were statistically significant in influencing the safety of the workers where gender had the greatest impact in the safety of the workers where males received more injuries (92.1%) than the females (χ2=27.72; p<0.05 and this was followed by age where the younger population received more injuries than the older workers (χ2=25.59; p<0.05). Duration worked followed where experience had a positive impact in the safety of the workers (χ2=22.12; p<0.05). The educational level of the workers was least of these demograhic factors in affecting the extent of injuries where workers with primary school education (92.5%) received more injuries than the ones with secondary school education (χ2=21.39; p<0.05). OSHA parameters were also examined in various categories of facilities and established that the awarness level of OSHA, 2007 and WIBA, 2007 were highest in export facilities and processing plants and lowest in local facilities (χ2=237.46; p<0.05) and followed by provision of Personal Protective Equipments (PPEs) in the same pattern (χ2=62.43; p<0.05). Inspection of enterprises was higher in export oriented slaughterhouses than in local facilities (χ2=15.97; p<0.05), training followed the same pattern (χ 2=28.5; p<0.05). Provision of safety and health policy was more pronounced in export and meat processing plants than local facilities (χ2 = 38.41; p<0.05) and followed by training (χ2 =28.5; p<0.05). The highest number of injuries were recorded in Category C facilities and lowest in export based facilities (χ2=23.554; p<0.05) and this was significant. Safety and health committes followed (χ2 =23.38; p<0.05).The least in impact was noted in inspection with (χ2 =15.97; p<0.05). From this results, compliance levels were fairly high in export and processing plants than local facilities. In total, 85% of the workers in the meat industry in Nairobi received injuries and 15,261 working days (122,088 man-hours) were lost in the course of that year under study, 2015. The incidence rate of injury stood at 21.9 per 100-full time workers in 2015. In conclusion, the study recorded high incidence of injuries among the workers being commonly reported in young male workers who had been the service for short period of time. The injuries were commonly reported in Category C slaughter houses where the compliance levels to OSHA was very low. The study recommended that OSHA, 2007 be prudently implemented in all slaughter and processing facilities in Nairobi and nationally in order to prevent this high injury rate noted
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    Household Hazardous Waste Management Practices among Pastoral Community of Mandera County, Kenya
    (Kenyatta University, 2018) Abukar, Abdi Sheikh
    Household hazardous waste possess physical, chemical or biological characteristics, which requires special handling and disposal procedures to avoid risk to health and/or environmental effects. The pastoral population of Mandera county has been treated in health facilities with complains of poisoning or reaction resulting from hazardous substances. Health effects of exposure to household hazardous waste could also take time to manifest in people who are exposed to it, such as development of cancers and effects on unborn babies. The pastoral population is unaware of the potential hazards caused by the many household hazardous waste in their homes therefore the options of safe disposal and storage are unexplored. The main objective of this study was to establish household hazardous waste management practices among pastoral community of Mandera County, Kenya. The specific objectives were; to identify the type of household hazardous waste generated and their disposal methods; to determine the occurrence of accidents related to household hazardous waste and to determine the level of knowledge on household hazardous waste management among household heads in the pastoral community. The study employed a descriptive cross sectional design. The sample size for this study was 415 household heads and 17 key informants from Mandera East Sub-County. The study used a multistage sampling technique that comprised of three steps: simple random sampling, systematic simple random sampling and purposive sampling. Data was collected by use of both qualitative and quantitative methods. Questionnaires, focus group discussions and key informant interviews tools were used to collect data. A pre test was conducted to assess the validity and reliability of the research instruments. Clean coded data was entered into SPSS version 20, frequencies and percentages were used for descriptive statistics while Chi square was used for inferential analysis. Quantitative data was presented in frequencies and percentages. The study found that almost half (48%) of the household heads in Mandera County had moderate knowledge on household hazardous waste while (32%) had good knowledge which had been obtained from radio and health workers. The study also found that almost all of the households at (99.5%) in Mandera County were generating used batteries and electronic items; unused drugs and pharmaceuticals for either human or animal use; remains of pesticides, herbicides, fungicides and accaracides; and used needles and syringes from animal treatment. The study found out that open dumping and incineration were the most common methods of waste disposal by all the study research participants. Further, to this, 8.3 per cent of the households in Mandera County had members who were victims of household hazardous waste related accidents. Most of these household members affected were aged between 0 and 5 years. The study established that there was a significant association between the level of education of research participants and segregation of household hazardous waste (p<0.05), the study also found that movement of households influences storage of HHW. Finally the size of land occupied by households had a significant association with the storage of HHW. This study recommends that the county government, national government and NGOs should initiate training and awareness creation programmes aimed at increasing knowledge on household hazardous waste in the pastoral population
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    The prevalence and associated risk factors for Taenia solium taeniasis in Kiambu County, Kenya
    (Kenyatta University, 2018-06) Mbuvi, David Mwikya
    Taenia solium taeniasis is an intestinal parasitic disease caused by infection with Taenia solium is also referred to as the pork tapeworm. The main objective of this study was to determine the prevalence and the risk factors that may lead to T. solium taeniasis amongst the community in Thika Sub County. A cross-sectional study design was used to collect both qualitative and quantitative data. The study was carried out in Thika Sub-County from November 2016 to January 2017. The study population were members of the community. Cluster sampling was used with administrative wards as the clusters and households as the sampling units. Systematic random sampling was used to select the households which participated in the study. Primary data was collected using structured Questionnaires, focused group discussions (FGDs), key informant interviews (KIIs) and Observations. Stool samples were obtained from all the participants for parasitological laboratory analysis of T. solium eggs, scolexes or proglottids. The data was analyzed using SPSS version 20. The statistical analysis included proportions such as mean, median, frequency, and range. Chi-square was used to show the association of risk factors and occurrence of T. solium taeniasis. A total of 384 respondents participated in the study and the same number of stool samples were collected and analyzed. The point prevalence for T. solium was found to be at 6.8%. Prevalence was found to be significantly related to the ward of the respondent at χ2= 7.153a, df=2, P=0.028 with respondents from Gatuanyaga showing a higher prevalence. The level of knowledge amongst the community on T. solium taeniasis was low and a majority 335 (87.20%) had never heard of it. Majority (380) of the respondents had latrines at 99.0%. The prevalence was significantly associated with having a latrine at χ2=55.657a, df=1, p=0.000. Respondents from households which had no latrine were more predisposed to T. solium taeniasis. The relative risk was 17.2727; 95% CI; P < 0.0001. Lack of deworming was also found to be a risk factor to T. solium taeniasis with a relative risk of 1.5211; 95% CI; 0.5513 to 4.1970; P = 0.0418. The study recommends that the county government of Kiambu should address the high prevalence of T. solium taeniasis through the promotion of good hygiene and food safety and thorough pork inspection. The county government should educate the community through media and public rallies so as to create awareness on the T. solium taeniasis. The county government should sensitize the community through health promotion activities such as the building of latrines so as to address the risk factors associated with T. solium taeniasis. This study recommends further studies on the prevalence of T. solium taeniasis, the level of awareness amongst the community and the risk factors in other counties. The study also recommends further studies to establish other diseases which may be caused by the high prevalence of T. solium taeniasis such as neurocysticercosis and porcine cysticercosis
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    Levels of environmental noise and perceived health implications in bus termini in Nairobi Central Business District, Nairobi City County, Kenya
    (Kenyatta University, 2018-07) Kogutu, Nyaranga Caleb
    Environmental noise is noise emanating from all other sources except the industrial workplace, main sources include road, rail and air traffic, industries, construction, public works and social activities. WHO and NEMA provides permissible environmental noise level standard to be 75 and 60 dB (A) respectively. Noise pollution has been linked to many adverse health effects and there is limited documentation to this effect within the CBD termini of Nairobi.The aim of this study was to assess noise levels and it’s perceived health effects across bus termini in Central Business District of Nairobi City. Using a cross-sectional study design and fishers et al (1983) to determine the sample size, a random sample of 422 community members working within nine bus termini for more than 8 hours a day were approached and recruited in the study. Noise levels were measured using Calibrated sound level meter (Model # 8926). A self-administered semi-structured questionnaire was used to collect data to identify perceived health risks of noise and safety practices across bus termini. Univariate Chi-square test of independence was used to test the association between noise levels and reported health implications. The response rate was 94.7% (n= 397). The study revealed that 66.8% of respondents (n=265) had awareness on effects of excessive noise exposure as compared to 33.2% (n=132).This study revealed that a higher proportion of respondents spending more than 3 days a week working at the bus termini visited the doctor for a perceived noise induced hearing problem. As such there was a significant association between the number of days spend working at the bus termini in a week and visiting a doctor for a noise induced hearing problem (χ2=16.52, df=2; p<0.001). In this study, the leading acute perceived health effects of excessive noise were reported to be sleep disturbance at 24.17% (n=152), hearing impairment at 23.05% (n=145), exhaustion at 13.04% (n=82), high blood pressure at 12.72% (n=80) and annoyance at 10.18% (n=64). This study revealed a high concentration of noise levels ranging between 88.14 to115.04dB(A) at Tuskys, St Peters Clavers, Central, Latema and Ronald Ngala bus termini as compared to Ngara and Railways bus termini which reported low concentration of noise levels ranging 85.45 to 93.63dB(A). There was a variation in maximum mean noise levels across the day, in the morning the maximum noise level was 93.65dB recorded at Old Nation Bus Terminus, at midday the maximum noise level was 94.28 dB recorded at Tuskys Bus Terminus while in the evening maximum mean noise level was 118.44 dB as recorded at Moi Lane Bus Terminus. This study revealed a significant association (χ2=27.663; df=8; p<0.001) between a respondent visiting a doctor for a perceived noise induced hearing problem and bus termini in which they are located. Hence a high proportion of respondents who visited the doctor for a perceived noise induced hearing problem were from bus termini that recorded high noise levels. This study revealed that safety practices most likely to be utilized across all occupational groups include; working few hours in the noisy environment (χ2=7.746; df=2; p<0.021); closing windows and doors to eliminate noise (χ2=3.89; df=2; p<0.05) and walking away from noise (χ2=5.29; df=2; p<0.024). However, a higher proportion of respondents across all the occupational groups reported not using personal protective equipment. In conclusion, this study has demonstrated that noise levels in Nairobi are beyond the permissible levels as per NEMA standards 60 dB(A) and WHO ( 75dB(A) standards. Location of bus termini close to each other contributes to the significant generation of noise. Consequently, the authorities should spread out bus termini to reduce high concentration of noise levels at single hotspots in the city. In addition, the public transport routes should be designed in a manner such that they do not terminate at one point in the city.
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    Determination of Fecal Contamination Status of Shallow Wells in Dede Division, Migori County, Kenya
    (Kenyatta University, 2018-11) Odiwuor, Oluoch Evance
    A shallow well is a hole dug, bored or drilled less than 50M deep to extract water. Contamination of shallow wells with fecal matter presents a grave public health threat in developing countries, such as Kenya, where large numbers of households lack access to clean and safe water supplies and rely on untreated surface water sources or shallow unprotected groundwater for domestic utilization. A report by WHO shows that 1 billion people practice open defecation with nine out of ten of them in rural areas and it is estimated that 1.8 billion people use a source of drinking water that is fecally contaminated. In Kenya unsafe water, sanitation and hygiene are the 2nd leading risk factors causing morbidity and mortality at the national and county levels respectively. In Dede Division, 65.5% of households depend on shallow wells for domestic needs and there are rising trends of confirmed cases of fecal-related diseases. The study sought to assess human and technical determinants of fecal contamination status of shallow wells in Dede Division. A cross-sectional study of households using the wells was conducted. Fisher’s formula was then used to calculate the sample size of the heads of households. Since the approximated number of households using shallow wells was <10,000 (4008), the two stages of the formula were adopted, giving a sample size of 386 heads of households. Out of the 180 shallow wells, 54 (30% of 180) were proportionately sampled and grab sampling technique adopted while sampling water from each of the sampled shallow wells. Basic physical parameters like temperature, turbidity and pH were analysed by a portable turbidity meter and pH meter while H2S rapid field test was employed for total corliforms analysis of grab samples in the field. Fecal contamination status of each well was determined by Membrane Filter Technique in kisumu government labaratory. Chi-square test was used to measure associations between variables while Multi-variate logistic regression analysis applied to test the hypotheses. The study reported significant relationship between level of knowledge of respondents on a well being too close to a latrine as a potential route (risk factor), a well located downhill a latrine, an open/uncovered well, surface run-offs into wells, dropping objects in shallow wells, using a dirty drawer, people/animals dropping in wells, doing laundry next to a well, and human/animal feces dropping in the well as potential routes of fecal contamination. It further revealed significant associations between several technical determinants and fecal contamination status of shallow wells e.g distance (M) from a latrine to a well, with majority of wells within safe distances of contamination (>10M) but still tested positive for fecal corliforms, distance (M) from the nearest cattle pen if any with a significant majority of shallow wells testing positive for fecal corliforms, damage or lack of concrete plinth, breaks/cracks on the parapet walls, breaks/cracks in the cover/top slab, breaks in the drainage channels, shallow well covered while not in use and shallow well fenced out respectively. Majority of shallow wells (69%) tested positive for E. Coli, a strong indicator for presence of fecal matter in water, with only 31% testing negative. Common human and technical determinants (risk factors) by and large are functions of fecal contamination status of shallow wells in Dede Division. Efficient protection of shallow wells is a critical pointer to their ground water quality. Households in Dede Division should ensure adequate treatment of shallow wells for fecal contamination before utilization of water from these sources. This can be both at source or household level. They should be sensitized by the relevant authorities on common routes of fecal contamination of shallow well water and safe hygiene and sanitation practices around shallow wells to prevent fecal contamination of the wells. Households using shallow wells in Dede Division should ensure proper sighting and location of latrines in relation to shallow wells to avoid fecal contamination of the wells through leaching. The pit latrines should be sighted down hill the shallow wells and located atleast 10 meters apart.
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    Predictors of Work-Related Musculoskeletal Disorders among Primary School Teachers in Machakos County, Kenya
    (Kenyatta University, 2019-10) Ndawa, Ancent Ndonye
    Musculoskeletal disorders refer to a broad range degenerative and inflammatory conditions that affect the joints, muscles, ligaments, tendons, bones, nerves, and the localized blood circulation system. Despite there being significant literature about musculoskeletal disorders among teachers in other parts of the world, Kenya lags behind in research this area. The current studies point out to high workloads and stress levels among primary school teachers following an increase in the teacher-pupil ratio. These are among the correlates of musculoskeletal disorders, suggesting an underlying problem worth exploring. The objective of this study is to determine the prevalence and person and work-related predictors of musculoskeletal disorders among Kenyan primary school teachers in Machakos County. The specific objectives of the study were: to determine the prevalence of Musculoskeletal Disorders among primary school teachers in Machakos County, to explore the person related predictors of musculoskeletal disorders and to explore the work-related predictors of musculoskeletal disorders. A cross-sectional design was used to collect data from 302 randomly selected teachers. The data was collected using a questionnaire and an observation checklist. It was analyzed using chi-square and logistic regression analysis and expressed as odds ratio. The prevalence of musculoskeletal disorders at any site of the body was 85.10% with lower back, knees, neck, and ankles being the most affected body sites at 58.60%, 57.6%, 53.3%, and 53% respectively. The least affected body part was the elbows at 25.2%. Neck musculoskeletal disorders were associated with being between 40 and 45 years (p=0.02) and over 50 years (p=0.01), and teaching while standing (p=0.01). Shoulder musculoskeletal disorders were associated with being between 45and 49 years and being over 50 years (p<0.01 for each), teaching while standing for 2-3 hours and for over 4 hours (p=0.03 and 0.01 respectively). Elbow musculoskeletal disorders were associated with being over 50 years (p=0.01). Musculoskeletal disorders of the knees were associated with lack of back support on chairs (p<0.01). Wrists/hands musculoskeletal disorders were associated with being over 50 years and teaching while standing (p=0.01 for both). Low back musculoskeletal disorders were significantly associated with being between 30-34 years (p=0.01), 35-39 years (p=0.01), 40-44 years (p<0.01) and being over 50 years (p<0.01). Musculoskeletal disorders of the ankles were significantly associated with working on a head-down posture (p=0.01). MSDs interfered with teachers’ ability their normal activities with lower back MSDs being the most prominent at 23.8%. This study reveals that musculoskeletal disorders are very common among primary school teachers in Machakos County, Kenya. The nature of the risk factors is diverse, calling for measures to reduce the notably high prevalence of MSDs, their progression, and burden.
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    Stress Levels among Construction Workers in Kibera Resettlement Action Plan Project in Nairobi City County, Kenya
    (Kenyatta University, 2020) Kioko, Ruth Kamene; Fidelis Kilonzo; Christine Majale
    Professionals engaged in the construction industry operate in highly competitive environment as they aim to keep pace with the global and national demands of infrastructural development. Workers engaged in the construction industry are expected to deliver designed projects within strict time lines and defined budgets. In this regard construction workers are subjected to emotionally and mentally demanding circumstances that contribute towards stress levels. Different studies done in segregated countries provide qualitative data concurrence that stress levels are high among construction workers. In Nigeria a study established there was high stress factors among construction workers. The contributing factors were insufficient thermal comfort, high work load; insufficient feedback on previous and ongoing building projects, inadequate security/ safety measures on site, and fragmentation of building work into specialized fields. In the United Kingdom, it was discovered that construction professionals were progressively viewing their work as being stressful. In Hong Kong, high levels of job burnout were evident among construction professionals. This has endangered their well-being and diminished their industrial efficiency and long-term competitiveness All things considered, to ensure that a given task is done considering spending plan and time, development laborers and specialists need to work for longer hours to achieve the targets that are set hence resulting to stress levels. This research looks at levels of stress in the construction business in Kenya with a focus on Kibera Resettlement Action Plan Project. In particular, the research investigates on what causes stress, stress levels and approaches to manage stress among work forces. This examination used a cross sectional descriptive investigation plan and focused on 176 employees working with H. Young and Company, (East Africa) Ltd to carry out the Kibera Resettlement Action Plan Project. The findings of the study found that the principal causes of work stress among construction workers are work overload, role conflict, complexity of roles and feedback which fall under task and organization stressors. The finding revealed that stress in construction firm is managed using different strategies that are either problem or emotional focused at the individual and company level and it established that male workers in the construction company had the highest levels of subjective stress while female workers in this construction company had the highest levels of objective stress. The study further found that general workers had the highest levels of subjective and objective stress followed by skilled workers and managers. The study thus postulates key recommendations in mitigation work stress among the construction workers. Foremost, the study recommends that construction firm to place more emphasis on task and organizational stressors especially with regard to role conflict, complexity of roles, work load and feedback. The second recommendation pertains to efforts by the management of construction firms in developing strategic ways that ensure the low cadre employees are not overburdened with work. The third recommendation is with regard to efforts by management of construction firm in regularly revising the company stress management strategies in order to maintain its efficacy. Finally, the study recommends that construction workers to form worker groups and unions in which they can share their work-related stress and report such stressors to the management for appropriate remedial measures.
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    Compliance with Occupational Safety Practice among Petrol Station Pump Attendants in Kaduna state, Nigeria
    (Kenyatta University, 2020) Kakwi, Josephine Daniel; Anthony W. Nyambura; Rosebella Iseme
    Petrol pump attendants in Kaduna encounter numerous hazards at the pump. This constitutes the most important threat to their survival at the workplace. Unfortunately, there are very few researches evaluating compliance with safe practices among pump attendants in Kaduna South, Nigeria. Therefore; the study objectives were to assess the compliance levels with safe practice, to establish pump attendant’s knowledge and attitude on safe practice and to determine the factors associated with the compliance rate. The study adopted a cross-sectional survey design. Two-stage cluster sampling technique was utilized to select 27 filling stations, of which, 212 petrol pump attendants were interviewed as respondents. Data were collected using an interviewer-administered questionnaire. Descriptive statistics including percentages and frequencies were utilised in summarizing the data. Findings of the study show that the level of compliance with safe practices in terms of fire extinguisher usage (76.9%) and use of PPE (77.8%) was good. However, other safe practices have been neglected. Knowledge was generally good, especially in terms of PPE usage (92%), fire extinguisher (99.1%), and the use of spill kits (64.6%). Pump attendant's also had a positive attitude towards compliance. Inferential analysis revealed that level of education (AOR 3.331, CI 95% 1.771-6.264), work experience (AOR 1.905, CI 95% 1.028-3.529) and attitude (AOR 5.216, CI 95% 1.458- 18.665) are the best predictors for compliance with safe practice. Therefore, the study concludes that pump attendants have a good knowledge and a positive attitude regarding safe practices, but recommends that education and training of pump attendants should be prioritized in order to boost compliance rate which was found to be poor. Department of Petroleum Resources (DPR) should enforce the adoption of safety regulations in order to improve compliance by both managers and pump attendants.
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    Prevalence and Antimicrobial Susceptibility Patterns of Salmonella and Campylobacter Species in Chicken Waste, Bungoma County, Kenya
    (Kenyatta University, 2020-01) Kaburia, Joan Ntinyari
    Antimicrobial resistance is a growing threat to public health and is driven by various factors including the overuse or misuse of antibiotics in poultry production which could lead to development of resistant bacteria that can be transferred to humans and hence compromise human medicine. The use of antibiotics in poultry production could be for vaccination/prophylaxis, treatment or growth promotion. This study was a cross-sectional study in Bungoma county that sought to establish the prevalence and antibiotic sensitivity of Salmonella and Campylobacter species, by sampling of chicken waste then analyzing it for presence of Salmonella & Campylobacter bacteria species and testing their sensitivity to 4 antibiotics. The aim of the study was to determine prevalence of Salmonella and Campylobacter species in chicken waste in Bungoma county, to determine the sensitivity of Salmonella and Campylobacter species to Tetracycline, Ampycillin, Imipinem and Co-trimazole antibiotics and to determine risk factors for Salmonella & Campylobacter infection and spread of resistant bacteria among chicken keeping households. Random sampling design was used to recruit 169 households where a duplicate of chicken waste samples was collected and a questionnaire issued to the farmers. The BS EN ISO 6579 -1-2017 technique was used in the identification of Salmonella species and ISO 10272-2:2017 technique used for the detection and enumeration of Campylobacter species. The disk diffusion test was used for antibiotic sensitivity testing of the bacteria. SPSS was used for analysis; Logistic regression was used to measure sensitivity of the bacteria to the specific antibiotics and Pearson’s r analysis used to measure correlation among variables. The prevalence for campylobacter was higher in the county of Bungoma at 4.32% compared to that of salmonella at 1.44%. The use of traditional medicine was found less likely to cause presence of resistant bacteria. Risk factors identified for the development and spread of AMR associated with chicken production include; use of antibiotics for growth promotion, frequency of use of antibiotics and use of chicken waste as manure in farming. The study recommended that farmers should be encouraged to obtain already vaccinated chicks and the use of traditional medicine be promoted during chicken production. Further research should be conducted on the possibility of transfer of resistance through food crops.
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    Assessment of Water Quality in Aquaculture Ponds in Tigoni , Kiambu County, Kenya
    (Kenyatta University, 2020-01) Mbuthia, Milkah Gathoni
    Fisheries and aquaculture is an important source of food, income and livelihoods for hundreds of millions of people around the world. Aquaculture production has increased fro m 29.5million tonnes in 2010 to 37.5 million ton nes in 2014 in the world and 1.3 million tons in 2010 to 3.8 million tonnes in Africa. There is no sufficient information suitability of water quality in aquaculture ponds in Tigoni . The aim of the study was to determine the suitability of aquaculture ponds for fish farming based on their water quality The specific objective s of the study were; t o find out quality of water in aquaculture ponds , t o identify the type of algae in aquaculture ponds and t o evalu ate the relationship s between water quality and algae in the aquaculture ponds. The study area was Tigoni in Kiambu County. Stratified random sampling design was used to select 8 sample ponds which water samples were collected twice a mont h for four months . Parameters were temperatures, pH, conductivity, dissolved Oxygen (DO), secchi depth, Biochemical oxygen demand (BOD), nitrates, phosphate and algae identification was also done. The mean values for the physical parameters ranged from 19.69±0.48 0 C to 22 .54±0.57 0 C (water temperature), 7.57 ±0.52 (pH), 190.25±127.86 to 416.50±168.93 µS/cm (conductivity), 14.13±3.36 to 28.38±7.13cm (transparency) and 4.03±1.39 to 6.63±1.37 mg/l . Chemical parameter 1.99±0.52 to 2.82±0.48 mg/l (BOD), 5.06±1.05 to 57.57±15.84 mg/ l (phosphate) and 0.38±0.10 to 8.86±1.20 ( One Way ANOVA indicated significant difference between pond F and H (P=0.001) (temperature), pond A and G (P=0.001) (pH), pond A and C (p=002) (conductivity). Pond D from G (p=0.000) (Secchi depth), pon d C and G (P=0.001) (DO). Pond D and G (p=0.001) (BOD) Pond F and H (p=0.001) (phosphates) and pond A and H (0.000) (nitrates). Mean temperature were in the lower range with pond D and H bein g below optimum range. DO t test, pond G had a significant differ ence (t=7.500, α=0.05, p=0.00) and there was no significant difference in BOD in all ponds. A total of 12 genera of algae were identified. Composition per pond was; pond A, B, C, D, E, F, G and H recorded 6, 10, 7, 6, 6, 7, 10 and 11 genera respectively. Temperature, lowest Pond H 6 genera identified, highest mean pond 7 genera were identified. Phosphate, Pond H highest mean 11 genera pond F 7 genera. Nitrates highest in pond H 11 genera while lowest was in pond A 6 genera were identified. In conclusion , water quality in most aquaculture ponds did not vary signific antly from one pond to another and the quality in most aquaculture ponds met quality for fish farming . Ponds high in phosphates and nitrates had more genera of The study recommends wate r management intervention be practced to manage water quality and control algae growth also water and soil conservation to control nutrient load in water sources . R esearch on suitability of water used for aquaculture in the area , a comparative study for wa ter quality in liner and earthen ponds and the algae composition and abundance in the aquaculture ponds
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    Adoption Level of a Proactive Safety Program Within the Construction Phase of Olkaria’s Geothermal Power Stations of Nakuru County, Kenya
    (Kenyatta University, 2020-02) Nzioka, Luka Musembi
    Kenya is among the leading countries globally with significant geothermal resources. Geothermal energy provides reliable, cost-competitive, base load power with a small carbon footprint, and reduces vulnerability to changes in climate by diversifying power supply away from hydropower. Kenya has set out ambitious targets for geothermal power plants to meet an increasing power demand with significant impact to the safety and health of the workforce. This study focused mainly on this sector with a great emphasis to Olkaria’s geothermal power stations of Nakuru County that are under development. Olkaria domes has over 71% of Kenya’s potential to geothermal power capability. The overall objective of this study was to determine level of adoption of proactive safety program measures within construction phase of Olkaria’ s geothermal power stations of Nakuru County. Additionally, the study sought to identify the level of importance attached to each proactive safety measure, determines the strategies employed in ensuring that proactive safety program measures are adopted at construction phase and to establish the barriers and success factors to the adoption of this proactive safety program measures. Safety performance metrics and leading indicators from Institute for Work and Health Organisational performance metrics provided measure for the safety performance. Known safety performance indicators of this study were quantitative and qualitative. A descriptive cross-sectional and evaluative study design which uses both quantitative and qualitative methods in data collection has been applied in this study, with a study population being the workers working at the two Geothermal power plants that are currently under construction, a sample was drawn from all the Departments, data was collected using a self-administered questionnaires, observations through a structured checklist, document review and key informant interviews. The data collected was computer managed and analyzed by using the Statistical Package for the Social Sciences software version 20.0. Analysis was achieved by use of descriptive statistics which includes frequencies, percentages, and the mean. The overall result shows that there is partial adoption of the proactive safety measures with dismal performance in process safety measures and thus need for contractors to have policy statement by the top management in commitment to support proactive safety program adoption and implementation. The research pointed out that, employee competency assessment is of great importance to this challenging area, and management should consider their competencies before being hired. Barriers to the adoption of this program has been noted, the management has not provided adequate budget allocation to the provision of personal protective equipment and thus workers are vulnerable to injuries as a result, there is need for management to incorporate safety budget in their core project budget. The findings of this study when adopted, will provide a body of knowledge to all players within the construction phase to enforce a positive safety culture, help to prevent accidents from occurring, and improve health and safety of workers. By incorporating these proactive safety measures as a zero-harm strategy, management shall understand that accidents are preventable and zero accident is a realizable goal.
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    Adherence to Pulmonary Tuberculosis Treatment in Murang’a County, Kenya
    (Kenyatta University, 2020-03) Gitonga, Charles Muthui
    Non-adherence to Tuberculosis treatment is a major barrier for TB control programs because incomplete treatment may result in prolonged infectiousness, drug resistance, relapse and death. Successful treatment of TB involves taking anti TB drugs for at least six months as per the doctors advise. Currently, Tuberculosis has become a resurgent public Health problem in developing countries and is the leading cause of death from any single infectious agent. The purpose of the study was to identify factors contributing to non-adherence to TB treatment amongst pulmonary TB patients in Maragua Sub-County of Murang’a County. The objectives included were to determine the social-economic related, healthcare-related, patient-related and disease and medicine related factors associated with non-adherence of TB treatment amongst patients in Murang’a County. The study was guided by the Health Belief model as the theoretical framework. A cross-sectional survey study design was used. Census method was used and all 270 people were considered. Data was collected using a mixed method approach of interview guides, questionnaires and Focus Group Discussions. A total of 270 adult Pulmonary TB patients, amongst whom 59 (47%) were adherents and 67(53%) non adherents with TB treatment, who received treatment in 2017 and had completed treatment, Community Health workers, and Health Personnel in the TB clinic participated in the study. Data was entered to EPI INFO version 3.5.3 and analysed using Statistical Package for Social Sciences (SPSS) version 22. Multiple logistic regressions was used to identify associations and to control potential confounding variables. Chi Square was used to test independence of categorical variables with p value of less than 0.05 at 95% confidence interval being considered significant. Data presentation was done using figures and tables. From the results of the study only the distance taken to collect drugs in the health facility was found to be associated with non-adherence to TB treatment (n=9 ,13%). The study recommends that measures should be undertaken so as to reduce the non-adherence level to TB treatment by ensuring anti-Tb treatment is accessible to patients at the nearest Health facility from their residence. Additionally, the study proposes that the patients should be sensitized on the importance of adherence to TB drug mediction. Interventions with Health promotion initiatives emphasizing the benefits of treatment adherence should be enhanced in the communities by further large scale multicentred studies and that an enabling environment which is conducive for good patient interactions should be created. The study concludes that there are challenges facing adherence of TB treatment which ought to be addressed. The study, suggests that measures to improve drug adherence such as improving health conditions, increasing the availability of drugs and conducting health educations to the patients is essential in minimizing the drug non-adherence to TB drugs.