PHD-Department of Community Health

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Browsing PHD-Department of Community Health by Subject "Effect"

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    Effect of Health Education Intervention in the Management of Type-II Diabetes Mellitus among Adults Attending Garissa County Referral Hospital, Kenya
    (Kenyatta University, 2022) Abdalla, Abdirahman; Ephantus W. Kabiru; Tom Were
    Diabetes mellitus (DM) is a metabolic disorder that is characterized by hyperglycaemia due to defective insulin action and/or secretion. Diabetes mellitus type-2 (DM2) is the most common and a major public health burden in Kenya. It is projected to reach a prevalence of 4.5% by the year 2025. Effective interventions for DM2 comprise improving diabetes knowledge, individualized health education, lifestyle and behavioural change, monitoring body mass index (BMI) and diabetes control markers, as well as pharmacological interventions. Despite studies showing that health education and improved knowledge of diabetes predict improved plasma levels of diabetes control markers in the DM2 patients, these markers have not been used in the management and control of the disease in Garissa County. The main objective of this study was to establish effect of group health education in the control and management of DM2 at Garissa County Referral Hospital. This study utilized an unequal proportion prospective quasi-experimental study among a total of 152 adults stratified into intervention (cases, n=83) and control (n=69) groups. The cases were individuals with DM2 from among those (n=500) who were screened following fasting. The controls comprised DM2 patients on standard care. The study participants were purposively selected into each arm of the study. Structured questionnaires were used for collecting socio-demographic, socio-economic, and lifestyle data. The intervention group was offered group based standard health education program. Baseline and post-test measurements of the diabetes control markers were analysed in both the cases and the control group. Data analysis was done using IBM/SPSS version 27.0. Socio-demographic and socio-economic assessment indicated that the distribution of age, gender, education levels, marital status, monthly house-hold income, house-hold size, and familial history of diabetes was similar between the cases and controls. The prevalence of type-2 diabetes was 16.6%. Lifestyle evaluation indicated higher rates of smoking a pack of cigarettes daily (71.1% vs. 24.6%) or more than a pack of cigarettes daily (9.6% vs. 17.4%; χ2=33.289; df=2; P<0.0001) in the cases and controls, respectively. Overall levels of good knowledge in the cases and controls at baseline (57.8% vs. 72.5%; χ2=3.816; df=1; P=0.051); and after intervention (88.0% vs. 66.7%; χ2=11.058; df=1; P=0.001), respectively. Diabetic control marker analysis indicated that only HbA1c levels were significantly lower in the cases compared to controls at baseline (P=0.002). After intervention, BMI (P=0.005), HbA1c (P<0.0001) and fasting glucose (P<0.0001) were significantly lower in the cases relative to the controls. In addition, among the intervention group, the BMI, HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides and fasting glucose were significantly lower after intervention compared to baseline levels (P<0.01 for all). Altogether, these results indicate that group health education intervention had an effect in improving the levels of knowledge on diabetes as well as improving the levels of diabetes control markers. Thus, it is recommended that promotion of group-based health educational programs improves management of DM2.
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    Effect of Mhealth Technology in Enhancing Postnatal Visits amongst Mothers Attending Mch/Fp Clinics in Selected Hospitals in Kakamega County, Kenya.
    (Kenyatta University, 2022) Ngigi, Charles Kiragu; Justus O. S. Osero; Anthony Wanyoro
    Postnatal care is the provision of health services to the mother and newborn after delivery. It offers the opportunity to assess the mother for any medical, mental, emotional and social issues, and early assessment of risk factors and physical problems with the baby. Postnatal care services are offered by skilled health care workers during the postnatal visits. In Kenya mothers are expected to attend a minimum of four postnatal visits spread across the postnatal period though only a few do that. Globally, very few postnatal mothers seek postnatal services within two days. High maternal and neonatal mortality rate is observed during the first forty two days after child birth. This trend continues throughout the first year of the neonate. The main goal of the study was to determine the effect of mobile health technology in enhancing postnatal visits among postnatal mothers in Maternal Child Health and Family Planning (MCH/FP) clinics in designated health facilities in Kakamega County, Kenya. The study was designed as a cluster Randomized Controlled Trial (RCT) that involved four arms. In control arm the participants received only the routine written and verbal communication whereas in intervention arm 1, participants received routine verbal and written communication and mobile SMS, in arm 2 they received written and verbal communication and a voice call whereas in arm 3, the participants received written/verbal communication and combination of voice call plus Short Text Messages sent to remind them to visit the postnatal clinic. The reminders were packaged together with postnatal (PN) educational health messages. The research involved a study population of 320 postnatal mothers attending MCH/FP clinics. The study sites were purposively selected from four Sub Counties in Kakamega County. Study subjects were selected using a systematic sampling technique until the target was achieved. Quantitative and qualitative data was collected using interview, FGD and KII guides. Data was entered into Microsoft Access data base and analysed using SPSS version 24. At the baseline it was observed that 27% of the participants adhered to 2nd and 3rd postnatal clinic visits. After the intervention there was significant difference (χ²=28, df=3, p=0.001) between control and intervention arm. Majority of participants (82%) had no/low knowledge on postnatal care before the intervention, however there was significant difference in knowledge between control and study arms (χ²=113, df=9, p=0.000) after sending health messages. This study concluded that postnatal mothers in Kakamega County have low or no knowledge on postnatal care and only a few attend postnatal clinic within two weeks. This is likely to affect the uptake of postnatal services. Postnatal mothers had a positive attitude on use of mobile health technology in health care. There is a significant relationship between mobile phone reminders and adherence to 2nd and 3rd postnatal visit. Kakamega County government should integrate use of mobile telephone services packaged together with postnatal educational health messages in the provision of health services.